DSM-5 Criteria for Binge Eating Disorder
Binge eating disorder (BED) is characterized by recurrent episodes of binge eating occurring at least once a week for 3 months, without compensatory behaviors, and is associated with marked distress. 1
Diagnostic Criteria
According to the DSM-5, binge eating disorder is diagnosed when the following criteria are met:
Recurrent episodes of binge eating characterized by both:
- Eating, in a discrete period of time (e.g., within a 2-hour period), an amount of food that is definitely larger than what most people would eat in a similar period under similar circumstances
- A sense of lack of control over eating during the episode (feeling that one cannot stop eating or control what or how much one is eating)
Binge eating episodes are associated with at least three of the following:
- Eating much more rapidly than normal
- Eating until feeling uncomfortably full
- Eating large amounts of food when not feeling physically hungry
- Eating alone because of feeling embarrassed by how much one is eating
- Feeling disgusted with oneself, depressed, or very guilty afterward
Marked distress regarding binge eating is present
The binge eating occurs, on average, at least once a week for 3 months
The binge eating is not associated with the recurrent use of inappropriate compensatory behaviors (e.g., purging, fasting, excessive exercise) and does not occur exclusively during the course of anorexia nervosa or bulimia nervosa 1, 2
Epidemiology and Clinical Significance
- BED is the most common eating disorder with an estimated lifetime prevalence of 2.6% among U.S. adults 2
- It affects both men and women regardless of weight status (normal weight, overweight, or obese) and across all ethnic and racial groups 2
- The disorder is associated with significant psychiatric comorbidities:
- 79% of adults with BED also experience anxiety disorders, mood disorders, impulse control disorders, or substance use disorders
- Almost 50% of persons with BED have 3 or more psychiatric comorbidities 2
Distinguishing Features
- Unlike bulimia nervosa, BED does not involve compensatory behaviors such as self-induced vomiting, laxative misuse, or excessive exercise 1, 3
- Unlike simple obesity, BED involves marked psychological distress about eating behavior 3
- BED was officially recognized in the DSM-5 as a distinct disorder, whereas in DSM-IV it was listed as a provisional diagnosis under "Eating Disorder Not Otherwise Specified" 3, 4
Clinical Implications
- BED is associated with increased risk of medical complications related to obesity, including cardiovascular disease, type 2 diabetes, and metabolic syndrome
- Patients with BED often report barriers to treatment, including healthcare providers focusing more on physical ailments, being judgmental about weight, and inability to distinguish BED from obesity 5
- Psychological treatments, particularly cognitive behavioral therapy, are recommended as first-line interventions 2
Common Pitfalls in Diagnosis
- Failure to screen for BED in patients with obesity: Not all obese individuals have BED, but approximately 30% of obese individuals seeking treatment may have BED 6
- Confusing BED with other eating patterns: Overeating occasionally differs from the persistent pattern seen in BED
- Missing the psychological component: The marked distress criterion is essential for diagnosis and distinguishes BED from non-pathological overeating 2
- Overlooking BED in normal-weight individuals: BED can occur at any weight status 2
- Focusing only on weight management: Treatment should address both the psychological aspects of the disorder and any weight-related health concerns
By recognizing and properly diagnosing BED according to these DSM-5 criteria, clinicians can provide appropriate treatment that addresses both the psychological distress and potential medical complications associated with this disorder.