DSM-5 to include binge eating disorder

When the Diagnostic and Statistical Manual of Mental Disorders fifth version (DSM-5) is released this May, binge eating disorder (BED) will have its own diagnostic code. Previously, this condition was listed as an eating disorder not otherwise specified (NOS) and also in the appendix as a diagnosis that required further study.

Marsha D. Marcus, Ph.D., a psychologist and professor of psychiatry and psychology at Western Psychiatric Institute and Clinic at the University of Pittsburg Medical Center, served as a member of the eating disorders work group. She notes that this task force, half of whom were psychologists, proved to be cohesive and arrived at a consensus point of view with little difficulty.

Marcus cites several benefits to including BED in the new manual. She says, “Hundreds and hundreds of research studies on binge eating disorder and relevant to the criteria, clinical utility and predictive validity and treatment were conducted. The findings support the validity and reliability of the diagnosis.”

However, final approval did not come without some controversy. “I was somewhat surprised that BED got a lot of attention from critics who speculated that anyone that overate would be given a psychiatric diagnosis,” Marcus says. While she admits the concern is not unfounded, she says there is a marked difference between someone with an eating disorder and a person who eats to excess on occasion. “We all overeat at times, but not enough to be a diagnosis. One time does not qualify as BED,” she says. “It’s the quality associated with the sense you can’t control what, when and where you’re eating that discriminates BED from simple overeating.”

Stuart Koman, Ph.D., president and CEO of Walden Behavioral Care headquartered in Waltham, Mass., agrees that binge eating has become much more prevalent and that the Centers for Disease Control and the National Institute of Mental Health suggest it may be as common as anorexia and bulimia combined.

Giving binge eating its own diagnostic category will facilitate reimbursement for providers and insurance coverage for clients, according to Koman. “It’s highly variable from insurance company to insurance company whether they will pay,” he says, adding that the diagnosis has been under-appreciated in the past. “There has been a complete misunderstanding of what binge eating is. There has been more discussion overall lately. It’s amazing the amount of attention paid to food and weight nowadays. More people may come forward now so this [problem] can be addressed directly,” Koman says.

Although not usually lethal if left untreated, binge eating may have secondary consequences, such as diabetes, says Koman. “The biggest problem is that quality of life suffers. People are keeping it a secret and are socially isolated. They have unhappy existences. It’s a 24-hour disease. And there’s a medical cost overtime.”

Marcus says, “The DSM at its core is not a research document, but it will promote more research in this area. We have much to learn about truly aberrant eating behavior. We do know that it occurs in people across the weight range.”