Reprinted from Eating Disorders Review
September/October 2006 Volume 17, Number 5
©2006 Gürze Books
Binge eating disorder (BED) was first officially recognized in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) in 1994. Although factors such as adverse childhood experiences and disturbed family function can increase the risk, until recently it wasn’t known why a particular individual develops BED at a certain point in time.
Dr. Kathleen Pike and a team of researchers recently traced the effects of life events during the 12 months before the onset of symptoms of BED in two groups. The first group included 162 matched pairs of black and white women with BED and women with no psychiatric disorders (NC group). The second group included 107 matched pairs of women with BED and a control group with a current psychiatric disorder (PC group) (Psychiatry Research 2006; 142:19).
The researchers explored two main questions. First, do individuals with BED have a significantly greater number of stressful life events during the year immediately before their disordered eating develops than do matched subjects with either other current general psychiatric disorders (PC group) or with no current psychiatric disorders (NC) at the same stage of their lives? Second, are particular types of antecedent life events especially likely to precede the onset of BED?
The study included women recruited from the community for the New England Women’s Health Project who participated in 15-minute screening interviews. Women over 40 years of age, or with physical conditions known to influence their eating habits or weight were excluded, as were those who were pregnant, or who had a psychotic disorder.
Current and lifetime psychiatric disorders were assessed with the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-IV). An abbreviated diagnostic version of the Eating Disorder Examination was also used; and prior life events were assessed with the Oxford Risk Factor Interview (RFI). The RFI, which includes 17 items with behavioral definitions of key concepts, is designed to minimize the biases of memory or reconstruction of events that often occur in retrospective reporting.
BED group vs. NC group. The BED group reported a significantly greater number of adverse life events than did the NC group during the year before the onset of BED symptoms. A higher percentage of the BED women than the NC women reported three or more life events stressors during the previous 12 months. Exposure to a greater number of life events (3 or more) was associated with a sixfold higher risk of BED. Specifically, the BED group reported a significantly greater number of major changes in their lives and relationships, including a major house move, death of a close relative, friend, or partner, change in family structure, and the end of a relationship with a boyfriend or partner.
Critical comments about shape and weight also took a toll. According to Dr. Pike and her colleagues, women with BED were seven times more likely to report being criticized for their weight and shape, and six times more likely to report physical abuse than were NC control subjects.
BED group vs. PC group. As in the first group, women with BED reported a greater number of stressful life events than did women in the PC group; exposure to a greater number of life events was associated with a relatively higher risk of developing BED.
Compared with the PC group, the BED group reported significantly more frequent exposure to several life events during the preceding year. The BED group reported more frequent changes in family structure and more critical comments about shape and weight. Also, compared with the PC group, the BED group showed a trend for more frequent ending of relationships with boyfriends/partners and increased concerns about safety or feeling unsafe in a variety of settings.
In both BED and control groups, previous life stressors were varied and idiosyncratic, and nearly one-third of the women with BED reported an event not otherwise assessed by the interview. For example, stressors mentioned included getting married, having a sister with an eating disorder who had to be hospitalized, starting to use drugs, and graduating from college. While these events are not all considered “adverse,” they did make the individual feel overwhelmed, stressed, and with a diminished capacity to cope.
There was no race-specific exposure to previous life events; among both groups, there was only one race-specific stressorblack women reported a significantly higher risk of becoming pregnant during the year before the onset of eating disorder symptoms than did white women.
The authors concluded that for most women who developed BED, it was not a matter of a single potent stressor, but the accumulation of a series of stressful events that finally triggered the eating disorder.
In addition to experiencing more adverse events, it’s also possible that women who develop BED may be more prone than others to experience and report that ordinary events of life, such as getting married or graduating from college, are more distressing for them than for others.