Binge Eating

Diagnosis

BED is currently listed in the appendix of the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association (DSM-IV; used to diagnose psychological disorders). BED currently falls into the eating disorder not otherwise specified (EDNOS) category; however, it is likely to be included as a recognized eating disorder (ED) in the next revision of the DSM (DSM-V). Although the majority of research in this area has focused on individuals meeting the diagnostic criteria for bulimia nervosa (BN), individuals with BN make up only a small fraction of those who regularly binge eat.

The larger “subclinical” group includes both men and women who meet some, but not all, of the diagnostic criteria for BN, as well as others who meet most or all the research criteria for BED. A summary of the diagnostic criteria for BED, according to the DSM-IV, is as follows:

To qualify as binge eating, a person must eat more than normal and exhibit a lack of control over food intake.

• A.
  Recurrent episodes of binge eating characterized by both:

  • 1.
    eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than most people would eat under similar circumstance in a similar period of time
  • 2.
    a sense of lack of control over eating during the episode (i.e., feeling that one cannot stop eating or control how much or what one is eating)
• B
  Binge eating episodes associated with 3+ of the following:

  • 1.
    eating much more rapidly than normal
  • 2.
    eating until uncomfortably full
  • 3.
    eating large amounts of food when not hungry
  • 4.
    eating alone because of being embarrassed by how much one is eating
  • 5.
    feeling disgusted with oneself, depressed, or very guilty after overeating
• C.
  Marked distress regarding binge eating.
• D.
  The binge eating occurs 2+ days per week (on average) for 6 months.
• E.
  The binge eating is not associated with the regular use of inappropriate compensatory behaviors (e.g., purging, excessive exercise) and does not occur exclusively during the course of Anorexia Nervosa (AN) or BN.

[Page 82]The current gold standard for the diagnosis of BED is the structured clinical interview, the Eating Disorders Examination (EDE). However, the EDE can take up to an hour to complete and requires training to ensure proper administration and scoring. As such, several brief paper and pencil measures of binge eating have been developed, although none are considered as valid as the EDE.

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