Binge eating disorder (BED) is listed in the Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition (DSM-5) as a severe, life-threatening eating disorder. According to National Eating Disorder Association (NEDA), it is characterized by “recurrent episodes of eating large quantities of food (often very quickly and to the point of discomfort); a feeling of a loss of control during the binge; experiencing shame, distress or guilt afterwards and not regularly using unhealthy compensatory measures (e.g., purging) to counter the binge eating.” Binge eating disorder is currently known to be the most common eating disorder in the United States.
How Is It Diagnosed?
According to the DSM-5, in order to be diagnosed with binge eating disorder, an individual must meet the following diagnostic criteria for BED:
- Recurrent episodes of binge eating, as characterized by both:
- Eating discretely (within any two hour period) an amount of food that exceeds what most people would eat in the same amount of time under similar circumstances
- Experience a lack of control over eating during the episode (i.e. feeling unable to stop eating and/ or an inability to control the amount of food one consumes)
- Binge eating episodes are associated with three or more of the following:
- Eating until feeling uncomfortably full
- Eating faster than normal
- Eating excessive amounts of food when not physically hungry
- Eating alone due to embarrassment of the quantity of food being consumed
- Feelings of disgust, guilt, depression after an episode
- Binge eating episodes occur (on average) at least once a week for a minimum of three months
- The binge eating episodes are not associated with the recurrent use of inappropriate compensatory behaviors (i.e. purging, abuse of diuretics, excessive exercise, etc.)
Obtaining an accurate mental health diagnosis is imperative to one’s treatment process. Specifically as it relates to binge eating disorder, it is important to note, that BED is a relatively new type of eating disorder recognized in the DSM-5. Due to its new status, without a proper DSM diagnosis, some insurance companies may not provide coverage for its treatment.
Treatment and DBT
Every individual is different and will require a customized treatment plan when it comes to struggling with binge eating disorder. Many individuals struggling with binge eating disorder are likely to have dialectical behavior therapy (DBT) incorporated into their treatment plan. Although DBT was originally developed to help better treat individuals diagnosed with borderline personality disorder (BPD), it has since become increasing effective for the treatment of additional mental health illnesses such as depression, anxiety, post-traumatic stress disorder (PTSD), substance use disorder, and eating disorders, including BED. More specifically, DBT helps individuals establish coping mechanisms to reduce anxiety in situations and environments that elicit the stress response associated with food.
Dialectical behavior therapy is comprised of individual psychotherapy sessions and DBT skills group sessions. Each component is essential to the efficacy of DBT. The individual therapy sessions provide the individual in treatment for binge eating disorder the ability co create behavioral plans and goals surrounding mindful eating with his or her mental health clinician. One-on-one therapy sessions are also used to help empower the formation of a positive self-identity, which helps to foster acceptance, an increased sense of self-worth, and self-compassion. They are also a space to process the information learned in the DBT skills group sessions, address any challenges that arose from the previous week and reinforce the practice of implementing the DBT skills learned.
The DBT skills group sessions are conducted by a qualified mental health professional and he or she teaches therapeutic skills in direct relation to the following four main areas, as described by the Linehan Institute:
- Mindfulness: the practice of being wholly aware and present in the given moment
- Distress Tolerance: skills to learn how to tolerate pain in difficult situations instead of attempting to change or avoid it
- Interpersonal Effectiveness: techniques that enable an individual to communicate with others in an assertive manner, while simultaneously maintaining self-respect and strengthening relationships
- Emotional Regulation: learning effective methods to adjust, shift, and/ or change unwanted emotions
After each DBT skills group session the facilitator will assign homework to encourage the participants to continue practicing the skills taught in the session. Participants are encouraged to share their experiences during the group sessions and provide supportive feedback to the peers in the group. Both one-on-one therapy sessions and DBT skills group sessions are usually held once a week and the entire program generally takes twenty-four weeks to complete.