Bret S. Stetka, MD; Christoph U. Correll, MD


May 21, 2013

In This Article

Binge Eating Disorder

The Change

In DSM-5, binge eating disorder graduated from DSM-IV's Appendix B -- Criteria Sets and Axes Provided for Further Study -- to an official diagnosis in the new manual's Section 2.

The Implications

DSM-IV recognized only 3 eating disorder diagnostic categories: anorexia nervosa, bulimia nervosa, and eating disorder NOS. The update allows for additional diagnostic nuance.

Binge eating disorder seems to have a distinct clinical profile from the eating disorders included in DSM-IV. Like bulimia nervosa, the condition is characterized by recurrent episodes of binge eating. However, unlike bulimia, patients do not exhibit inappropriate compensatory behaviors, such as purging, fasting, or excessive exercise.

Critics have noted that (1) a binge eating diagnosis may share considerable symptom overlap with nonpathologic problematic eating, and (2) binge eating can be a manifestation of other illnesses, and therefore the new manual fails to address causation. This controversy highlights the complexities of abnormal eating behaviors that, again, are on a continuum from normal to problematic to a becoming a disorder. Inclusion of binge eating disorder without compensatory behaviors also implies the recognition of psychiatric underpinnings of certain types of obesity.