Monte Nido® Eating Disorder Treatment Center

diagnostic criteria for eating disorders
Binge Eating Disorder

Defining characteristics of Binge Eating Disorder:

The following descriptions are taken from The Diagnostic Manual of Mental Disorders, 4th Edition

A. Recurrent episodes of binge eating. An episode is characterized by:
1. Eating a larger amount of food than normal during a short period of time (within any two hour period)
2. Lack of control over eating during the binge episode (i.e. the feeling that one cannot stop eating).

B. Binge eating episodes are associated with three or more of the following:
1. Eating until feeling uncomfortably full
2. Eating large amounts of food when not physically hungry
3. Eating much more rapidly than normal
4. Eating alone because you are embarrassed by how much you're eating
5. Feeling disgusted, depressed, or guilty after overeating

C. Marked distress regarding binge eating is present

D. Binge eating occurs, on average, at least 2 days a week for six months

E. The binge eating is not associated with the regular use of inappropriate compensatory behavior (i.e. purging, excessive exercise, etc.) and does not occur exclusively during the course of bulimia nervosa or anorexia nervosa.

Distinguishing people who overeat from people with binge eating disorder is like distinguishing dieting from anorexia; it is a matter of definition and degree. The marked distress regarding binge eating is present. It is a common misconception that all people with binge eating disorder are overweight, even though most of them are.

Many of these people suffer from debilitating eating patterns often cued by the need for self-soothing rather than by physiological cues. Such patterns usually produce weight gain and even obesity, a symptom upon which physicians, dietitians, and other health professionals often focus their attention, without inquiring about possible binge eating patterns or overeating as a form of psychological self-medication. However, it is also very important to emphasize that being overweight or even obese is not enough to warrant the diagnosis of BED. There are a variety of causes for obesity. Some overweight individuals graze on food all day long or eat high-calorie foods but do not binge. Researchers in weight control and obesity are increasingly discovering evidence that biological predispositions may also play a role.

Some professionals are of the opinion that there are two distinct subcategories of binge eating: deprivation-sensitive binge eating and addictive or dissociative binge eating. The deprivation-sensitive category appears to be the result of weight-loss diets or periods of restrictive eating, both of which can lead to binge eating episodes. However, the addictive or dissociative category is related to self-medication or self –soothing rather than a reaction to prior restricting. Such individuals may report feelings of numbness, dissociation, calmness, or a return of inner equilibrium after binge eating.

BED treatment focuses on binge eating, compulsivitywith food, an inability to control food intake, and the use of food as a method of coping with anxiety or other underlying issues and dieting or deprivation which leads to bingeing. Weight loss in the treatment of BED is a very touchy and difficult issue, and attempts to lose weight before resolving any contributory psychological, emotional, or relational issues will most likely result in failure. Eating disorder therapists often shy away from any discussion of weight loss as a goal, having been sensitized to this danger by years of working with individuals with anorexia and bulimia for whom the goal is to get the focus off weight. Professionals are also worried about sounding like they are weight prejudiced or creating bulimia or anorexia in clients with BED. These are important issues to consider but so is weight loss for people whose health is in jeopardy. An experienced and sensitive clinician has to negotiate these difficult nuances with each individual. To date, most studies that report successful treatment of BED are unsuccessful in the area of weight loss.

More research is necessary to understand this illness, find proper treatments, and prevent the ongoing inappropriate treatment of binge eating disorders solely with weight- loss diets and exercise programs. These types of recommendations may exacerbate the disorder and tragically fail clients who need more extensive help to recover.

The following is an excerpt from the diary of a person with binge eating disorder:
"When I start eating, I can't stop. I don't know when I'm hungry or when I'm full anymore. I really don't know; I can't remember what it was like to know. Once I start, I just keep eating until I literally can't take another bite."