THE VICIOUS CYCLE OF POLYCYSTIC OVARY SYNDROME AND BINGE EATING DISORDER: A REVIEW OF METABOLIC, PSYCHOLOGICAL, AND IATROGENIC PATHWAYS

Background: Polycystic Ovary Syndrome (PCOS) is a prevalent endocrine and metabolic disorder traditionally managed through a weight-centric paradigm, which frequently overlooks the significant psychiatric comorbidity of Binge Eating Disorder (BED). This narrative review aims to systematically map the interacting metabolic, psychological, and iatrogenic pathways driving BED in women with PCOS. Methods: A comprehensive literature search was conducted across electronic databases, primarily PubMed, for peer-reviewed articles published up to May 2026. The review focused on studies examining the intersection of PCOS and eating disorders, emphasizing metabolic and neuroendocrine mechanisms, psychosocial impact, and recent clinical guidelines. Findings: The biological susceptibility to BED in PCOS is driven by severe insulin resistance, reactive hypoglycaemia, reduced cholecystokinin (CCK) secretion linked to hyperandrogenism, and disrupted mesolimbic reward pathways. This physiological predisposition is heavily exacerbated by psychosocial distress stemming from visible hyperandrogenic symptoms, diagnostic delays, and pervasive societal and provider-induced weight stigma. Furthermore, standard clinical recommendations enforcing strict caloric restrictions often act as an iatrogenic trigger for rebound binge eating due to the profound metabolic inflexibility in these patients. Conclusions: Dismantling the vicious PCOS-BED cycle requires an urgent shift away from punitive, weight-centric models. In alignment with the 2023 International Evidence-based Guidelines, multidisciplinary clinical management should incorporate mandatory eating disorder screening, trauma-informed cognitive-behavioural therapy (CBT), intuitive eating principles, and the evaluation of novel pharmacological agents, such as GLP-1 receptor agonists, to target the underlying pathophysiological mechanisms of hyperphagia.