Binge-eating disorder (BED) often improves with time, but full remission can take many years and relapse is common, new research suggested.
The study revealed that 61% individuals still suffered from BED 2.5 years after their initial diagnosis, and 45% continued to struggle with the disorder at 5 years.
“The big takeaway is that binge-eating disorder does improve with time, but for many people it lasts years,” first author Kristin N. Javaras, DPhil, PhD, with the Division of Women’s Mental Health at McLean Hospital, Belmont, Massachusetts, said in a statement.
The study was published online on May 28, 2024, in Psychological Medicine.
Clinic Experience vs Literature
BED is the most common eating disorder in the United States, which is estimated to affect between 1%-3% of US adults, with onset usually around age 25 years.
“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’s 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,” Javaras said.
To better understand the natural course of the condition, Javaras and colleagues followed for 5 years a community-based sample of 137 adults (78% women) with BED, according to Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) criteria. Mean age at baseline was 47 years, and mean BMI was 36 kg/m2.
Nearly two thirds (61%) of participants assessed at 2.5 years and nearly half (46%) assessed at 5 years still met DSM-IV criteria for BED at those follow-up timepoints.
The researchers noted that the percentages meeting the broader DSM-5 BED criteria at these timepoints would be even higher — 68% and 59%, respectively.
Only a minority of individuals assessed at 2.5 and 5 years of follow-up experienced remission (15% and 22%, respectively). At 2.5 years, 23% had clinically significant symptoms but below the threshold for BED by DSM-IV. At 5 years, that increased to 33%.
The median time to remission exceeded 60 months, and median time to relapse (subthreshold or full BED) after remission was 30 months.
“Taken together, these results suggest that, under naturalistic circumstances, the majority of individuals with BED will experience some improvement in binge eating within a 5-year period, but achieving full remission within this time frame is not common,” Javaras and colleagues wrote in their article.
While there was some variation among participants in the likelihood of remission and time to remission, they couldn’t identify any strong clinical or demographic factors that might help predict how long the disorder may last.
The factors that contribute to a better or worse natural course of BED — or to binge-eating cessation in the context of treatment — “remain to be fully elucidated,” the investigators wrote.
Support for the study was provided in part by an investigator-initiated grant from Ortho-McNeil Janssen Scientific Affairs and by grants from the National Institute of Diabetes and Digestive and Kidney Diseases, the Brain & Behavior Research Foundation, National Institute of Mental Health, and the Swedish Research Council. Javaras owned equity shares in Sanofi and Centene Corporation and served on the clinical advisory board for Beanbag Health.
