The Los Angeles Times is taking a very interesting in-depth look at binge eating this weekend, asking a question that the American Psychiatric Association has yet to answer: is binge eating truly a psychiatric disorder?
Though anorexia and bulimia are already in the APA's diagnostic manual, with proper descriptions, diagnostic criteria, and potential treatment options, binge eating, the process of consuming large amounts of food in a compulsive manner without purging, is often lumped under the vague "ED-NOS" or "eating disorder not otherwise specified," a diagnosis given to those who display symptoms of disordered eating but don't fit the standard eating disorder diagnostic criteria.
As Melissa Healy of the Times writes, "In light of new research and a seemingly growing population of patients who fit the broad description of binge eaters, psychiatrists must decide whether "binge eating disorder" should stand alongside anorexia nervosa and bulimia nervosa as a separate psychiatric condition — identifiable by a distinct set of symptoms, a recognizable pattern of progression and a track record of response to certain treatments." Supporters of this inclusion feel it would help sufferers of binge eating disorder to get proper treatment, while critics, Healy notes, fear that the diagnosis would be overused and given to people who aren't necessarily suffering from compulsive overeating as much as a "lack of willpower."
"In short," Healy writes, "the specialists involved in the deliberations are picking their way through a minefield of controversies: the causes of a national obesity crisis, personal responsibility versus the medicalization of risky behavior, the nature of addiction and compulsion, even the respective roles of nature and nurture in shaping who we are and how we behave."
As someone who has been fortunate enough to receive proper treatment for an eating disorder, I find it somewhat troublesome that the concern over including binge eating disorder in the DSM comes back to worrying about doctors over prescribing medication or patients who rely on the diagnosis as some excuse to continue engaging in unhealthy behavior. As anyone who has been through a period of binge eating can tell you, binges are often terrifying and filled with a great deal of shame and sadness. This is not about just wanting to hang out and eat four boxes of cereal; the mental and emotional processes that go into overeating are much more complex than that.
I was able to get proper treatment because my eating disorder was clearly defined in the DSM, and the treatment plan for someone struggling with my symptoms was laid out and continues to be perfected by researchers dedicating to studying the disorder. Will binge eating disorder be overdiagnosed if it is included? Perhaps. But that's a phenomenon that occurs on every end of the mental illness spectrum, and it rings a bit false to blame those who are struggling for the psychiatric community's tendency (and big pharma's push) to write a prescription for those who might not need it. As they always told us in the hospital: it's never about the food, and it's never about the weight. It's the behaviors that need exploring, the behaviors that need to be treated. If including binge eating disorder in the DSM ensures that proper research, treatment, and understanding is given to those struggling with the behaviors, it might make all the difference in the world.
Is Binge Eating A Psychiatric Disorder? [LATimes]