Binge-eating disorder (BED) is more common than both anorexia nervosa and bulimia nervosa combined. On Long Island, N.Y., it is estimated that there are over 26,000 cases of BED. Binge-Eating Disorder was a diagnosis that was previously classified in prior DSM-4 under the category Eating Disorder Not Otherwise Specified (EDNOS). In the new DSM-5, binge-eating disorder now has its own diagnostic code and classification in the eating disorder section.
The DSM-5 criteria for diagnosis of bulimia nervosa include:
- Recurring episodes of binge eating, characterized as the consumption of food in a short period of time (under 2 hours), eating substantially more than most people would eat under similar circumstances. During these episodes a sense of a lack of control over the behaviors is experienced and there is marked distress when binge eating is present.
- The binge eating episodes occur in the absence of compensatory behaviors that are associated with bulimia nervosa (i.e. self-induced vomiting, laxatives, diuretics, enemas, fasting).
- The binge eating behaviors occur, on average, at least once a week for a period of at least 3 months.
- The binge eating episodes are associated with 3 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.
Higher rates of a diagnosis of Binge-Eating Disorder can often be found in certain regions of the country and with certain lifestyles because criteria such as ‘feeling embarrassed’ and ‘feeling guilty afterwards’ or ‘disgusted with oneself,’ are not always experienced with certain cultures. For instance, while men often engage in eating ‘contests’ with friends such as “who can eat the most chicken wings”, women often feel ashamed completing a full meal at a restaurant. Food and large body types are often valued parts of some cultures and binge eating is considered a norm without the pressure of guilt. High rates of Binge-Eating Disorder are prevalent on Long Island, NY because of the stress of living here and the emphasis for many on style and appearance and the social aspects that support this. These types of stressor contribute to binge-eating behaviors. Thus, binge-eating behaviors are often an attempt to ease stressors but lead to an unintentional cycle distress where individuals continue to feel shame and attempt to hide their behaviors from others.
The primary treatment for BED is psychotherapy to address any underlying psychological issues and to learn new behaviors surrounding food. For this reason, many therapist prefer cognitive-behavioral therapy (CBT) and it is often beneficial to work a specialist in eating disorder treatment who understands the links between psychology and eating and has techniques they can teach the patient. Some medications have also proven helpful to reduce behaviors but work best in conjunction with therapy. A thorough medical exam is necessary to rule-out any possible medical causes or contributions such as thyroid disorders, sleep disorders, or congenital disorders
Binge-eating also gets reported to clinicians as emotional eating, compulsive-overeating, impulsive eating, and in other terms, however, there are differences with these others disordered patterns of eating. Dr. Jeffrey DeSarbo and ED-180 has been developing a screening tool that helps clinicians distinguish the subtle differences with these descriptive eating patterns and terms.