11 General introduction 1 unable to play football with her boys. She perceives the urge to overeat especially when she feels sad or lonely, and senses that binge eating provides her with a short moment of relief. Yet, after a binge episode, Alice tells herself things like: “Oh you stupid fat pig, you did it again. You have no control, you are such an idiot! You start afresh tomorrow: skip your breakfast and stick to your diet”. Overall, she feels depressed and anxious. Currently, BED is estimated to affect 1.5% of adult women and 0.3% of adult men worldwide (Keski-Rahkonen, 2021). A lifetime diagnosis of BED is reported by 2.8% (0.6–5.8%) of women and 1.0% (0.3–2.0%) of men. This makes BED more common than AN and BN, with a lifetime prevalence of respectively 1.4% and 1.9% for women and 0.2% and 0.6% for men (Galmiche et al., 2019). Specific prevalence rates of BED among those people whose gender identity differs from the gender they were assigned at birth (transgender and gender diverse people), are so far unknown. However, based on self-report, eating disorders in general are more prevalent in this group than among people whose gender identity aligns with gender assigned at birth (cis-gender) (Diemer et al., 2015). Although relatively prevalent when compared to AN or BN, and associated with a serious clinical burden, BED tends to go undetected and untreated in the community (Coffino et al., 2019; Hudson et al., 2007). This may, at least in part, be due to the fact that individuals with BED do not fit the public image of eating disorders: a low-weight, white, young woman (Sim, 2019). For therapists and physicians in the field, this image is strengthened by the fact that eating disorder research is predominantly done in treatment-seeking individuals, where both men and ethnic minorities are substantially underrepresented (Coffino et al., 2019; National Institutes of Health, 2018). This underrepresentation may also apply to transgender and gender-diverse people as they have reported to experience various barriers in access to eating disorder screening and treatment (Ferrucci et al., 2023). Specific treatments have shown to be effective in treatment-seeking adults with BED (Linardon, Fairburn et al., 2017; Linardon, Wade et al., 2017). The strongest evidence is for cognitive behavior therapy (CBT), which is the current treatment of choice according to clinical practice guidelines (e.g. Akwa GGZ, 2017; Hay et al., 2014; NICE, 2017). Interpersonal psychotherapy (IPT) is considered a strong empirically-supported alternative (Linardon, Fairburn et al., 2017). In BED research, treatment outcome is primarily defined in terms of a decrease in or absence of eating disorder psychopathology or OBE episodes (Linardon, Fairburn et al., 2017). With CBT, up to 50% of patients reach abstinence from binge eating (Linardon, 2018). The positive effects of CBT extend to depressive symptoms (Fairburn et al., 2015; Turner et al., 2016) and to cognitive symptoms like eating concerns and
RkJQdWJsaXNoZXIy MjY0ODMw