Academic journal article Journal of Professional Counseling, Practice, Theory, & Research

Binge-Eating Disorder: A Primer for Professional Counselors

Academic journal article Journal of Professional Counseling, Practice, Theory, & Research

Binge-Eating Disorder: A Primer for Professional Counselors

Article excerpt

Binge-eating disorder (BED) is a new mental disorder in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association [APA], 2013). Prior to the DSM-5, binge eating was listed under Eating Disorder Not Otherwise Specified (EDNOS) with research criteria listed in appendixes (APA, 2000). Researchers recommended BED be included as an independent diagnosis in the DSM-5 after finding that the diagnosis made up a large percentage of EDNOS diagnoses and had distinct clinical indicators and outcomes (APA, 2013; Citrome, 2015; Tanofsky-Kraff et al., 2013; Wonderlich, Gordon, Mitchell, Crosby, & Engel, 2009).

Binge-eating disorder is the most common eating disorder in the United States, with lifetime prevalence rates estimated between 1-3% in the general population (APA, 2013; Cossrow et al., 2016; Brownley et al., 2016; Grucza, Przybeck, & Cloninger, 2007; Hudson, Hiripi, Pope, & Kessler, 2007; Iacovino, Gredysa, Altman, & Wilfley, 2012). Recent research suggests prevalence rates have increased further since the publication of the DSM-5 (Cossrow et al., 2016). Women are diagnosed at higher rates than men; however, less of a gender gap in diagnosis exists between men and women than in other eating disorders (APA, 2013). Prevalence rates appear to be similar across African American, Caucasian, and Hispanic racial/ethnic groups in the United States (Franco et al., 2012; Hudson et al., 2007; Iacovno et al., 2012). Kessler et al. (2013) examined BED prevalence rates in international populations and found rates similar to those reported in the United States. Although the average age of onset is slightly later than other eating disorders, estimated at 25.4 years old, researchers suspect symptoms begin more commonly in late childhood and adolescence (Hudson, et al., 2007; Tanofsk-Kraff et al., 2013).

Untreated chronic binge eating is associated with serious psychological, physical, and social problems (Brownley et al., 2016; Tanofsky-Kraff et al., 2013). Individuals with BED experience a range of negative outcomes, from diminished interpersonal functioning to increased suicidality. The mortality risks related to BED are strongly correlated with medical comorbidities, including obesity, high blood pressure, high cholesterol levels, heart disease, and diabetes (Bulik & ReichbornKjennerud, 2003; Grilo, White, Barnes, & Masheb, 2013; Tanofsky-Kraff et al., 2013). Despite the frequency and severity of BED, the condition often goes undiagnosed and untreated in counseling (Citrome, 2015; Cossrow et al., 2016; Hudson et al., 2007). In the following article, we will discuss fundamental principles related to BED diagnosis, screening and assessment, and treatment that will help prepare counselors to identify and work with clients that experience binge eating symptoms.


Recurrent and persistent episodes of binge eating provide the foundational criteria for BED (APA, 2013). Refer to the DSM-5 for the complete diagnostic criteria for BED. The only change in criteria from the prior edition of the DSM was the reduction in time (from six months to three months) and frequency (from twice to an average of once a week) required for symptom manifestation (Tanofsky-Kraff et al., 2013). Some researchers question the validity and reliability of the new DSM-5 criteria, suggesting the need for additional research (Klein, Forney, & Keel, 2016). One area of criticism relates to severity measures. Grilo et al. (2015) argued that the current severity specifiers (based solely on frequency of binge eating episodes) are not empirically supported. They conducted a preliminary study and found support for using overevaluation of shape/weight as a severity specifier. Individuals that have this type of negative body image have more pathology and psychological distress than individuals with BED who do not exhibit overevaluation of shape/weight.

Differential Diagnosis

With the exception of pica, current diagnoses within the feeding and eating disorder chapter of the DSM-5 are mutually exclusive (APA, 2013). …

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