Binge Eating Disorder: Diagnostic Criteria Need Fine Tuning

Unlike anorexia nervosa and bulimia nervosa, no criteria about dysfunctional attitudes about eating, weight, or shape are included in the DSM-IV diagnostic criteria for binge eating disorder (BED). According to Drs. Carlos M. Grilo and Robin M. Masheb of Yale University School of Medicine, cognitive criteria—as well as behavioral diagnostic criteria–should be added to the diagnostic criteria for BED (Comprehen Psychiatry 2000; 41:159).

The researchers reached this conclusion after studying 129 women who met DSM-IV criteria for either BED or bulimia nervosa (BN), purging subtype. The women were divided into 3 groups, including obese patients with BED (n=51), non-obese BED patients (n=32), and patients with BN (n=46), and compared using the Eating Disorders Examination-Questionnaire (EDE-Q). The BED groups were older and had a higher body mass index (BMI) than the BN group.

Although binge-eating frequency was similar among the 3 groups, the BN subjects purged regularly, and the groups differed by dietary restraint, even after controlling for BMI and age. The BN group had significantly higher dietary restraint than both BED groups. Finding that dietary restraint was significantly lower in BED than BN patients is an indication that these patients do not restrict their eating even outside of binge- eating episodes. Thus, while BN patients tend to swing between excessive dietary restriction and binge-eating episodes that are clearly followed by purging, BED patients seem to have little control of chaotic eating marked by binge-eating episodes. This finding underscores the need for interventions aimed at helping BED patients structure and normalize eating during the day.

Those with BED also showed cognitive symptoms on the EDE-Q, such as dysfunctional attitudes about eating and overvalued ideas about weight and shape, which were comparable to those seen in the BN group. According to the authors, this speaks to the potential importance of classifying this behavior and intervening. They believe that cognitive criteria should be added to future revisions of the official BED diagnostic criteria.

Subthreshold BED

Results of another study pointed out the need to further evaluate the severity criterion currently specified for BED (Int J Eat Disord 2000; 27 :270). Dr. Ruth Striegel-Moore and colleagues compared a community-based sample of 44 women with BED, 44 women with subthreshold BED, and 44 healthy controls on demographic characteristics, BMI, eating disorder symptoms, and psychiatric distress. To be included as a subthreshold BED case, binge eating had to occur at least once a month for the previous 6 months. The women were all participants in the New England Women’s Health Project, a community-based study of risk factors for BED.

After adjusting for significant group differences in BMI, the authors found that the two eating disorder groups did not differ significantly on measures of weight and shape concern, restraint, psychiatric disorders, and history of seeking treatment for a weight or eating problem. Women with subthreshold BED appear to be at similar risk for obesity and psychiatric distress as women with full-syndrome BED. Because eligibility for treatment covered by health insurance often depends on diagnostic status, the authors believe a re-evaluation of the severity criterion for BED is warranted.