Authors: Cynthia M. Bulik, PhD; Paul E. Keck Jr, MD; Susan L. McElroy, MD; Charles P. Vega, MD, FAAFP
Release Date: March 26, 2014
Expiration Date: March 26, 2015
CME/CE Credit: 1 Credit
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The American Psychiatric Association (APA) recognized binge eating disorder (BED) as a distinct eating disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).
The hallmark clinical feature of BED is recurrent binge eating. First recognized in 1959 by Stunkard in a subset of obese individuals, binge eating is defined as "eating, in a discrete period of time (eg, within any 2-hour period), an amount of food that is definitely larger than what most people would eat in a similar period of time under similar circumstances."What distinguishes binge eating from regular overeating is the sense of lack of control during the episode, which can manifest as feeling that one cannot stop eating once one has started or cannot control how much one is eating. BED is distinct from bulimia nervosa insofar as individuals diagnosed with BED do not experience recurrent inappropriate compensatory behaviors such as self-induced vomiting, laxative abuse, or excessive exercise.
In the DSM-5 BED criteria, binge eating must occur, on average, once a week for 3 months. This is a significant departure from the DSM-IV criteria, which required an average of 2 episodes of binge eating per week for 6 months, and brings the frequency and duration criteria for BED in line with those for bulimia nervosa.
In addition to the core behavioral feature of binge eating, to meet diagnostic criteria for BED the binge eating must lead to marked distress and be characterized by 3 or more of the following features: rapid eating, eating until uncomfortably full, binge eating when not hungry, eating alone due to embarrassment, and feeling disgusted, depressed, or guilty after eating. It is noteworthy that these additional features are not required for the diagnosis of bulimia nervosa.
Unlike anorexia nervosa and bulimia nervosa, there are no diagnostic criteria for BED related to body image or the influence of weight and shape on self-evaluation. Although many individuals with BED suffer from poor body image, it is not required for a diagnosis. Moreover, there is no body mass index (BMI) criterion for BED. It is important to note that BED can occur in individuals of any BMI but is commonly associated with overweight or obesity.
Eating disorders continue to carry considerable shame and stigma. Many individuals suffer with BED for decades without divulging their symptoms to their health care providers, and many remain unaware that their dysregulated eating is a recognized, treatable syndrome. Two important challenges are spreading awareness of the nature and treatability of the disorder and reducing the stigma and shame related to it. Individuals who are overweight or obese are stigmatized throughout the world, even within the medical profession, and overweight or obese individuals with a diagnosis of BED bear a double stigma. Understanding that the causes of BED are multifold and include both genetic and environmental factors may assist in the recognition that BED is an illness, not a choice.