Experts debate making binge eating disorder official

19th December 2008

Experts debate making binge eating disorder official

posted in Eating Disorders, Mental Health, Personal |

It’s estimated that anorexia affects about one percent of the U.S. population and bulimia 4 percent. Binge eating disorder eclipses both, affecting about 10 percent of the population but it has yet to be recognized as a diagnostic eating disorder unto itself. Despite the vast range of eating disordered behaviors, there are exactly three disorders one can be classified with: Anorexia nervosa, Bulimia, and Eating Disorders Not Otherwise Specified (ED-NOS). Binge eating disorder falls into the latter category, a vague catch-all diagnosis for people who don’t fit one or more of the criteria for anorexia and bulimia. Those classified with ED-NOS can range from a morbidly obese binge-eater to a 90-pound girl who meets every criteria for anorexia, except she still menstruates.

That might soon change. According to the New York Times, panels of psychiatrists are in the process of updating and revising the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). The current edition of the manual, the DSM-IV, was published in 2000. The manual’s importance cannot be overstated. It’s used by doctors to make a diagnosis and provides insurance companies with diagnostic codes without which the insurers will not reimburse patients’ claims for treatment. Conditions now up for debate to be added as official diagnoses include compulsive shopping, gender identity, conditions affecting children, sensory processing disorder and also binge eating.

The American Psychiatric Association publishes the manual and according to the Times, the process has become such a contentious exercise that for the first time the APA has required its contributors to sign a nondisclosure agreement. Those scientists who accepted an invitation to work on the new manual, a prestigious assignment, agreed to limit their income from drug makers and other sources to $10,000 a year for the duration of the job, so as to better insure that pharmaceutical perks don’t unduly influence the authors’ decisions.

The fact that binge eating disorder is up for consideration is certainly encouraging news, but it’s not yet a done deal. There are some mental health experts who don’t think that it should be classified as a disorder at all. Dr. Michael First, a professor of psychiatry at Columbia who edited the fourth edition of the manual but is not involved in the fifth, is among them. As quoted in the Times article:

“A lot of people want that included in the manual,” Dr. First said, “and there’s some research out there, some evidence that drugs are helpful. But binge eating is also a normal behavior, and you run the risk of labeling up to 30 percent of people with a disorder they don’t really have.”

Frankly, I don’t understand how experts like Dr. First recognize bulimia as a legitimate mental health disorder and not binge eating disorder. Sure, binge eating in itself can be a natural, non-disordered behavior — food eating competitions are just one example, stuffing oneself beyond fullness at Thanksgiving is another — but like all eating disorders, binge eating disorder is about much more than food. The generally accepted criteria for it reads similar to that for bulimia, except people with binge eating disorder don’t try to rid themselves of the extra calories through self-induced purging or exercising. Otherwise, the psychological anguish and emotional torment is much the same. In addition to psychotherapy, there are medications that have been shown to help people with binge eating disorder (Topamax and Wellbutrin, for example). If binge eating disorder were included in the manual as a legitimate eating disorder, those people who struggle with it might have an easier time getting insurers to cover the treatment and medication they so desperately need.

In any case, the fact that binge eating disorder is up for serious consideration for inclusion in the new manual is encouraging. As noted, psychiatrists involved in the new manual are under a gag order, but they also say that its too soon for them to have made any concrete decisions. The book is still at least three years away from publication, so only time will now tell.

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This entry was posted on Friday, December 19th, 2008 at 5:21 pm and is filed under Eating Disorders, Mental Health, Personal. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.

