Binge eating disorder, or BED, was only just recently recognized by the Diagnostic and Statistical Manual of Mental Disorders in its fifth edition (DSM-V), which was published by the American Psychiatric Association (APA) in May of 2013. In the DSM-IV, published in 1994, BED was included in Appendix B under the diagnosis of “Eating Disorder Not Otherwise Specified” (EDNOS). BED was first officially identified in the United States in 1959, but not even mentioned in the DSM until 1987 with its third edition. Since this recognition, BED has become common knowledge and the Binge Eating Disorder Association (BEDA) was founded in 2008.
Although BED has only formally been recognized in modern times, it, of course, has been around as long as human history has been recorded. As early as the fifth century AD, the Talmud described a wild hunger that could only be cured by eating sweets. From Ancient Roman times through the Middle Ages, gorging on food and even puking to make room for more signified wealth and luxury. The term “binge” wasn’t even used until nineteenth-century England, where it was used to describe excessive drinking.
Binge eating’s first appearance in the psychiatric world occurred in 1959 with Dr. Albert Stunkard’s paper “Eating Patterns and Obesity.” Stunkard is known for his work on “Night Eating Syndrome.” During his research, he observed three main behaviors: night eating, eating with no satiation, and binge eating. Some of the proposed names for BED included “Stuffing Syndrome,” “Hyperorexia,” and “Dietary Chaos Syndrome.”
“Binge eating” is characterized by eating an amount of food over a period of time that is greater than what most people would eat in the same time under similar circumstances. Binge eating also includes the sense of a lack of control of eating during this episode.
The four diagnostic symptoms of BED, according to the APA DSM-V, include the following:
1. Recurrent and persistent episodes of binge eating.
2. Binge eating episodes associated with three or more scenarios listed below—
a. Eating much faster than normal.
b. Eating until feeling uncomfortably full.
c. Eating a large amount of food when not hungry.
d. Eating alone due to embarrassment about the quantity of food consumed.
e. Feeling disgusted, depressed, or guilty after overeating.
3. Feeling distressed after binge eating or because of it.
4. An absence of regular compensatory behaviors, such as purging, fasting, or excessive exercise.
In addition to these symptoms, the DSM-V outlines frequency and duration criteria as well as a severity grading scale. According to the APA, binge eating has to occur at least 2 days a week for 6 months (or 1 day a week for 3 months) to be considered as BED. The severity scale ranges from mild to extreme. Mild includes one to three episodes per week, moderate four to seven, severe eight to thirteen, and extreme 14 or more. The lack of compensatory behaviors differentiates this binge eating from other eating disorders like anorexia nervosa or bulimia nervosa. Anorexia nervosa often entails fasting or excessive exercise, and bulimia nervosa is mainly characterized by purging.
Long term consequences of BED can include weight gain, high blood pressure, cardiovascular disease, and diabetes. Additionally, up to two-thirds of people with BED are medically obese and there seems to be a correlation between BED and other mental health issues. For example, people with BED are more likely to experience anxiety and major depression than those without the eating disorder (ED).
BED is the most common eating disorder in the United States, affecting as many as 3% of the adult population and 2% of adolescents. BED is usually seen in teens and early young adults but can occur at any time to anyone. There is no clear relationship between race and BED, but it is more common among women than men.
Over the past few decades, there have been thousands of research papers which support that BED is its own specific and unique diagnosis, markedly different from other EDNOS.
Research has also identified a number of effective treatments. Both cognitive based therapy (CBT) and interpersonal therapy (IPT) have been proven to improve BED behaviors. Medications, such as selective serotonin reuptake inhibitor (SSRI) antidepressants and anticonvulsants, can reduce binge eating. As recently as 2015, the Federal Drug Administration (FDA) approved the use of lisdexamfetamine dimesylate, also known as Vyvanse, to treat BED. The combination of therapy and medication is often suggested as a treatment plan, but CBT is the most popular approach for both in- and outpatient care.
The National Eating Disorders Association helpline is available for support, resources, and treatment options at https://www.nationaleatingdisorders.org/help-support/contact-helpline. You can always leave a message if the Helpline is not available and a volunteer will contact you.
References:
American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders. (4th ed.) Washington, DC: APA Press.
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders. (5th ed.) Washington, DC: APA Press.
National center for Biotechnology Information. (n.d.). Retrieved March 24, 2021, from https://www.ncbi.nlm.nih.gov/
National Eating Disorders Association. (n.d.), from https://www.nationaleatingdisorders.org/