The diagnostic validity of the criteria for binge eating disorder

Abstract

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 in surgical weight-loss treatments. Long-term associations with weight loss, health related quality of life (HRQL), and psychopathology

“…In agreement with some 12,[16][17][18]49 but not all prospective studies 21,22 , however, these binge eating participants did not have less successful long-term BMI outcomes. As mentioned above, comparison with previous research is difficult due to differences in methodology.…”

“…The large number of binge eaters identified strongly questions studies that have shown that binge eating is markedly reduced or even absent post-treatment [49][50][51] . These studies have all used the definition of binge eating in the DSM-IV 35 , which requires the amount of food consumed to be objectively large.…”

Health-Related Quality of Life in Women with Eating Disorders: Association with Subjective and Objective Binge Eating

“…Despite the clinical significance of SBEs, they are not included as a diagnostic criterion for any DSM-IV eating disorder (APA, 2000). In the development of the next version of the DSM (DSM-V), it may be beneficial to consider the growing body of evidence on the clinical implications of this symptom (Latner & Clyne, 2008). The present findings also suggest that SBEs, as contributors to psychopathology, may be important to include as specific targets in treatment.…”

The significance of overvaluation of shape and weight in binge eating disorder

“…With the impending publication of DSM-V, several questions regarding the validity of BED and its diagnostic criteria remain (Latner & Clyne, 2008;Wilfley, Bishop, Wilson, & Agras, 2007; Wonderlich, Gordon, Mitchell, Crosby, & Engel, in press). In particular, it has been suggested that overvaluation of shape and weight be included in BED's diagnostic scheme in DSM-V, given evidence that it reliably predicts elevated levels of psychosocial impairment (Grilo et al, 2009;Grilo et al, 2008; Grilo, Masheb, & White, in press;Hrabosky, Masheb, White, & Grilo, 2007;Latner & Clyne, 2008;Mond, Hay, Rodgers, & Owen, 2007). Further research is needed to establish the clinical utility of this construct in adults with BED.…”