1 On December 19th, 2008, Melissa said:

i disagree with the “expert” who thinks binge eating is natural. i don’t think it is. there’s a reason why people stuff themselves, and it’s not about food. i think people who can’t stop at Thanksgiving before they’re nearly ill do have a problem. i know a lot of people (and i resent them all) who eat quite normally at Thanksgiving because they’re in touch with hunger, not getting “something” from food. and yes, please, let’s recognize binge eating as a very real disorder.

posted on December 19th, 2008 at 5:50 pm

2 On December 19th, 2008, Rachel2 said:

This “expert” is not an expert at all. It’s funny how people not on the front lines of a debate are usually the ones to make the quickest judgments…

posted on December 19th, 2008 at 5:58 pm

3 On December 19th, 2008, lilacsigil said:

There is a difference between occasionally eating more than is comfortable (as many people do on festive occasions) and actual binge eating (which I am struggling with). Any official definition should differentiate between the two – there really is a trend to medicalise *everything* for the benefit of drug companies so I can see where the concern comes from – just as there is a difference between disordered eating and dieting behaviour and actual anorexia.

posted on December 19th, 2008 at 6:45 pm

4 On December 19th, 2008, Janey said:

“binge eating is also a normal behavior”

Ohmigod. And every once in a while people get sad. So depression isn’t a real disorder?

I could be wrong here, but I’d guess that most binge eaters are women. Dr. Michael First is a man, as are (probably) all the previous editors of the DSM-V.

“If is hasn’t happened to me or anyone I know, it isn’t real.” (Words I am attributing to every man I have ever known.)

posted on December 19th, 2008 at 8:11 pm

5 On December 19th, 2008, Janny said:

I’ve struggled with binge eating all my life, and it wasn’t until I was 21 (less than four years ago) that I realised binge eating=eating disorder. I grew up with a mom who wanted to make sure I was well-fed (because she wasn’t as a child) and who was an emotional eater, which is something she sort of passed on to me. I also had a father who called me fat a lot (otherwise, he was a wonderful dad), so I, of course, ate more because I was already fat, according to him, so no one was gonna want/like me anyway (according to me).

I’ve had a lot of time to self-analyze and think about this on my own, and bounce ideas and things off of friends (who I’ve always had to explain the concept of binge eating to), but it would have helped me out a lot if medical help for it were more readily available and the idea not met with “Well, why don’t you just stop eating like a pig?”

I’d love for some form of help with this, and for binge eating to be fully recognized as something that deserves attention and aide, because it’s hard to deal with. It’s not a self-control issue, totally; I have remarkable control in other aspects of my life. But I cope with food. The only time I haven’t was when I was 18 and my dad died and my boyfriend dumped me, but I compensated with other mental issues (I decided that starving myself would solve all my problems! HA!). Food=safety/happiness/celebratory awesomeness/love. And when I give in, I hate myself. And I in turn eat more to make myself feel better. It’s a vicious cycle. It’s draining, physically and emotionally. And it’s doubly hard when it’s something that isn’t well-understood or accepted.

posted on December 19th, 2008 at 10:18 pm

6 On December 20th, 2008, occhiblu said:

That quote is interesting, in that it kind of conflates “Drugs cure this” with “This is a valid diagnosis.” Which is, in some respects, a huge problem with the DSM in general — the idea that “If drugs can help the problem, it’s a valid mental health issue.”

posted on December 20th, 2008 at 12:17 am

7 On December 20th, 2008, Lindsay B said:

Janey, a lot of people don’t see Depression as a real disorder. My father is one of them. He doesn’t put together the apathy, lack of motivation, loss of interest in once-loved activities, and the self-degrading self-flagellating bull that tends to go hand-in-hand with Depression. He honestly believes that people who suffer from Depression would be able to just get up and get over it if they “tried”, since HE suffered from depression(temporary) after divorcing my mother, and got better.

Not even a psychologist explaining to him what real depression is convinced him to think any differently.

posted on December 20th, 2008 at 1:40 am

8 On December 20th, 2008, Janey said:

Yes, you’re right Lindsay. It’s frustrating. I once saw Dr. Phil tell a teenager with ADD, “You don’t have attention problems. We know you can concentrate – when you want to! When it’s something you’re interested in!” I was practically screaming at the tv “That’s the definition of ADD, you moron!”

(And sorry about the “man” comment. I was in a bad mood, lol.)

posted on December 20th, 2008 at 9:14 am

9 On December 20th, 2008, Niika said:

What!? Binge eating is a NORMAL behavior? Okay, so I guess starving yourself is a normal behavior, too! I guess binging and purging is also a normal behavior! Oh my GOD!!!

