10 Chapter 1 General introduction Alice is a 36-year old mother of two boys, aged eight and ten years. She is married and currently on sick leave from her job as a nurse because it all felt too much for her. Ever since she was about 15 years old, she has, on and off, been suffering from episodes in which she eats a lot more than most people would eat under similar circumstances. In these episodes, she senses a lack of control over her eating, she eats without feeling hungry and eats much more rapidly than normal, until feeling uncomfortably full. After such an episode, she feels disgusted, depressed and guilty. Over the past three months she had one to seven of these binge eating episodes each week and, painfully, nobody knows. A behavioral pattern of recurrent episodes of uncontrollable overeating, in the absence of compensatory behaviors that are typical for bulimia nervosa (e.g. self-induced vomiting, using laxatives), was identified as a topic for further research three decades ago in DSM-IV (APA, 1994). In DSM-5, the provisional criteria of this ‘new’ eating disorder were refined, and included as binge eating disorder (BED) in the feeding and eating disorders section (APA, 2013: see appendix for criteria). An important distinction between BED and the two ‘classic’ eating disorders, anorexia nervosa (AN) and bulimia nervosa (BN), is that no body-image aspects (e.g. overvaluation of bodyweight and – shape in self-esteem) are incorporated in the classification. The severity of the disorder is typically specified based on the amount of uncontrollable, actual overeating (objective binge eating: OBE) episodes per week ranging from mild (1 – 3) to extreme (14 or more OBE episodes per week). BED is significantly associated with somatic comorbidity, specifically with obesity, diabetes and circulatory system diseases. Individuals with BED and obesity are more likely to report a lifetime history of respiratory and gastrointestinal diseases than those with BED without obesity. However, some diseases in individuals with BED, including components of metabolic syndrome, may not be merely due to the effects of obesity (Thornton et al., 2017). Besides somatic comorbidity, psychiatric comorbidity such as mood disorders, anxiety disorders, alcohol and drug use disorders, and personality disorders, is common in individuals with BED (Udo & Grilo, 2019; Welch et al., 2016). And, partly related to this, BED is associated with significant psychosocial and health related impairment in quality of life (Ágh et al., 2015; Striegel et al., 2012). Alice feels terribly ashamed about her body and tends to hide it from other people, including her husband. These feelings may also prevent her from going out with friends. She worries about the possible physical consequences of her overweight (she currently has a BMI of 40) and it makes her feel sad to notice that she is physically
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