Q: I am currently seeing a client who has bulimia nervosa and as a part of her treatment we are monitoring her binge eating. It is clear that she often has eating episodes with loss of control but sometimes this involves large amounts of food, and at other times just small amounts. She asked, should she should record all binges, or just the large ones. (LVN, Cincinnati)
A: The diagnostic criteria for binge eating (in various eating disorders) has historically required consumption of a large amount of food—typically referred to as objective binge eating (OBE)—excluding amounts that are not large (a subjective binge-eating episode, or SBE). Does this distinction really matter?
Several researchers have questioned this distinction, and recent work by Brownstone and Bardone-Cone (Eat Weight Disord, online Nov 16, 2020) adds further evidence that the OBE-SBE distinction may not be useful. In this study, people with OBEs (n=132), SBEs (n=35) or neither (n=133) were recruited and assessed online with the Eating Disorders Questionnaire (EDE-Q). The EDE-Q assessed eating disorder variables; the Body Shame subscale of the Objectified Body Consciousness Scale, the Depression and Anxiety Stress Scale, the UCLA Loneliness Scale, and The Multidimensional Scale of Perceived Social Support were also used.
The results showed that people with SBEs demonstrated more compensatory behaviors (both vomiting and laxative use, as well as exercise), more restriction, more depression and anxiety, and worse body image than those with OBEs or those without loss of control eating. These results certainly suggest that SBEs are not “less severe” than OBE, and seem to argue strongly for monitoring both SBE and OBE during treatment.