Understanding the factors that place people at risk for binge-eating disorder is essential for informing the development of effective preventative approaches.
More specifically, if we know what variables place people at risk for binge-eating disorder, then interventions can be designed in a way that attempts to modify these risk factors.
The implications are that, theoretically, we should be able to prevent the onset of new binge-eating disorder cases.
Binge-eating disorder is a type of eating disorder characterised by recurrent (i.e., at least weekly) episodes of binge eating during which a person eats an unusually large amount of food accompanied by a sense of loss of control.
Many people with binge-eating disorder also present with extreme body image concerns that resemble those present in bulimia nervosa 1Grilo, C. M. (2013). “Why no cognitive body image feature such as overvaluation of shape/weight in the binge eating disorder diagnosis?” International Journal of Eating Disorders 46: 208-211..
For example, people with binge-eating disorder usually equate their self-worth with the ability to control their weight and shape (i.e., “an overvaluation of shape/weight”)2Linardon, J. (2016). “Correlates of the over-evaluation of weight and shape in binge eating disorder and mixed eating disorder samples: A meta-analytic review.” Eating disorders 25: 183-198..
Binge-eating disorder is one of the more prevalent eating disorders, estimated to affect around 2% of the female population and 0.5% of the male population, globally3 Erskine, H. E. and H. A. Whiteford (2018). “Epidemiology of binge eating disorder.” Current opinion in psychiatry. .
There are a whole range of negative physical, psychological, and social consequence that result from binge-eating disorder, some of which include: obesity and obesity-related diseases (e.g., Type 2 diabetes, hypertension), depression and anxiety, substance use and abuse, low self-esteem, and social isolation4 Fairburn, C. G. and P. J. Harrison (2003). “Eating disorders.” The Lancet 361: 407-416. .
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Causes of binge-eating disorder
Unlike other eating disorders, such as bulimia nervosa and anorexia nervosa, the causes of binge-eating disorder are not well-understood. Only a few biological and psychological risk factors have been established, and it is widely believed that the interaction among these risk factors places someone at risk for binge-eating disorder. In other words, no risk factor works in isolation.
Let’s take a look at what the literature has identified.
Biological Causes
Genetic factors seem to play a part in causing binge-eating disorder, although the evidence for genetic factors is less conclusive relative to studies on bulimia nervosa and anorexia nervosa.
Twin studies have investigated the heritability of binge-eating disorder, and these studies have found that additive genetic factors significantly contributed to binge-eating disorder onset. Heritability estimates range from 43-61%, suggesting that around half of the variation can be explained by genetic factors 5Javaras, K. N., Laird, N. M., Reichborn‐Kjennerud, T., Bulik, C. M., Pope Jr, H. G., & Hudson, J. I. (2008). Familiality and heritability of binge eating disorder: Results of a case‐control family study and a twin study. International Journal of Eating Disorders, 41(2), 174-179..
There is also emerging evidence to suggest that abnormalities in peptides involved in the regulation of appetite, including ghrelin, may play a role in causing binge-eating disorder. 6 Monteleone, P., Tortorella, A., Castaldo, E., Di Filippo, C., & Maj, M. (2007). The Leu72Met polymorphism of the ghrelin gene is significantly associated with binge eating disorder. Psychiatric Genetics, 17(1), 13-16
Psychosocial causes
Childhood abuse
Childhood abuse has been shown to predict the onset of binge-eating disorder.
Several hypotheses for why childhood abuse is associated with binge-eating disorder have been put forth. First, childhood abuse can cause intolerable emotions, so binge eating behaviour can serve as an attempt to modulate these emotions. Second, childhood sexual abuse can lead to a dissociative coping style that is later displayed as binge eating7 Caslini, M., Bartoli, F., Crocamo, C., Dakanalis, A., Clerici, M., & Carrà, G. (2016). Disentangling the association between child abuse and eating disorders: a systematic review and meta-analysis. Psychosomatic medicine, 78(1), 79-90. .
Being bullied
Being teased or bullied about one’s weight can put people at risk for binge eating disorder.
Being bullied has been shown to contribute to low self-esteem, social isolation, and a poor body image, all of which place people at risk for binge eating behaviour and disorder8 Copeland, W. E., Bulik, C. M., Zucker, N., Wolke, D., Lereya, S. T., & Costello, E. J. (2015). Does childhood bullying predict eating disorder symptoms? A prospective, longitudinal analysis. International journal of eating disorders, 48(8), 1141-1149. .
Dietary restraint
Dietary restraint, which refers to the conscious attempt to restrict food intake for weight control, has been shown to predict binge eating.
The reason why dieting leads to binge eating is because it increases preoccupations with food and eating, and also contributes negatively to body image concerns. In addition, the physiological and psychological deprivation experienced through prolonged dieting attempts places people at risk for loss of control eating9 Polivy, J. and C. P. Herman (1985). “Dieting and binging: A causal analysis.” American Psychologist 40(2): 193. .
Dysphoric moods
Affective disorders are much more prevalent in obese individuals with binge-eating disorder than in those without the disorder. Many people with binge-eating disorder report feeling sadness, anger, or lonely before engaging in binge eating.
Dysphoric moods place someone at risk for developing binge-eating disorder because overindulging in palatable foods are a way in which a person can temporarily escape from these mood types10 Stice, E. (2002). “Risk and maintenance factors for eating pathology: a meta-analytic review.” Psychological Bulletin 128: 825-848. .
Body dissatisfaction
Body dissatisfaction refers to the general unhappiness one has with their body.
Body dissatisfaction has an indirect effect on binge eating behaviour via a couple of pathways. First, having an unfavourable attitude toward your body weight and shape causes a whole host of negative emotions.
Negative emotional states are unpleasant, so people try to find ways to escape them. One-way people escape is through food.
Unfortunately, some people take it to the extreme by overindulging and bingeing to cope with these negative feelings.
The second pathway that explains why body dissatisfaction leads to binge eating is via dietary restraint. When people are unhappy with their body, they usually try to change their body in a way that will make them feel better themselves. The most common way to modify shape and weight is through dietary restraint, which, as discussed before, is a powerful factor that causes binge eating11 Fairburn, C. G. (2008). Cognitive behavior therapy and eating disorders. New York, NY, Guilford Press. .
These are the more established binge-eating disorder risk factors. As I mentioned earlier, none of these factors work in isolation – they all interact together to make people more susceptible to developing binge-eating disorder.
Given the increased prevalence of binge-eating disorder and the serious physical and psychological consequences arising from this disorder, targeting these risk factors is one crucial for possibly preventing the onset of binge-eating disorder.
References