What are the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) criteria for diagnosing binge eating disorder?

DSM-5 Criteria for Binge Eating Disorder

Binge eating disorder is officially recognized in the DSM-5 as a distinct disorder characterized by recurrent episodes of binge eating at least once a week for 3 months, without compensatory behaviors, and is associated with the development of obesity. 1

Core Diagnostic Criteria

• Recurrent episodes of binge eating characterized by both:

  • Eating a larger amount of food within a 2-hour period compared with peers 1
  • A perceived lack of control during the time of the binge 1

• Binge eating episodes are associated with at least 3 of the following:

  • Eating faster than normal 1
  • Eating until uncomfortably full 1
  • Eating large quantities of food when not physically hungry 1
  • Eating alone because of embarrassment about the quantity of food eaten 1
  • Feeling disgusted with oneself, depressed, or very guilty after eating 1

• Marked distress regarding binge eating 1

• Binge eating behavior occurs at least once a week for 3 months 1

• Binge eating is not followed by the use of unhealthy compensatory behaviors (such as purging) and does not occur exclusively during the course of anorexia nervosa or bulimia nervosa 1

Important Distinctions from Other Eating Disorders

• Unlike bulimia nervosa, binge eating disorder does not involve compensatory behaviors such as self-induced vomiting, misuse of laxatives, periods of starvation, or compulsive exercising 1

• Unlike anorexia nervosa binge-eating/purging subtype, individuals with binge eating disorder do not maintain a significantly low body weight 2

• Binge eating disorder is now formally recognized as a distinct disorder in DSM-5, whereas previously it was classified under "Eating Disorder Not Otherwise Specified" in DSM-IV 3

Epidemiology and Clinical Significance

• The lifetime prevalence of binge eating disorder in adolescent females is approximately 1.6% 1

• Binge eating disorder is associated with the development of obesity 1

• The disorder affects both males and females, with a less skewed gender ratio than other eating disorders 1

Clinical Considerations

• Careful assessment is needed to distinguish between objectively large binge eating episodes (required for diagnosis) versus subjectively experienced episodes that may not involve objectively large amounts of food 4

• The reduction in frequency threshold from twice weekly (in DSM-IV research criteria) to once weekly in DSM-5 is supported by empirical evidence and facilitates earlier intervention 4

• Environmental factors that may contribute to binge eating disorder include systemic issues, economic factors, trauma, stigmatization, and social messaging 5

• Early identification and intervention are critical as eating disorders have high mortality rates and significant medical complications 2

Common Pitfalls in Diagnosis

• Failing to recognize binge eating disorder in individuals who are not overweight or obese (the disorder occurs across weight categories) 5

• Confusing subjective binge episodes (feeling out of control but not consuming objectively large amounts of food) with objective binge episodes required for diagnosis 6

• Not adequately assessing the sense of loss of control, which is a central feature of the disorder 6

• Overlooking binge eating disorder in males and minority populations, where it may be underdiagnosed 1