How is Binge Eating Disorder Diagnosed?

I am a clinical mental health therapist and have been in the psychology realm through advocacy, school, and work for about 10 years. Almost as long as I’ve been in the eating disorder realm, again through similar channels except one – I struggled with an eating disorder for over 9 years.

With all of this time surrounded by mental health and eating disorders, sometimes, I forget that things like the steps behind a diagnosis can be completely foreign and frightening for those that are unfamiliar with it.

Whether you are concerned that you or a loved one may struggle with Binge Eating Disorder (BED), you have been diagnosed and are unsure of what that means, or you simply want to learn more, consider this your short guide to binge eating disorder diagnosis.

The DSM-5

The DSM-5 is the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders, which contains definitions, symptoms, statistics, and other criteria and information about all official mental health diagnoses.

The American Psychological Association, who published the DSM-5, describes that “It provides a common language for clinicians to communicate about their patients and establishes consistent and reliable diagnoses that can be used in the research of mental disorders [1].”

Essentially, it is the holy grail text for any professional diagnosing mental illness to ensure that, no matter where they are, all professionals are referring to and understanding the same symptoms and psychological when faced with a diagnosis.

DSM-5 and Binge Eating Disorder Diagnosis

BED became an official, stand-alone diagnosis when the DSM-5 was released in 2013. However, it has been around much longer than that, and it impacts 3.5% of women, 2% of men, and 1.6% of adolescents in the United States [2].

Many individuals may experience symptoms of varying mental illnesses. However, not everyone warrants a diagnosis. Many people refer to themselves as having anxiety because they struggle with worries and stress.

While these emotions are valid, a big part of differentiating between experiencing stress and being diagnosed with Generalized Anxiety Disorder comes from the specific criteria that show the individual struggles with these symptoms so consistently and severely that it heavily impacts their daily life.

BED diagnosis is similar, in that struggling with bingeing can occasionally happen to many people. It is the consistent pattern of behaviors and the related symptoms that lead to the diagnosis of a disorder.

There are 5 criteria an individual must meet for BED diagnosis [1]:

1. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:

• Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than most people would eat in a similar period of time under similar circumstances.
• The sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).

2. Binge-eating episodes are associated with three (or more) 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 being embarrassed by how much one is eating
• Feeling disgusted with oneself, depressed, or very guilty after overeating

3. Marked distress regarding binge eating is present.

4. The binge eating occurs, on average, at least 1 day a week for 3 months.

5. The binge eating is not associated with the regular use of inappropriate compensatory behavior (e.g., purging, fasting, excessive exercise) and does not occur exclusively during the course of anorexia nervosa or bulimia nervosa.

The DSM-5 also allows professionals to specify the severity of the individual’s BED based on how many binge-eating episodes they experience per week using the following scale:

• Mild – 1 to 3 episodes per week
• Moderate – 4 to 7 episodes per week
• Severe – 8 to 13 episodes per week
• Extreme – 14 or more episodes per week

Diagnosis is more than checking off boxes, however. It often involves a discussion between professional and patient, exploring the unique aspects of the individual’s struggle to determine what their experience of their disorder is and how treatment can support them. This is where the DSM-5 severity rating scale becomes helpful in providing more detail about where the patient is with their BED symptoms.

The DSM-5 has received some flack for assuming that everyone’s experience of mental illness displays in the same way. While the DSM-5 is extensively researched and is entirely evidence-based, it is true that not everyone experiences any disorder in the same way.

For those that struggle with BED symptoms but may not meet all criteria, your struggle is still valid, and it is important for you to reach out for help.

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Resources:

[1] Berkman, N. D. et al. (2015). Management and outcomes of binge eating disorder. Comparative Effectiveness Reviews, 160.

[2] Marx, R. (2014). New in the DSM-5 – binge eating disorder. National Eating Disorders Association. Retrieved from https://www.nationaleatingdisorders.org/blog/new-dsm-5-binge-eating-disorder.

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About the Author:

Margot Rittenhouse, MS, PLPC, NCC is a therapist who is passionate about providing mental health support to all in need and has worked with clients with substance abuse issues, eating disorders, domestic violence victims, and offenders, and severely mentally ill youth.

As a freelance writer for Eating Disorder Hope and Addiction Hope and a mentor with MentorConnect, Margot is a passionate eating disorder advocate, committed to de-stigmatizing these illnesses while showing support for those struggling through mentoring, writing, and volunteering. Margot has a Master’s of Science in Clinical Mental Health Counseling from Johns Hopkins University.

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The opinions and views of our guest contributors are shared to provide a broad perspective on eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Published February 4, 2020, on EatingDisorderHope.com
Reviewed & Approved on February 4, 2020, by Jacquelyn Ekern MS, LPC