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.

Approximately 40% 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 are overweight, 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 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 episodes of binge eating at least once a week for three months. During these episodes, the person will feel a lack of control over their eating (they can't stop eating or control how much or when they eat). 

Binge-eating episodes 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.

Binge-eating episodes are associated with three (or more) of the following symptoms: 

• 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

A major distinction between binge eating disorder and bulimia nervosa is that there are no recurrent behaviors used to avoid weight gain or compensate for binge eating. Known as “compensatory behaviors,” these behaviors may include purging or extreme restriction of food intake.

Treatments for binge eating disorder include medications (SSRIs and Vyvanse) and psychotherapy, such as cognitive behavioral therapy and interpersonal therapy. Guided self-help may also be effective. Discuss and work with your doctor to find the right treatment for you.

The DSM-V also allows 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.