ICD-11 Criteria for Binge Eating Disorder (6B82)

Binge eating disorder is characterised by frequent, recurrent episodes of binge eating (e.g. once a week or more over a period of several months). A binge eating episode is a distinct period of time during which the individual experiences a subjective loss of control over eating, eating notably more or differently than usual, and feels unable to stop eating or limit the type or amount of food eaten. Binge eating is experienced as very distressing, and is often accompanied by negative emotions such as guilt or disgust. However, unlike in Bulimia Nervosa, binge eating episodes are not regularly followed by inappropriate compensatory behaviours aimed at preventing weight gain (e.g. self-induced vomiting, misuse of laxatives or enemas, strenuous exercise). There is marked distress about the pattern of binge eating or significant impairment in personal, family, social, educational, occupational or other important areas of functioning.

Exclusions:  

• Bulimia Nervosa (6B81)

Diagnostic Requirements

Essential (Required) Features:

Frequent, recurrent episodes of binge eating (e.g., once a week or more over a period of 3 months). Binge eating is defined as a discrete period of time (e.g., 2 hours) during which the individual experiences a loss of control over their eating behaviour and eats notably more or differently than usual. Loss of control over eating may be described by the individual as feeling like they cannot stop or limit the amount or type of food eaten; having difficulty stopping eating once they have started; or giving up even trying to control their eating because they know they will end up overeating.

The binge eating episodes are not regularly accompanied by inappropriate compensatory behaviours aimed at preventing weight gain.

The symptoms and behaviours are not better accounted for by another medical condition (e.g., Prader-Willi Syndrome) or mental disorder (e.g., a Depressive Disorder) and are not due to the effects of a substance or medication on the central nervous system, including withdrawal effects.

There is marked distress about the pattern of binge eating or significant impairment in personal, family, social, educational, occupational or other important areas of functioning.

Additional Clinical Features:

Binge eating episodes may be ‘objective’, in which the individual eats an amount of food that is larger than most people would eat under similar circumstances, or ‘subjective’, which may involve eating amounts of food that might be objectively considered to be within normal limits but are subjectively experienced as large by the individual. In either case, the core feature of a binge eating episode is the experience of loss of control over eating.

Additional characteristics of binge eating episodes may include eating much more rapidly than usual, eating until feeling uncomfortably full, eating large amounts of food when not feeling physically hungry, or eating alone because of embarrassment.

Binge eating is typically experienced as very distressing. This is often manifested in negative emotions such as guilt, disgust, or shame, which also typically negatively affect the individual’s self-evaluation.

When there are multiple binge eating episodes per week and these are associated with significant distress, it may be appropriate to assign the diagnosis after a shorter period (e.g., 1 month).

Binge Eating Disorder is often associated with weight gain over time and obesity. However, individuals with Binge Eating Disorder may be of normal weight or even low weight (though not sufficiently to meet the diagnostic requirements for Anorexia Nervosa). The diagnosis of Binge Eating Disorder is based on the presence of regular binge eating that is not accompanied by regular inappropriate compensatory behaviours, regardless of overweight status.

Preoccupation with one’s body weight or shape, frequent checking or avoidance of checking body weight or size, and strong influence of body weight or shape on self-evaluation are commonly present, though not required for a diagnosis of Binge Eating Disorder.

Boundary with Normality (Threshold):

Infrequent overeating or feasting during culturally sanctioned holidays or occasional celebrations should not be characterized as binge eating for the purpose of assigning a diagnosis of Binge Eating Disorder.

Individuals who report patterns of overeating that do not meet the definition of binge eating should not be diagnosed with Binge Eating Disorder. Examples include mindless eating that can be resisted or stopped (e.g., if there is a distraction or interruption) or eating more than originally intended without a sense of loss of control, even if this kind of eating is distressing.

Course Features:

Onset of Binge Eating Disorder is typically during adolescence or young adulthood but can also begin in later adulthood.

The experience of loss of control over eating or sporadic episodes of binge eating may occur prior to the onset of Binge Eating Disorder.

Binge Eating Disorder is more common among individuals seeking weight-loss treatment. Typically, these individuals seek weight loss treatment after the onset of the disorder; binge eating does not typically arise as a consequence of treatment.

Binge Eating Disorder occurs more often among overweight and obese individuals than those with normal body mass indices.

Individuals who seek treatment for Binge Eating Disorder are typically older in age compared to individuals who seek treatment for other Feeding or Eating Disorders.

Binge Eating Disorder, although often persistent, has a higher rate of remission than other Feeding or Eating Disorders, with remission sometimes occurring spontaneously or as a result of treatment.

The features of Binge Eating Disorder may evolve over time, such that another Feeding or Eating Disorder may better characterize the current symptoms.

Developmental Presentations:

In children, as in adults, Binge Eating Disorder is associated with weight gain, increased body fat, concealing one’s eating, and use of binge eating to regulate emotions.

Binge Eating Disorder is more difficult to diagnose in childhood due to normative difficulty engaging in introspection in order to articulate reasons for binge-eating behaviour. Children are likely to report feeling out of control while eating rather than indicating that the amount of food consumed was excessive.

Children with Binge Eating Disorder may experience less frequent and briefer binges as compared to adults because they typically cannot gain access to food without the assistance of adults.

Binge Eating Disorder is common among adolescents and young adults.

Culture-Related Features:

Compared to other Feeding or Eating disorders, Binge Eating Disorder appears to be more equally distributed across countries, ethnic groups, and genders. The prevalence of Binge Eating Disorder is at least as high in low- and middle-income countries as across high-income countries and tends to correlate with rise of body mass index in the general population.

The relationship between ideal body size, body satisfaction, and Binge Eating Disorder is complex. For example, women who report strong identification with African American or Black Caribbean culture also tend to report larger body ideals and higher body satisfaction, yet tend to have elevated rates of binge eating.

Sex- and/or Gender-Related Features:

Binge Eating Disorder is more common in females.

There are no significant gender-related differences in the symptoms or course of Binge Eating Disorder.

Boundaries with Other Disorders and Conditions (Differential Diagnosis):

• Boundary with Bulimia Nervosa: If an individual regularly engages in inappropriate compensatory behaviours following episodes of binge eating (e.g., self-induced vomiting, use of laxatives, enemas, diuretics, fasting, strenuous exercise or omitting insulin), the diagnosis of Bulimia Nervosa rather than Binge Eating Disorder should be assigned.
• Boundary with obesity: Obesity is a common consequence of Binge Eating Disorder and should be recorded separately. However, obese individuals who report overeating patterns that do not meet the definition of binge eating should not be diagnosed with Binge Eating Disorder.

REFERENCE:

International Classification of Diseases Eleventh Revision (ICD-11). Geneva: World Health Organization; 2022. License: CC BY-ND 3.0 IGO.

https://creativecommons.org/licenses/by-nc-nd/3.0/igo/