Diagnostic Criteria for Binge-Eating Disorder

Binge eating disorder (BED) is an eating disorder introduced in 2013 in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Although newly recognized as a distinct disorder, it is the most common eating disorder, more common than anorexia nervosa and bulimia nervosa. It is estimated that between 0.2 percent and 3.5 percent of females and 0.9 percent and 2.0 percent of males will develop binge eating disorder. Approximately 40 percent of those with binge eating disorder are male. BED often begins in the late teens or early 20s, although it has been reported in young children as well as older adults.

Binge-eating disorder is sometimes mischaracterized as food addiction, which is not a recognized psychiatric disorder. While a large number of people with binge eating disorder live in larger bodies, BED can also occur in people who are normal weight. As most overweight and obese people do not have BED, it is important not to conflate obesity, which is not a disorder, but body size, with binge eating disorder.

While many people may think of binge-eating disorder as a less serious disorder than anorexia nervosa or bulimia nervosa, it can be severe, debilitating, and even life-threatening. 

To be diagnosed with binge eating disorder, a person must have the following symptoms:

• Episodes of binge eating which means that the person eats an unusually large amount of food within a certain time period. During that episode they will feel a lack of control over their eating, and that they can't stop eating or control how much they eat or even what they eat. 
• The binge-eating episodes are associated with three (or more) of the following: 
  • Eating much more quickly than normal
  • Eating until uncomfortably full
  • Eating large amounts of food even when not physically hungry
  • Eating alone because of embarrassment about how much one is eating
  • Feeling disgusted with oneself, depressed, or very guilty afterward
• The binge eating causes distress and occurs at least once a week for three months.
• A major distinction differentiating binge-eating disorder from bulimia nervosa is that there are no recurrent behaviors used to avoid weight gain or compensate for binge eating in binge eating disorder. These behaviors are referred to as “compensatory behaviors” by professionals and may include purging or extreme restriction of intake, among others. The binge-eating symptoms cannot occur exclusively during the course of anorexia nervosa. Repeated attempts to stop binge eating, or repeated attempts at dieting, do not exclude someone from a binge-eating disorder diagnosis.

Treatments for binge eating disorder include medications and psychotherapy, such as cognitive-behavioral therapy.​ Self-help may also effective. Discuss and work with your doctor to find the right treatment for you.

The DSM-V also allows for professionals to specify if a person is in partial remission or in full remission (recovery) from binge-eating disorder. The severity, based on the average frequency of binge-eating episodes, can also be specified:

• Mild: 1 to 3 episodes each week
• Moderate: 4 to 7 episodes each week
• Severe: 8 to 13 episodes each week
• Extreme: 14 or more episodes each week

Regardless of how frequent, if you or someone you know is struggling with binge-eating or compulsive overeating episodes, it is important to see a physician, dietician, or a mental health professional for an assessment. Treatment is available and recovery is possible.

Several triggers for binge eating have been reported in people with binge eating disorder. These include feeling unhappy, anxious, or having other negative emotions, particularly about body weight, body shape, or food. Sometimes, people are triggered to binge eat when they are feeling bored. Binge eating during or after problems in interpersonal relationships is also common. Many people with binge eating disorder experience weight stigma which can exacerbate binge eating.

These emotional triggers for out of control, excessive behavior is another similarity between binge eating disorder and substance use disorders. People who develop addictions to alcohol and drugs typically find the desire to drink or to use drugs is greatest when they are triggered by negative feelings, such as depression and anxiety, as well as when they are having difficulties in their relationships with others, or when they are bored.