Making a Diagnosis of Binge Eating Disorder [Use These Criteria]

To make a diagnosis of Binge Eating Disorder, you must determine whether a patient fulfills all of the DSM-5 diagnostic criteria, as follows:

1. Regular binge eating instances during which both of the following are taking place:
   • Regularly eating far more food than most people would in a similar time period under similar circumstances
     • To qualify as “regular binge eating,” the instances must take place at least once per week for three months
     • The time period during which binge eating instances take place can vary by individual, but it is generally considered to be less than two hours and does not have to be in one setting
   • Feeling that one’s eating is out of control during a binge
     • The feeling of not being in control can be either the inability to keep from starting to eat or the inability to stop eating once a binge eating episode has begun
2. Binge eating instances that include three or more of the following: Eating extremely fast
   • Eating beyond feeling full
   • Eating large amounts of food when not hungry
   • Eating alone to hide how much one is eating
   • Feeling emotional distress after a binge
3. Being very upset by one’s eating binges
4. Binge eating takes place on at least a weekly basis for three months
5. Unlike people with other eating disorders, adults with BED do not routinely try to “undo” their excessive eating with extreme actions like throwing up or over-exercising

Assessing Level of Severity in Your Binge Eating Disorder Diagnosis

The level of severity of a BED diagnosis is based on the frequency of episodes of binge eating:

• Mild — 1 to 3 binge-eating episodes/ week
• Moderate — 4 to 7 binge-eating episodes/ week
• Severe — 8 to 13 binge-eating episodes/ week
• Extreme — ≥ 14 binge-eating episodes/ week (Figure 2)

The level of severity may be increased to reflect other symptoms and the degree of functional disability.

BED is reliably associated with overweight and obesity in treatment-seeking individuals. However, while BED is associated with obesity, it has several distinct features that are important to understand. In studies of how people eat, obese adults with BED eat more calories compared with weight-matched obese adults without BED. Obese adults with BED also show:

• More functional impairment
• Greater self-reported distress
• Impaired quality of life
• More coexisting psychiatric conditions

Tools for Helping Make Binge Eating Disorder Diagnosis

A number of tools exist for clinicians and patients that may be helpful for identification and assessment of adults with BED.

Clinician Evaluation:

• Eating Disorder Examination (EDE) 11: An exam to help identify an individual’s eating disorder and quantify the degree of severity based on DSM-5 diagnostic criteria.
• Yale-Brown-Cornell Eating Disorder Scale (YBC-EDS) 12: An 8-item scale for assessing the severity of commonly occurring eating disorder preoccupations and rituals.

Self-Evaluation:

• Eating Disorder Examination-Questionnaire (EDE-Q) 13: A variation on the EDE that accommodates scenarios that don’t allow clinical interviews to be conducted and is designed to be completed in under 15 minutes.

• Diagnostic Survey for Eating Disorders (DSED) 14: A survey that covers topics related to eating disorders (e.g., dieting, binge eating, purging, exercise, medical and psychiatric history, etc).
• Questionnaire of Eating and Weight Patterns (QEWP, Spitzer et al. 1992) 15: A questionnaire to quantify the type and quantity of binge eating episodes.

 

Dr. Wendy Oliver-Pyatt is a world-leading expert on treating eating disorders. With more than 20 years of clinical experience, Wendy has developed a unique treatment approach that delves into the underlying issues that place a person at risk for mental health conditions and eating disorders and lead to healing, health and inner peace. Wendy, Mental Health Speaker, Eating Disorder Educator, and Mental Health Advocate, currently delivers keynote speeches for leading organizations on topics such as eating disorders, treating serious mental health issues, and healthful approaches to weight concerns. Contact Wendy for your next keynote!