Binge Eating Disorder

This post isn’t really about fatness, but I was thinking about binge eating disorder as a diagnosis. You can take a look at the diagnostic criteria here, but it seems to get into a thorny realm because one criterion is a sense of lack of control. To me, that sounds like saying “addictive behavior” while avoiding that phrase. It leads to some questions:

  • Is binge eating itself a problem, or just a symptom of a deeper problem?
  • Does this diagnosis really help people?
  • Is there an issue with the diagnosis being incorrectly applied to fat people?
  • The diagnosis also mentions distress, disgust, etc. If one binges without these feelings, does one have the disorder?

I don’t have a firm viewpoint, but I’d like to hear yours.

2 thoughts on “Binge Eating Disorder

  1. 1.) Whether binge eating is analogous to addiction is a complicated issue that is far from settled. Our understanding of both eating disorders and addictions is far from perfect. I can speak from personal experience and say that, as someone who has suffered from both EDs and a classic addiction (chemical dependency), I have certainly noticed similarities between the two. And in both cases I would say that the eating/using behaviors are a problem (if they are causing distress) and they are also a symptoms of a deeper problem (e.g., depression, low self-worth, stigma/oppression, trauma). I don’t think it’s an either/or proposition.
    2.) There have been times in my life when the DSM-5 diagnostic criteria for binge eating disorder fit me perfectly. There have been other times when my symptoms fit better into the bulimia nervosa or anorexia nervosa categories. I personally do find the binge eating disorder category to be helpful because it validates that this set of behaviors and emotions is truly an eating disorder, not just “being gluttonous” as it is often perceived by others. It’s true that not everyone will find it useful to their understanding of themselves to be diagnosed, and some will find it harmful. However, for now, the diagnoses exist as much as a tool for billing/insurance purposes as anything else, and for that reason it is helpful to have BED as a category to allow clinicians to get reimbursed for services they provide to folks whose symptoms happen to best fit that category.
    3.) There is definitely a problem with assumptions being made by clinicians about the experiences, emotions, behaviors, and lifestyles of fat people. Whether these false assumptions result in incorrect diagnoses of BED, I’m not sure we have evidence of that yet.
    4.) Yes, you can fit the diagnostic criteria even if you don’t feel disgust around binge eating. The second diagnostic criterion specifies that one must have 3 out of 5 symptoms, feelings of disgust being just one of those. However, if distress is totally absent, there’s no reason to diagnose someone with this disorder. Distress and impairment (in social or occupational realms) are really the hallmarks of mental disorders (with the arguable exception of some personality disorders which may cause no distress to the people who have them), so in the absence of both, there’s not much justification for diagnosis.

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