Elsevier

Comprehensive Psychiatry

Volume 48, Issue 2, March–April 2007, Pages 124-131
Comprehensive Psychiatry

Prevalence and correlates of binge eating disorder in a community sample

https://doi.org/10.1016/j.comppsych.2006.08.002Get rights and content

Abstract

Objective

Diagnostic criteria for binge eating disorder (BED) appear in Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition as “criteria for further study.” Few epidemiological studies of BED have been conducted. Our aim was to describe the prevalence and correlates of BED, as assessed by the Patient Health Questionnaire (PHQ) in a community sample.

Method

Descriptive epidemiology from a survey of 910 randomly ascertained participants residing in the greater metropolitan area of St Louis, Mo.

Results

Sixty individuals (6.6%) screened positive for current BED, as assessed by the PHQ (BED+). Men were as likely to screen positive as women. BED+ subjects were at substantially elevated odds for depression, generalized anxiety disorder, panic attacks, and past suicide attempts; individuals with obesity who screened negative for BED (BED−) were not at elevated odds for these syndromes. BED+ subjects, but not other obese individuals, exhibited substantially lower scores on measures of mental health–related quality of life. Personality traits associated with BED symptoms included high Novelty Seeking, high Harm Avoidance, and low Self-directedness. Personality and psychiatric profiles in obese, BED− individuals were closer to those for normal-weight, BED− individuals, suggesting that BED is distinct from typical obesity. BED+ subjects reported mean body mass index of 34.1, more than 6 units above BED− subjects.

Conclusion

PHQ-BED criteria are associated with substantial impairment, psychiatric comorbidity, and obesity and effectively discriminate obese individuals with psychological problems from obese subjects without similar problems. BED may be considerably more prevalent than other eating disorders and equally prevalent among men and women.

Introduction

Binge eating disorder (BED) resembles bulimia nervosa but is characterized by the absence of purging and other behavior compensatory to binge eating. Diagnostic criteria for BED were introduced in Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition under “criteria for further study.” Early field trials found a high prevalence (30%) among individuals seeking treatment for obesity [1], [2]. Given the emergence of obesity as a growing public health problem [3], such observations suggest that BED may be a significant, modifiable cause of morbidity and mortality. Additionally, BED is accompanied by significant psychiatric comorbidity [4], [5]. Only a handful of BED prevalence studies have been conducted in community samples. Studies in the United States have found point prevalences of only 1% to 3% in the general population (reviewed in Refs. [6], [7]). However, not all of these studies used population-based sampling strategies. Consequently, the precise contribution of BED to obesity remains an open question. In spite of this uncertainty, available evidence suggests that BED may be the most common eating disorder and that it is accompanied by substantial distress, impairment, and comorbidity [8].

The goal of the present study is to describe the prevalence and correlates of BED in a community-based, epidemiological sample. Specifically, we examined the prevalence of BED symptomatology, as assessed by the Patient Health Questionnaire (PHQ), a validated self-administered instrument with good predictive validity for BED diagnosis [9]. Our aim was to describe the associations with common psychiatric outcomes, clinically relevant personality characteristics, health-related quality of life, and obesity. In addition to establishing the association of BED symptoms with other adverse conditions, we sought to contrast BED, as assessed by the PHQ, with obesity in the absence BED symptomatology. Although obesity without BED may arise from a variety of causes, it is a logical comparison category for determining whether BED symptomatology is distinct from nonpsychopathological overeating. In short, the purpose of this work is to examine the criterion validity and discriminant validity of the BED diagnostic construct, as operationalized by the PHQ.

Section snippets

Survey description

The St Louis Personality Health and Lifestyle Survey (SLPHL) was administered by mail between November of 2001 and February of 2002 to a stratified random sample of adults 18 years and older. Recruitment was through random digit dialing targeting St Louis City, St Louis County, and the 5 immediately surrounding counties in Missouri and Illinois. Quotas for sampling strata were set based on county (or city), sex, age, and race using 2000 US census data for the equivalent geographic sampling

Prevalence and demographics

A total of 67 of 917 individuals (7.2% of the total sample) screened positive for BED, as assessed by the PHQ, but 7 of those subjects reported symptoms of bulimia and were excluded from the analyses. This results in a final sample size of 910 and a sample prevalence of 6.6% for positive screens on the BED section of the PHQ. Demographic makeup of the sample was 55% women and 45% men; 15% African American/Black, 82% White, and 3% other race/ethnicity; mean age was 44 years (SD, 14; median, 46).

Overview

Using the PHQ-BED module, 67 (7.2%) of 917 participants in the SLPHL survey screened positive for current BED. Seven cases were classified as indeterminate because symptoms of bulimia nervosa were also reported, resulting in a final sample prevalence of 6.6% for BED (n = 60). There were no significant associations with sex, age, education, marital status, or race/ethnicity. Notably, roughly the same percentage of men screened positive for BED as females (6.8% compared with 6.4%, respectively).

Acknowledgment

This study was supported by grants from the National Institute on Drug Abuse (no. K01 DA 16618, R.A.G.), National Institute of Mental Health (#T32 MH17104; R.A.G., former trainee; Linda B. Cottler, Principal Investigator), Center for Psychobiology of Personality and Sansone Family Center for Well-Being, and Washington University School of Medicine (C.R.C., Director).

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