Objective: This paper considers whether the criteria currently used to classify the diagnosis of binge eating disorder (BED) are valid and appropriate.Method: We review evidence that reflects on the validity of the current criteria for binge eating episodes and BED, using literature retrieved through major psychology and psychiatry search engines (e.g., PsycInfo, PubMed).Results: Evidence from experimental research points to the relative importance of episode frequency, the amount of food consumed at episodes, the subjective sense of loss of control over eating, and several additional criteria associated with binge episodes in BED. Evidence on the differences in psychopathology between BED and bulimia nervosa and between BED and obesity without binge eating, as related to diagnostic criteria, is reviewed. Binge eating disorder (BED) is highly prevalent among individuals seeking treatment for obesity, with prevalence estimates ranging between 15 and 50%. In the general population, the lifetime prevalence of BED is between 0.7% and 4%. Conclusion1 BED is defined in the fourth edition (text revision) of the Diagnostic and Statistical Manual (DSM-IV-TR) as frequent binge eating episodes, characterized by the consumption of a large quantity of food in a discrete period of time, accompanied by a subjective sense of loss of control over eating. Individuals with BED must also experience distress about their binge eating, and binge episodes are associated with at least three of the following: eating more rapidly than normal, eating until uncomfortably full, eating large amounts when not hungry, eating alone because of embarrassment, and feeling disgusted, depressed, or guilty about overeating. 1 BED, as it is currently defined, is associated not only with eating disorder psychopathology, but also with comorbid psychiatric disorders, health problems, and obesity.2 Health-related quality of life is significantly impaired in obese women with BED relative to obese women without BED.3,4 For these reasons, it has been argued that BED is a distinct and significant disorder of clinical severity that requires specific treatment.5 However, it has also been proposed that the frequent psychiatric comorbidity, good response to many forms of treatment, and the lack of agreement on what constitutes a large amount of food make the BED diagnosis more useful as a marker for other psychopathology in obese individuals than as a clinical disorder in its own right. 6 Another potential problem with the diagnostic definition of BED lies in the question of whether the criteria for the disorder are valid. Kendell and Jablensky 7 have suggested that validity in psychiatric disorders is present if the defining characteristics of a syndrome can be demonstrated to be an entity, separated clearly from neighboring syndromes and from normality. This article examines the evidence regarding the DSM-IV criteria for BED. The diagnostic criteria have two major components: the definition of a binge episode, and BED-specific criteria. This review first...

Binge eating within Binge Eating Disorder (BED) may represent ineffective management of, and inappropriate escape from, strong, dysphoric emotions, but treatments have been slow to incorporate an emotion regulation focus. Eleven women meeting criteria for BED participated in 11 sessions (2 hours per week) of a psychoeducational group program providing training in emotion recognition and management, problem-solving, assertion training, relaxation and stress management. Outcome was evaluated using a multiple-baseline design replicated across groups. Binges were self-monitored daily, and self-report questionnaires assessed wellbeing and emotion regulation at pretreatment, posttreatment and follow-up. Cognitive changes from pre to posttreatment were evaluated by Articulated Thoughts in Simulated Situations. The program was effective in reducing binge eating, alexithymia, stress and depression, and it improved coping and positive cognitions. No participant met criteria for BED at follow-up. The findings provide support for the inclusion of training in emotion recognition and regulation in treatments for BED and for affect regulation models of binge eating.

The link between negative affect and binge eating in those with binge eating disorder (BED) has been well established. The present study examined the efficacy of a treatment for BED designed to increase recognition and regulation of negative emotion, replicating and extending a previous investigation (Clyne, C., & Blampied, N.M. [2004]. Training in emotion regulation as a treatment for binge eating: A preliminary study. Behaviour Change, 21, 269-281) by including a control group, a larger number of participants, and formal diagnoses rather than classifying binge eating symptomatology from self-report questionnaires. Twenty-three women diagnosed with subthreshold or full syndrome BED (using the Eating Disorders Examination) participated in a treatment program that focused on increasing emotional regulation skills. Each participant completed the Eating Disorders Examination Questionnaire, the Binge Eating Scale, the Emotional Eating Scale, and completed self-monitoring records of binge episodes. Binge abstinence rates following treatment (post-treatment and 1 year follow-up were 78% and 87% respectively) were comparable to other empirically supported treatments for BED. Other positive changes in eating and general pathology were observed. These effects were well-maintained up to 1 year later.