Binge Eating Disorder: Is This for Real and Should It Be Medication-Managed?

In the Twitter world, the buzz term seems to be what’s “trending.” In the world of mental disorders, “bingeing” is increasingly gaining attention. We’ve long been familiar with binge drinking, but now we’ve got a new binge kid on the block — binge eating for which there are established DSM-5 criteria.

binge_eatingBED came on the scene in 2013 when the DSM-5 made its debut. To meet core diagnostic criteria for BED, an individual must have recurring episodes — at least once a week over 3 months — of binge eating. Binge eating is defined as a time-dependent (DSM-5 mentions two hours) period of eating significantly more food than most people would consider normal, accompanied by a sense of having lost control of one’s eating. There’s no purging or inordinate exercise to ward off BED-related weight gain and there’s no real concern with body image.

I could expound at length on the ridiculousness of this disorder, but I’ll confine myself to a few comments.

  1. This disorder seems to be no more than one of occasional overeating. Instead of micromanaging excessive eating by restricting criteria to bingeing behavior, DSM-5 could have gone the extra mile and established criteria for “Overeating Disorder;” but they didn’t, and instead have contributed to the creation of a new subset of patients guilty of “feasting” every now and then. Additionally, BED trivializes the real problem — which is obesity. Currently 69 percent of the U.S. population is either overweight or obese, whereas the prevalence rates of BED are a mere 2 percent in men and 3.5 percent in women.
  2. Verbatim from DSM-5: “The context in which the eating occurs may affect the clinician’s estimation of whether the intake is excessive. For example, a quantity of food that might be regarded as excessive for a typical meal might be considered normal during a celebration or holiday meal.” Translation: The goalposts evidently aren’t in a firm, fixed position when it comes to clinician evaluation. Celebratory eating can get a pass and the lines between normal and excessive eating can be blurred because of circumstances. I’m from New Orleans where there is literally a festival or celebration of some sort 50 weeks a year with world class food in abundance. So because of where I live, some clinician could determine that my overeating is really normal but a guy or gal living in Des Moines, for example, can be tagged with a BED diagnosis. This is a sham because overeating is overeating irrespective of when or where, and allowing for clinical discretion regarding exceptions weakens this disorder’s diagnostic features, rendering them toothless.
  3. The creation of Binge Eating Disorder has ushered in the opportunity for the pharmaceutical industry, with the help of the FDA, to come to the rescue. And rise to the occasion they have.

In February of this year,Vyvanse (lisdexamfetamine), gained FDA approval for BED. Vyvanse is in the family of detroamphetamine drugs used to treat ADHD. Yes, our FDA has approved a stimulant for the treatment of binge eating. Here’s a little flashback for you: Diet doctors and weight loss clinics were the craze in the 1960s with FDA-approved stimulants being prescribed in droves for weight loss. This got so out of control that it became an amphetamine epidemic that landed in Congress’s lap — shaping changes to our controlled substances drug policies. Sure, overweight stimulant users lost weight initially, because all stimulants reduce appetite and promote weight reduction, but very well crafted follow-up studies indicated that the vast majority of them gained back what weight they had lost upon stimulant discontinuation.

no_pillsI’m reminded of the quote “Give a man a fish and you feed him for a day; teach a man to fish and you feed him for a lifetime.” Drugs do not provide teachable moments for how to lose weight and keep it off long-term. Better and more productive eating habits have to initiated, learned or relearned and there are a plethora of ways to accomplish these goals. Drug makers though, salivate at the opportunity to “feed” the desires of people to lose weight quickly and effortlessly, but only wind up promising more than they actually deliver. And our own FDA has aided them in providing this false hope.

In the newly minted third edition of my book, I praise the DSM-5 for tightening up loosely defined criteria that I believe has dogged previous DSMs. That said, Binge Eating Disorder is an unnecessary diagnostic category whose focal point centers on intermittent overeating.

Of course I can’t speak for you, but I encounter far worse issues than BED in my everyday work with patients.


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Attribution Statement:
Joe Wegmann is a licensed pharmacist & clinical social worker has presented psychopharmacology seminars to over 10,000 healthcare professionals in 46 states, and maintains an active psychotherapy practice specializing in the treatment of depression and anxiety. He is the author of Psychopharmacology: Straight Talk on Mental Health Medications, published by PESI, Inc.

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