The American Psychiatric Association has just completed its second round of comments and suggestions for inclusion in the Diagnostic and Statistical Manual, version V (DSM-V). A key consideration is the addition of Binge Eating Disorder (BED) as a recognized diagnosis. At the conclusion of the meeting it appears highly likely that Binge Eating Disorder will be recognized. This would make it easier for men and women with binge eating to receive care and have it paid for by insurers.
The DSM is a comprehensive classification of officially recognized psychiatric disorders used by mental health professionals to ensure uniformity of diagnosis. The DSM describes symptoms of major disorders, prevalence, and demographics but does not discuss the causes of the disorders. DSM-IV-TR is currently the latest edition. Current diagnostic standards would diagnose Binge Eating as an “eating disorder not otherwise specified (EDNOS),” a category that is notoriously hard to receive insurance coverage for.
The Rationale for Change
The current work group has proposed that Binge Eating Disorder be recognized as a freestanding diagnosis. They based this on a comprehensive literature review that compared BED to other eating disorders and obesity, and found that BED had a number of important distinctions. BED differs from obesity in terms of greater concerns about shape and weight and a higher likelihood co-occurring mood and anxiety disorders. BED was also associated with a lower quality of life than obesity.
BED also showed a greater degree of diagnostic stability, is the degree to which a diagnosis remains constant at subsequent patient assessments than other eating disorders, and a greater likelihood of remission. Individuals with BED also had a more positive response to specialty treatments than to generic behavioral weight loss treatments in terms of reduction of eating disorder symptoms.
The DSM-V criteria for BED would be as follows:
A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
1. eating, in a discrete period of time (for example, within any 2-hour period), an amount of food that is definitely larger than most people would eat in a similar period of time under similar circumstances
2. a sense of lack of control over eating during the episode (for example, a feeling that one cannot stop eating or control what or how much one is eating)
B. The binge-eating episodes are associated with three (or more) of the following:
1. eating much more rapidly than normal
2. eating until feeling uncomfortably full
3. eating large amounts of food when not feeling physically hungry
4. eating alone because of feeling embarrassed by how much one is eating
5. feeling disgusted with oneself, depressed, or very guilty afterwards
C. Marked distress regarding binge eating is present.
D. The binge eating occurs, on average, at least once a week for three months.
E. The binge eating is not associated with the recurrent use of inappropriate compensatory behavior (for example, purging) and does not occur exclusively during the course Anorexia Nervosa, Bulimia Nervosa, or Avoidant/Restrictive Food Intake Disorder.
The Face of BED
Cindy, a 16-year-old from Yardley Pa. is a binge eater. She initially began binging to help manage feelings of anxiety, and now struggles with nighttime binging. “I binge after everyone in the family goes to bed. My parents are frustrated, and I’m frustrated with myself.” Cindy has gained over 80 pounds and is so devastated by the weight gain that she will not attend school. She is working to stop binging and get her life back on track.
People with BED frequently eat large amounts of food and feel a loss of control over their eating. There are often feelings of disgust, depression, or guilt after overeating. Although many seek help, there are often limited resources to support them.
Support for the Change
Practitioners in the field are extremely positive about the changes. “Shame and stigma represent important barriers to care for many patients with eating disorders. People with binge eating symptoms have long faced skepticism about whether their illness was real or deserving of care,” said Dr. Douglas Bunnell, director of non-residential clinical services for The Renfrew Center in Philadelphia, Pa.
“The inclusion of Binge Eating Disorder (BED) in the DSM 5 will have real and practical implications for the millions of women and men with this disorder. Detection, diagnosis and referral will help direct them to the treatment they need and deserve. Furthermore, increased awareness of BED will lead to more resources for research and development of treatment strategies.”
There are likely changes coming for other eating disorders as well, particularly anorexia. Stay tuned, more information to come.
Hold the Date:
Binge Eating Disorder Association National Conference
March 2-4, 2001
Hyatt Regency at Penn’s Landing