I have known at least one person with binge eating disorder, and seen many more on television shows. It is REAL, and very damaging to a person’s health and life. I don’t see how anybody could possibly refute its existence.

Eating a lot once in awhile might be normal. Similarly, going without food once in awhile might be normal. But the extremes of either food behavior are not normal at ALL. We have a diagnosis for one of the extremes of this spectrum… why not the other end?

posted on December 20th, 2008 at 11:32 am

10 On December 20th, 2008, Piffle said:

I totally agree with the point above that something can be a real disease even if there’s no known medicine to treat it. Bah, were infections not real before we had antibiotics? Was cancer not real before chemo? Absolute nonsense!

Plus, it looks like there may be a good therapy solution for many eating disorders:

http://www.sciencedaily.com/releases/2008/12/081215074404.htm

posted on December 20th, 2008 at 12:05 pm

11 On December 20th, 2008, Rachel2 said:

Janey, Dr. Phil is a HUUUUUGE wiener… For that very reason. Also, he really has no idea what he’s talking about, and just comes off as pompous and arrogant. He can f**k off. Seriously.

posted on December 20th, 2008 at 8:38 pm

12 On December 21st, 2008, Lael said:

Binge eating is different from overeating. Binge implies a loss of control which more often then not is linked to psychological disturbance and eating has become the coping mechanism. Yes, it should be an official disorder for many reasons, an example is that psychologists use bmi’s (body mas index) to diagnose a patient with anorexia nervosa because of the health risks posed by a low bmi, therefore since a high bmi also has serious health risks (heart disease, diabetes, etc) it should be considered in the process of making binge eating disorder official.

posted on December 21st, 2008 at 6:20 pm

13 On December 21st, 2008, Janey said:

I just realized both my previous comments were OT. I had to come back to say I have suffered from binge eating on and off for years. I don’t kow what triggers it, but I know it’s not normal.

I do know that several years ago I read about bulimia being recognized as a “new” disorder, in addition to anorexia, and I thought that since I didn’t purge, and therefore my overeating did not qualify as a recognized mental health disorder, I was just a pig.

I don’t think that anymore, but I’m older, and have learned to cut myself a whole lot of slack. I worry about those teens and twenty-somethings, though. I hate that they are sitting somewhere right now, eating until they throw up, and believing that they are weak and pathetic.

posted on December 21st, 2008 at 6:58 pm

14 On December 21st, 2008, Rachel said:

Lael — I don’t think BMI should be a factor in diagnosing binge eating disorder. Most who struggle with it are overweight or obese, but there are also thin people with BED, too.

posted on December 21st, 2008 at 7:10 pm

15 On December 21st, 2008, Ellie said:

I don’t know if you’ve already seen it, but my co-blogger, Morgan, has a lot to say on her road to recovering from BED. It is every bit as real and as serious as any other eating disorder, but I think it doesn’t get the attention it deserves because it’s viewed as gluttony, not a “real” eating disorder. Binge eaters try to heal and control their environment every bit as much as anorexics or bulimics. I think it really speaks volumes that BED isn’t “officially” recognized because a lot of its sufferers are fat, therefore thought of as just pigs that can’t control themselves, not people suffering from a real disease.

posted on December 21st, 2008 at 9:12 pm

16 On December 25th, 2008, Chevese Turner said:

I was so happy to see this blog! I am the founder of a new national organization called the Binge Eating Disorder Association (BEDA). Our web site is http://www.bedaonline.com. We were established in June of 2008 and are working to raising awareness in the general population, and educate those with BED and those who treat the disorder. There is a lot of work to be done!! We posted a response on our web site to the NYT article referenced here and are working to bring together the other major eating disorder groups (including the EDC, AED, and NEDA)to build a BED coalition. We need to get the CORRECT information out to the public and raise awareness. I have dealth with the disorder for ~30 years and for many of those years I felt like an outsider who had no “willpower”. Understanding this is a disorder is empowering and we all are worthy of help. I intend to see this happens for those who want it through BEDA. Check us out…we will be beginning our membership drive in January. We need all your voices to be heard!!

posted on December 25th, 2008 at 9:37 pm

17 On January 6th, 2009, carnival of eating disorders #23 - part 2 said: