Binge Eating a Psychiatric Disorder, Obesity is Not

Binge eating should be included in the Diagnostic and Statistical Manual of Mental Disorders, but obesity should not, says a group of medical experts.

A group of medical experts is recommending that binge eating be included as an official psychiatric disorder in new mental health guidelines; however, obesity should not.


At the annual meeting of the American Psychiatric Association (APA) last week, the work group revising the Diagnostic and Statistical Manual of Mental Disorders (DSM) offered several recommendations for overhauling the eating disorders category, including adding binge eating as a psychiatric disorder. The DSM lists symptoms and criteria for diagnosing mental disorders, as well as treatments and insurance plan coverage. If the changes are approved, binge eating disorder may become recognized as an illness alongside other disorders, like anorexia and bulimia.

Binge eating is defined as consuming amounts of food larger than most would eat in a period of time under similar circumstances, and feeling a lack of control during the episode, according to the DSM group’s proposed revision. Binge eating is the most common eating disorder in the United States but it is very difficult for doctors to identify and treat.

Researchers found scientific evidence that binge eating tends to run in families and is most common in older males, with a later onset of personality disturbances. According to the DSM work group’s proposed guidelines, the person must feel distressed when eating and the binging must occur at least once a week for three months.

In addition, a binge eating episode meets at least three of these criteria:
- eating much more rapidly than normal
- eating until uncomfortably full
- eating large amounts when not physically hungry
- eating alone due to embarrassment
- feeling depressed or very guilty after overeating

Currently, binge eating falls within the category known as “Eating Disorder Not Otherwise Specified” (EDNOS), which also includes purging disorder (a person vomits after eating without binging before) and night eating syndrome (a person wakes up at night and eats).

Obesity was not recommended as a psychiatric disorder because “it’s a physiological, anatomical abnormality of excess body fat,” said Dr. B. Timothy Walsh, the chair of DSM-V’s eating disorders work group. He feels it should not be categorized as a mental illness.

Noted Dr. Walsh, “There are people who are overweight or obese and have eating disorders, but then there are many people who are overweight or obese and don’t have eating disorders.”

The proposed draft revisions to the DSM disorders and criteria, which include several changes to the EDNOS category, are posted on the DSM website.