Binge Eating Disorder: It Officially Exists!

The American Psychiatric Association recently announced their officially proposed updates to the DSM-5. The mental health professional community had already let it be known that the addition of binge eating disorder would likely be among the changes--it's the APA's rationale that's news to me. (In the DSM-4, BED was listed as a variant of eating disorder-not otherwise specified; this change would make it a discrete diagnosis.)

*BED tends to run in families yet is not a simple familial variation of obesity.

*BED has a greater likelihood of male cases and a later age of onset than other eating disorders.

*Compared with obesity, BED sufferers have greater concerns about shape and weight and a higher likelihood of mood and anxiety disorders.

*BED is associated with a lower quality of life than obesity.

*BED has a greater likelihood of medical comorbidities than either other eating disorders or obesity.

*BED has a lower level of diagnostic stability and a greater likelihood of remission.

*Individuals with BED have a more positive response to specialty treatments than to generic behavioral weight loss treatments.

I’m hoping that BED’s inclusion helps with the last two items in this list. If mental health providers are more aware of BED and know that it is a treatable condition, it makes sense that patients will get care more swiftly--and that the care will be more effective--than they would were they to follow standard medical advice given to those whose primary issue is that they’re overweight, not that they suffer from BED. I wonder if the “later age of onset” for BED is actually “later age of diagnosis.” Of BED sufferers whose personal histories I know, their behaviors began in childhood, even if they didn’t reach clinical frequency until adulthood.

The proposed change is important for another reason: It would lessen the frequency of ED-NOS diagnoses. Right now, ED-NOS is the most fatal eating disorder, yet is the least-known—and, because of its breadth, perhaps the least understood. Given that BED has a greater likelihood of medical comorbidities than other eating disorders, this could shed some light on the actual risks of ED-NOS. Right now, ED-NOS is a sort of catch-all diagnosis; it’s actually the most common diagnosis at the Renfrew Center, a leading treatment facility. An ED-NOS diagnosis can mean anything from a binge-starve cycle, to chewing and spitting, to food rituals that disrupt one’s life, to purging disorders (purging without bingeing). It can also mean anorexic, bulimic, or binge eating behaviors that do not meet the criteria for frequency or severity: for example, someone who binges and purges twice a month as opposed to twice a week (required by DSM for a diagnosis of bulimia), or someone who restricts her food, has an intense fear of gaining weight, and has body dysmorphia but has not dipped below the 85% of appropriate body weight, as specified by DSM for a diagnosis of anorexia. (It’s noteworthy that another proposed DSM change removes the requirement for amenorrhea for being diagnosed with anorexia; this criterion “disqualified” a lot of anorexics from being diagnosed as such, and I’m glad to see it removed.)

I would love to see more research into ED-NOS, for a variety of reasons. Because of its breadth, it can be more difficult for sufferers to recognize themselves and seek help. (What I listed above—someone who restricts her food, has an intense fear of gaining weight, and has body dysmorphia without going below 85% of her appropriate body weight—applies to a lot of women who wouldn’t think of themselves as having eating disorders.) I’m still wrestling with the question of biology, and whether eating disorders are on a sliding scale or on an on/off mode—like, is a woman who perpetually diets actually a woman with a mild (or not mild) case of ED-NOS, or is there another factor--possibly a biological one--missing from the plain old dieter that she’d need to be considered an ED patient? (Carrie Arnold wrote about this much more clearly here.) And is ED-NOS actually, depending on the symptoms, a “touch” of anorexia or bulimia? (I don’t think that’s the case, but if the sliding-scale theory is correct, that’s a logical conclusion.)

What the DSM-5 proposed changes do for BED is begin to legitimize it. I’m sure that eventually the fat-haters will laugh at the diagnosis (“Put down the potato chips, honey, that’s your prescription!”) but I’m confident that it will encourage more sufferers to recognize that they can seek appropriate treatment, and that with time even some of the haters would see that treating BED as a psychiatric diagnosis instead of as mere obesity (all the better if more non-overweight BED sufferers speak up) is a better cure for both the symptom and the cause. I hope that eventually these changes will lead to the same for ED-NOS as well.