Binge Eating Disorder
CARLOS M. GRILO
Binge eating disorder (BED) is one example of the eating disorder not otherwise specified (EDNOS) category in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) of the American Psychiatric Association. (The category of EDNOS is discussed further in Chapter 30.) There it is defined as follows: “Recurrent episodes of binge eating in the absence of the regular use of inappropriate compensatory behaviors characteristic of bulimia nervosa.”
BED is also included in Appendix B of DSM-IV, which is reserved for possible new diagnostic categories that were not included in DSM-IV since there were insufficient data to warrant their inclusion. Tentative research criteria are provided in this appendix based on the findings of two initial field trials. This chapter reviews the accumulating research regarding the clinical features of BED and major issues pertaining to the validity of the concept and the provisional diagnostic criteria.
The general descriptive definition of BED is shown above (in italics), and the tentative research criteria are shown in Table 31.1.
The research criteria are noteworthy in several respects when compared with those for bulimia nervosa, the well-established eating disorder that is also characterized by the presence of regular binge eating. (See Chapters 28 and 29 for a discussion of diagnostic criteria and clinical features of bulimia nervosa.) First, the BED requirement that binge episodes occur 2 days per week is different than the requirement of two episodes per week for bulimia nervosa. Unlike in bulimia nervosa, where the binge eating is usually clearly terminated by some form of purging or the reestablishment of strict dietary restraint, the eating habits of patients with BED are more amorphous and sometimes difficult to separate into discrete episodes. Thus, the current practice is simply to determine the number of days on which binge eating occurred. Recent findings, however, suggest