New Research: Revealing the True Duration of Binge-Eating Disorder

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A new 5-year study from investigators at McLean Hospital shows that binge-eating disorder lasts much longer and the likelihood of relapse is much higher than previously suggested, with 61% of individuals still experiencing binge-eating disorder after 2.5 years and 45% still experiencing it 5 years after their initial diagnoses.¹

"It's noteworthy that in high-quality randomized clinical trials of specific treatments for binge-eating disorder, the percentage of participants still experiencing binge eating several years after the treatment ended was lower than the analogous percentage of participants in our naturalistic study, few of whom were probably receiving evidence-based treatments,” study first author Kristin Javaras, DPhil, PhD, an assistant psychologist in the Division of Women’s Mental Health at McLean, exclusively told Psychiatric Times. “This suggests that adults with binge-eating disorder may be more likely to get better if they receive evidence-based care than if they do not undergo treatment.”

Investigators studied 137 adult community members with binge-eating disorder for 5 years in order to better understand the duration of this disorder. Participants included individuals who aged anywhere from 19 to 74 and had an average BMI of 36. They were assessed for binge-eating disorder at the study outset and reexamined both 2.5 and 5 years later.

After 5 years, most participants still experienced binge-eating episodes, with 46% of participants meeting the full criteria and a further 33% experiencing clinically significant but subthreshold symptoms. After 2.5 years, 61% of participants still met the full criteria for binge-eating disorder at the time the study was conducted, and a further 23% experienced clinically significant symptoms, although they were below the threshold for binge-eating disorder. Furthermore, approximately 35% of the participants in remission at the 2.5-year follow-up had relapsed to either full or subthreshold binge-eating disorder at the 5-year follow-up. Following the study’s completion, the criteria for diagnosing binge-eating disorder changed and under these new guidelines, an even larger percentage of the study’s participants would have been diagnosed with the disorder at the 2.5 and 5-year follow-ups.

“The big takeaway is that binge-eating disorder does improve with time, but for many people it lasts years,” Javaras shared in a press release. “As a clinician, oftentimes the clients I work with report many, many years of binge-eating disorder, which felt very discordant with studies that suggested that it was a transient disorder. It is very important to understand how long binge-eating disorder lasts and how likely people are to relapse so that we can better provide better care.”²

Previous prospective studies had limitations, including a small sample size (less than 50 participants), and they focused only on adolescent or young-adult females, most of whom had BMIs less than 30, whereas around two-thirds of individuals with binge-eating disorder have BMIs of 30 or more.

Also worth noting is the study’s more accurate representation of binge-eating disorder’s natural duration, as the participants were community members who were possible receiving treatment, not actual patients enrolled in a treatment program. In comparing the community sample with those in treatment studies, it appears that treatments lead to faster remission. This reinforces the need for intervention in patients with eating disorders.

Investigators were unable to identify strong clinical or demographic predictors for the duration of binge-eating disorder. “This suggests that no one is much less or more likely to get better than anyone else,” Javaras said.²

Binge-eating disorder is the most prevalent eating disorder, with 1% to 3% of US adults affected.3 Following the study’s completion, investigators have been working to develop treatment options and screening methods for this common disorder to best improve patient outcomes.

“We are studying binge-eating disorder with neuroimaging to get a better understanding of the neurobiology involved, which could help enhance or develop new treatments,” said Javaras. “We are also examining ways to catch people earlier, because many do not even realize they have binge-eating disorder, and there is a major need for increased awareness and screening so that intervention can begin earlier.”²

Full results were published today, May 28, in Psychological Medicine.

References

1. Javaras KN, Franco VF, Ren B, et al. The natural course of binge-eating disorder: findings from a prospective, community-based study of adults. Psychol Med. 2024:1-11.

2. Binge-eating disorder not as transient as previously thought. News release. May 28, 2024.

3. Eating disorders. National Institute of Mental Health. Accessed May 24, 2024. https://www.nimh.nih.gov/health/statistics/eating-disorders