What are the diagnostic changes for Binge‑Eating Disorder across the Diagnostic and Statistical Manual of Mental Disorders (DSM) versions III, III‑TR (Text Revision), IV, V, and V‑TR (Text Revision), and the International Classification of Diseases (ICD) versions X and XI?

Evolution of Binge-Eating Disorder Diagnostic Criteria Across DSM and ICD Versions

Binge-Eating Disorder (BED) was first introduced as a provisional diagnosis in DSM-IV (1994) and achieved full diagnostic status in DSM-5 (2013), while ICD-11 (2020) formally recognized it as a distinct eating disorder category for the first time. 1, 2, 3

DSM-III and DSM-III-TR (1980-1987)

• Binge-Eating Disorder did not exist as a diagnostic entity in DSM-III or DSM-III-TR. 4
• The concept of "binge eating" was only described as a behavior within the context of bulimia nervosa or as problematic eating patterns in certain overweight individuals. 4

DSM-IV and DSM-IV-TR (1994-2000)

• BED was introduced as a provisional diagnosis requiring further research and was classified as an example of "Eating Disorder Not Otherwise Specified (EDNOS)." 4, 1, 2
• The DSM-IV research criteria required recurrent binge eating episodes characterized by consuming objectively large amounts of food in discrete time periods with lack of control, without compensatory behaviors. 4, 5
• The frequency threshold was set at twice weekly, though this was part of provisional research criteria. 6
• Associated features included eating until uncomfortably full, eating when not physically hungry, eating alone due to embarrassment, and feelings of depression or guilt afterward. 5
• This provisional status meant that most individuals with BED symptoms were diagnosed with the heterogeneous EDNOS category, which provided limited clinical utility. 7

DSM-5 (2013)

• BED was elevated to a full, formal diagnostic category, becoming the third classical eating disorder alongside anorexia nervosa and bulimia nervosa. 2, 7
• The frequency threshold was reduced from twice weekly to once weekly for a continuous 3-month period, substantially expanding the number of individuals meeting diagnostic criteria. 8, 6
• Core criteria require recurrent binge eating episodes involving consumption of a larger amount of food within a 2-hour period compared with peers, accompanied by perceived lack of control. 8
• At least 3 of 5 associated features must be present: eating faster than normal, eating until uncomfortably full, eating large quantities when not physically hungry, eating alone due to embarrassment, and feeling disgusted/depressed/guilty afterward. 8
• Marked distress regarding binge eating became a required diagnostic feature. 8
• The absence of compensatory behaviors distinguishes BED from bulimia nervosa, and the lack of significantly low body weight distinguishes it from anorexia nervosa binge-eating/purging subtype. 8, 9
• This change dramatically reduced the proportion of patients classified under the residual "Other Specified Feeding or Eating Disorder" (OSFED) category. 6, 7

DSM-5-TR (2022)

• The core diagnostic criteria for BED remained unchanged from DSM-5. 8
• The frequency threshold continues to require binge eating episodes at least once weekly for 3 months without compensatory behaviors. 8
• Text revisions provided clarifications but did not alter the fundamental diagnostic structure established in DSM-5. 8

ICD-10 (1992)

• ICD-10 did not include Binge-Eating Disorder as a distinct diagnostic category. 3
• Individuals with BED symptoms would have been classified under residual or atypical eating disorder categories, similar to the DSM-IV EDNOS classification. 3
• ICD-10 provided less precise specifications for eating disorder frequency thresholds and detailed criteria compared to DSM systems. 6

ICD-11 (2020)

• ICD-11 formally recognized BED as a distinct diagnostic entity, characterized by frequent and recurrent episodes of binge eating. 3
• This represents a major advancement, aligning ICD classification with DSM-5 by acknowledging BED as a separate condition rather than a residual category. 3, 6
• ICD-11 introduced dimensional extensions for severity, course, and specific symptomatology across eating disorders, enhancing clinical granularity while maintaining categorical diagnoses. 3, 6
• The ICD-11 approach mirrors the shift toward recognizing BED as clinically valid and distinct from both bulimia nervosa and obesity. 3

Key Clinical Implications of These Changes

• The reduction in frequency threshold from twice to once weekly in DSM-5 facilitated greater access to evidence-based treatments for individuals who previously fell into the less useful EDNOS/OSFED category. 6, 7
• BED is now recognized as affecting approximately 30% of obese individuals seeking treatment, with a lifetime prevalence of approximately 1.6% in adolescent females. 8, 5
• BED has a more equal gender distribution than bulimia nervosa, and should not be overlooked in males and minority populations. 8, 5
• The formal recognition in both DSM-5 and ICD-11 validates that BED represents a distinct clinical entity with unique psychopathology, separate from both bulimia nervosa (which includes compensatory behaviors) and simple obesity (which lacks the psychological features of loss of control and marked distress). 1, 2, 3