Overeating—consuming food in excess of one’s needs—has become a commonplace occurrence in many parts of the world, especially the United States. For some individuals, however, overeating becomes highly recurrent and (in the words of Moore et al, 2017) ‘pathological,’ causing psychological distress, impairment in daily functioning, or physical health problems. Although there are many forms of pathological overeating, the best studied is binge eating. Clinically, binge eating is operationalized as consuming an unusually large amount of food during a short period of time, accompanied by a sense of loss of control. Binge-eating behavior is a defining characteristic of bulimia nervosa (BN), a psychiatric disorder in which recurrent episodes of binge eating are accompanied by inappropriate weight control behaviors such as vomiting. Binge-eating behavior can also occur in anorexia nervosa (AN), a psychiatric disorder characterized by persistent behaviors (eg, extreme dietary restriction) to maintain low body weight. Further, an additional 4.0% of US men and women report having experienced binge-eating episodes twice a week or more outside the context of AN or BN (Hudson et al, 2007). Individuals who experience recurrent binge eating in the absence of inappropriate or extreme weight control behaviors can receive a diagnosis of binge-eating disorder (BED), provided the binge-eating behavior causes them psychological distress. BED is the most common eating disorder in the United States, and it is associated with significant functional impairment, especially in the social domain (Kessler et al, 2013). Although not all individuals with BED have high levels of adiposity (and vice versa), individuals with BED are more likely to have a body mass index in the obese range. Further, BED may confer risk for development of metabolic syndrome over and above its association with obesity. Cognitive-behavioral therapy and psychotropic medications (eg, second-generation antidepressants, lisdexamfetamine) are efficacious treatments for BED (Brownley et al, 2016), but many individuals do not respond entirely or at all, and relapse can occur after cessation of treatment. Thus, there is considerable room for advances in the treatment of BED, as well as other forms of pathological overeating.

To this end, Moore et al posit that certain forms of pathological overeating, including binge eating in BED, are compulsive in nature and can be usefully modeled by three, non-mutually-exclusive elements (or domains) thought to characterize drug addiction: (1) habitual overeating, (2) overeating to relieve a negative emotional state, and (3) overeating despite aversive consequences. Each of these domains is instantiated via (overlapping) neurobiological substrates including the basal ganglia, the extended amygdala, and the prefrontal cortex, respectively.

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