A binge episode is defined as the consumption of a large amount of food within a discrete period of time, accompanied by a sense of loss of control over eating. Researchers and clinicians have agreed that loss of control involves the subjective feeling that one cannot stop eating or control what or how much is being eaten. However, there has been much less agreement about the size and duration of a binge eating episode. Specifically, there is no consensus as to what constitutes a large amount of food, and the duration of binge eating episodes can vary widely, sometimes continuing throughout an entire day. Many individuals have difficulty delineating binges into discrete episodes but can more readily recall whether a binge occurred or not on a given day. Thus, the BED diagnosis is made based on binge 'days' rather than 'episodes.' Similarly, many observers have concluded that the loss of control, rather than the amount of food ingested during a binge (i.e., a 'large' amount), is the hallmark of binge eating. See Table 1 for the full research criteria for BED.
Several methods can be used to assess BED, including clinical interviews, self-reports such as questionnaires and food diaries, and observation of eating behavior in the laboratory. Currently, a clinical interview by a trained professional is the preferred assessment method. It provides the opportunity to standardize definitions of key concepts such as a 'large amount of food' and 'loss of control.' Although questionnaires are relatively easy to administer, there is high potential for misinterpreting these terms. Interview-based assessments tend to yield ratings of binge eating that are lower, but more precise, than questionnaire-based surveys.
Food diaries involve having individuals keep a daily record of the specifics of eating episodes, including how much food was consumed, whether or not there was loss of control over eating, any use of
Table 1 DSM-IV-TR criteria for binge eating disorder
1. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
Eating, in a discrete period of time (e.g., within any 2-h period), an amount of food that is definitely larger than most people would eat in a similar period of time under similar circumstances
A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating)
2. The binge eating episodes are associated with at least three (or more) of the following:
Eating much more rapidly than normal
Eating until feeling uncomfortably full
Eating large amounts of food when not feeling physically hungry
Eating alone because of being embarrassed by how much one is eating
Feeling disgusted with oneself, depressed, or very guilty after overeating
3. Marked distress regarding binge eating is present.
4. The binge eating occurs, on average, at least 2 days a week for 6 months.
5. The binge eating is not associated with the regular use of inappropriate compensatory behaviors (e.g., purging, fasting, and excessive exercise) and does not occur exclusively during the course of anorexia nervosa or bulimia nervosa.
inappropriate compensatory behavior, and the associated context. Food diaries can provide detailed assessment information without introducing the bias of retrospective self-report; however, self-monitoring also has been shown to affect eating behavior and is frequently employed in clinical treatment. Findings from studies that have utilized food diaries indicate that BED patients report higher calorie intakes than non-binge eaters on both 'binge days' and 'non-binge days.'
Observation of binge eating in the laboratory is a specialized technique that is limited to use in research settings, providing the opportunity to document actual eating behavior and measure consumption. Laboratory studies with relatively small samples have shown that, compared to equally overweight patients who do not binge eat, BED patients ingest more calories, both during binges and at 'regular' meals. This difference in eating behavior in binge compared to non-binge eaters supports the validity of BED as a distinct diagnostic category.
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