by Ya-Ke (Grace) Wu, PhD, RN
Binge eating disorder (BED) is the most common eating disorder and affects approximately 6-8 million people in the United States. However, BED remains under-recognized and under-treated among U.S. adults.1 A large national study showed that, among adult individuals who met criteria for BED, only 3.2% reported ever being diagnosed with BED by a healthcare provider.2 Left untreated, BED increases risk for poor mental and physical health as well as work impairment.3,4
The criteria for diagnosing BED are found in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the standard classification of mental disorders used by mental health professionals in the U.S.5 One of the diagnostic criteria of BED is binge eating defined as recurrent episodes (i.e., occurring on average at least once a week for >3 months) of eating an unusually large amount of food in a short period time with an associated loss of control over eating during the episode.5
BED research illustrates many reasons why patients with BED often do not receive proper care:
- Limited knowledge and awareness of BED
The general population has limited knowledge and awareness of BED and individuals may not recognize their binge eating as a problem behavior unless they are directly asked about the symptoms of BED by a health care provider.6 Also, individuals may believe that their binge eating is not severe enough to warrant treatment, leading them not to seek help for their BED.7
- Shame or embarrassment
Some individuals may be reluctant to discuss binge eating with their healthcare provider because they feel embarrassed about the behavior.8 Backer and colleagues conducted a qualitative study to identify patients’ perspectives on social barriers to receiving eating disorder treatment. They found that adults with eating disorders were hesitant to discuss symptoms with healthcare providers out of fear that their binge eating would be viewed as a “weakness” or a “character flaw.” 8 Further, individuals BED often fear stigma, judgement, or being labelled as having a mental illness by healthcare providers.
- Previous negative experiences
Individuals with BED may have had negative experiences and unhelpful advice from providers when they attempted to discuss their BED symptoms in the past.9 It is possible when discussing their BED with providers, providers focused more on the need for weight loss rather than helping them get their eating under control.10 In short, they did not feel “heard” and opted to remain silent about their eating problems.
- Limited resources for BED treatment
Individuals with BED may not live near a specialist eating disorders service and may lack the time or resources to travel for treatment.11 Patients with Medicare or Medicaid may be ineligible to receive treatment at many clinics without paying out of pocket.9 Regardless of health insurance status, individuals may be unable to afford the cost of eating disorder treatment.12
Health care providers can use simple screens to encourage their patients to discuss eating concerns. The Binge Eating Disorder Screener-7 (BEDS-7)13* can be used to screen for binge-eating behavior and to guide a conversation with the patient about eating concerns. A simple screener like the BED-7 can be especially helpful for clinicians who feel ill-equipped to ask sensitive questions related to BED symptoms or lack time for more extensive interviews about eating behaviors.14 A positive screen can help a provider gauge how severe the BED is and guide the specialist referral process. If you think you might have BED yourself, you can take the screener at home, and bring it with you when you talk to your healthcare provider. This can increase your confidence in speaking with your provider about BED.
Raising awareness of BED is important to help more people get the treatment they deserve. Effective treatments for BED exist, but they can only work if someone can access treatment.
*Note: The BED-7 was developed by Shire US Inc. (a pharmaceutical company), but is a free resource that is available for use by anyone.
- Kornstein, S. G. (2017). Epidemiology and recognition of binge-eating disorder in psychiatry and primary care. Journal of Clinical Psychiatry, 78 (Suppl 1), 3-8. doi:10.4088/JCP.sh1 6003su1c.01
- Cossrow, N., Pawaskar, M., Witt, E. A., Ming, E. E., Victor, T. W., Herman, B. K., . . . Erder, M. H. (2016). Estimating the prevalence of binge eating disorder in a community sample from the United States: Comparing DSM-IV-TR and DSM-5 criteria. Journal of Clinical Psychiatry, 77(8), e968-974. doi:10.4088/JCP.15m10059
- Ling, Y. L., Rascati, K. L., & Pawaskar, M. (2017). Direct and indirect costs among patients with binge-eating disorder in the United States. International Journal of Eating Disorders, 50 (5), 523-532. doi:10.1002/eat.22631
- Pawaskar, M., Witt, E. A., Supina, D., Herman, B. K., & Wadden, T. A. (2017). Impact of binge eating disorder on functional impairment and work productivity in an adult community sample in the United States. International Journal of Clinical Practice, 71(7). doi:10. 1111/ijcp.12970
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: American Psychiatric Association.
- Kornstein, S. G., Kunovac, J. L., Herman, B. K., & Culpepper, L. (2016). Recognizing binge-eating disorder in the clinical setting: A Review of the literature. prim care companion The Primary Care Companion for CNS Disorders, 18 (3). doi:10.4088/PCC.15r01905
- Cachelin, F. M., & Striegel-Moore, R. H. (2006). Help seeking and barriers to treatment in a community sample of Mexican American and European American women with eating disorders. International Journal of Eating Disorders, 39(2), 154-161. doi:10.1002/eat. 20213
- Becker, A. E., Hadley Arrindell, A., Perloe, A., Fay, K., & Striegel-Moore, R. H. (2010). A qualitative study of perceived social barriers to care for eating disorders: Perspectives from ethnically diverse health care consumers. International Journal of Eating Disorders, 43(7), 633-647. doi:10.1002/eat.20755
- Innes, N. T., Clough, B. A., & Casey, L. M. (2017). Assessing treatment barriers in eating disorders: A systematic review. Eating Disorders, 25 (1), 1-21. doi:10.1080/10640266. 2016.1207455
- Citrome, L. (2017). Binge-eating disorder and comorbid conditions: Differential diagnosis and implications for treatment. Journal of Clinical Psychiatry, 78 (Suppl 1), 9-13. doi:10.4088/JCP.sh16003su1c.02
- Dearden, A., & Mulgrew, K. E. (2013). Service provision for men with eating issues in Australia: An analysis of organisations’, practitioners’, and men’s experiences. Australian Social Work, 66(4), 590-606. doi:10.1080/0312407X.2013.778306
- Hepworth, N., & Paxton, S. J. (2007). Pathways to help-seeking in bulimia nervosa and binge eating problems: A concept mapping approach. International Journal of Eating Disorders, 40(6), 493-504. doi:10.1002/eat.20402
- Herman, B.K., Deal, L.S., DiBenedetti, D.B., Nelson, L., Fehnel, S.E., Brown, T.M. (2016) Development of the 7-Item Binge-Eating Disorder Screener (BEDS-7). Primary Care Companion CNS Disorders, 18(2). doi: 10.4088/PCC.15m01896.
- Supina, D., Herman, B. K., Frye, C. B., & Shillington, A. C. (2016). Knowledge of binge eating disorder: A cross-sectional survey of physicians in the United States. Postgraduate Medicine, 128 (3), 311-316. doi:10.1080/00325481.2016.1157441