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In conversations and debates on eating disorders, binge eating disorder (BED) is often the odd disorder out, even though it’s estimated to affect about 10 percent of the U.S. population and eclipses both anorexia (one percent) and bulimia (four percent) combined.  In fact, BED has yet to even be recognized as an official disorder unto itself — it’s currently lumped into the ED-NOS category in the DSM-IV.* So, it’s refreshing to see the Los Angeles Times do a four-part special feature today on BED, covering such basics as what it is, how it’s defined, who suffers from it and its triggers and health risks.

• Trying to define binge eating disorder

• Is binge eating disorder a psychiatric illness?

• Binge eating: Is it a form of an addiction?

• Holidays can feed binge eaters’ problem

I’ve been meaning to write for a while now on a disturbing trend I’ve noticed in the past few years in which researchers and medical professionals lump obesity in with other clinically recognized eating disorders like anorexia and bulimia as if being fat itself is a symptom of a psychiatric illness.  This is despite the fact that the medical definition of obesity — the abnormal accumulation of body fat — denotes no specific action or criteria.  By contrast, there are strict diagnostic criteria, which include specific actions and behaviors, that must be met before one can be diagnosed with anorexia or bulimia.  For example, to be diagnosed with bulimia, one must engage in recurrent episodes or binge eating and employ inappropriate behaviors like self-induced vomiting, laxatives, fasting and/or exercise to “compensate” for binges.  To be considered obese, by contrast, one must only weigh 20 percent above what is considered to be “normal.”

So, I was relieved to read in the first of the LA Times’ series that not all health professionals and professional groups consider fatness itself to be indicative of a psychiatric illness:

In a paper prepared for one of the [American Psychiatric Assn.'s work group on eating disorders'] first meetings, University of Pittsburgh psychologist Marsha D. Marcus challenged members to answer a provocative question: Do all of the nation’s 72 million obese adults have a mental disorder — because, despite clear evidence of negative health consequences, they continue to consume more calories than needed to achieve a normal, healthy weight?

The group’s answer, said [Columbia University psychiatrist B. Timothy] Walsh, was a decisive no.

In the case of binge eating, he adds, mental illness can contribute to behavior that results in obesity. But not all who are obese have an eating disorder. And, in fact, not all patients who would meet the criteria for binge eating disorder are overweight. (While almost 40% of those with presumed binge eating disorder are thought to be obese, the rest are spread across the range of normal and overweight. Some, in fact, are underweight.)

I should add here that not all who are fat are so because they consume “more calories than needed to achieve a normal, healthy weight.”   Recent studies have confirmed that excess weight can be a side effect of psychiatric medications and we’ve discussed here before medical conditions like thyroid disorders and PCOS that can also result in weight gain despite consuming sufficient or even less than sufficient calories needed to maintain a “healthy” body weight.

So, what exactly is BED?  The LA Times offers the experiences one such woman, Rina Silverman, as a case study:

Overwhelming feelings of sadness, anger or stress trigger episodes of eating unusually large quantities of food, often when she’s not at all hungry. The guilt and shame that follow these episodes sustain her low opinion of herself, and Silverman assumes that her excess weight [50 pounds] prompts others to share that opinion…  She skips meals and eats erratically in an effort to compensate for her binges.

Experts are converging on the belief that a patient’s preoccupation with size — what Terry Wilson, a Rutgers University psychologist, calls “a dysfunctional concern over weight and shape” — should be a hallmark of a diagnosis for binge eating disorder.

But psychiatrists and psychologists say they must focus on a patient’s emotional pain and its effects on day-to-day functioning, not the patient’s weight.

When a person stops attending parties for fear she’ll embarrass herself with a spasm of eating; when out-of-control eating and the resulting weight gain stop a person from taking a bike ride with his kids or attending a beloved exercise class; when a bout of overconsumption is regularly triggered by anger, stress or sadness, or an unwillingness to acknowledge those feelings, these are cases of impairment and emotional distress that warrant the profession’s consideration, Wilson says.

The rest of the series addresses finer points of the debate, such as whether BED is an addiction and thus a kind of brain disorder or if its roots are more psychologically- than biologically-based.  The last article in the series briefly touches on therapeutic ways to break the patterns and behaviors associated with BED.  For more information on any of the above, check out the relatively new Binge Eating Disorder Association.

*Experts are currently debating including BED as a diagnosis unto itself in the fifth edition of the DSM.  For more on this, read here.