DSM-5 Diagnostic Criteria for Binge Eating Disorder
Binge Eating Disorder requires recurrent episodes of binge eating at least once weekly for 3 months, accompanied by marked distress and specific behavioral features, without compensatory behaviors. 1
Core Diagnostic Criteria
A binge eating episode must include both:
- Eating an objectively larger amount of food within a discrete 2-hour period than most people would eat under similar circumstances 1
- A sense of lack of control over eating during the episode 1
Required Associated Features
The binge eating episodes must be associated with at least 3 of the following 5 characteristics: 1
- Eating much more rapidly than normal
- Eating until feeling uncomfortably full
- Eating large amounts of food when not physically hungry
- Eating alone due to embarrassment about the quantity of food consumed
- Feeling disgusted with oneself, depressed, or very guilty after overeating
Frequency and Duration Requirements
- Binge eating must occur at least once per week for 3 months 1
- Marked distress regarding the binge eating behavior must be present 1
Critical Exclusion Criteria
The binge eating is NOT associated with: 1
- Recurrent use of inappropriate compensatory behaviors (distinguishes from bulimia nervosa)
- Self-induced vomiting
- Misuse of laxatives, diuretics, or other medications
- Periods of starvation
- Compulsive or excessive exercise
The individual does NOT maintain a significantly low body weight (distinguishes from anorexia nervosa binge-eating/purging subtype) 2
Clinical Context and Pitfalls
Common diagnostic errors to avoid:
- BED occurs across all weight categories—do not assume it only affects individuals with obesity 1
- Males are more commonly affected than in other eating disorders; do not overlook based on gender 1
- Minority populations may be underdiagnosed due to screening biases 1
Associated clinical features: 1
- Strong association with obesity development
- Lifetime prevalence approximately 1.6% in adolescent females 1
- Community prevalence 2-5%, but up to 30% in weight-loss treatment seekers 3
The disorder carries significant morbidity with high rates of co-occurring psychiatric conditions and medical complications, making early identification critical 4.