Binge Eating Disorder (BED) is a newly introduced diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition or DSM-5. In the previous edition, DSM-IV-TR, Binge Eating Disorder was acknowledged, but not recognized as a stand alone disorder. The inclusion of Binge Eating Disorder in DSM-5 is a landmark in the recognition of what many clinicians refer to as food addition or compulsive eating -- habitual overeating, even when you don't want to, when it causes distress, and when it leads to physical problems, such as obesity.
Binge eating is eating an excessive amount of food within a relatively short time frame, for example, within a two hour period. What is excessive? The DSM states that for a binge to occur, the amount of food is "definitely larger than what most people would eat in a similar period of time under similar circumstances." While this seems quite vague, the clinician making the diagnosis would have to consider the context in which the person was eating the excessive amount. For example, eating a much larger amount than usual is common and expected during holidays and celebrations such as Thanksgiving, Christmas and birthday parties, but wouldn't be expected at the end of a typical workday, when regular meals had been consumed at breakfast and lunchtimes, with snacks in between.
In fact, although a binge eater might overeat at times of celebration, that alone would not lead to a diagnosis of Binge Eating Disorder. To meet the criteria for the disorder, the person would have to be binge eating on a fairly regular basis, on average, at least once per week for three months. Even if you overate at every celebration, as long as it was only at these times, it wouldn't meet the criteria for Binge Eating Disorder because it would not occur with enough frequency.
Another type of overeating that wouldn't meet the criteria for Binge Eating Disorder is snacking. Even continual snacking on small amounts isn't bingeing, because it doesn't fit the binge phenomenon in which bingeing occurs, which is eating large amounts of food within a fairly short amount of time.
Out of Control EatingAnother factor that distinguishes Binge Eating Disorder from other types of overeating is the sense of lack of control over eating during the binge. Sometimes there is a feeling that you cannot stop eating, or control what or how much you are eating. This characteristic is very similar to how people describe other addictive behaviors, including various kinds of drug addiction, heavy drinking, sex addiction, and shopping addiction.
Eating That Doesn't Feel Good
For Binge Eating Disorder to be diagnosed, the eating behavior would create at least three of these unpleasant feelings:
- Eating faster than normal
- Eating until you feel too full
- Eating a lot when you aren't physically hungry
- Eating on your own because you are embarrassed about how much you are eating
- Feeling disgusted, depressed, or guilty about your eating.
As well as these specific unpleasant feelings, binge eating isn't Binge Eating Disorder unless you are very upset about binge eating.
The final criterion for Binge Eating Disorder is that the binge eating is not part of another eating disorder, such as Anorexia Nervosa or Bulimia Nervosa, both of which can include bingeing. If you have Binge Eating Disorder, you don't try and compensate for overeating by purging, over exercise or misuse of laxatives or diuretics.
American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders Fifth Edition. DSM-5TM American Psychiatric Association, 2013.