Binge Eating Disorder (BED) is a serious mental health condition characterized by recurring episodes of consuming an amount of food that is larger than what most people would eat in a similar period of time under similar circumstances. BED can be challenging to understand due to common misconceptions in the Western world about food intake and health standards. One of the myths of BED is those who are struggling with it are also struggling with challenges related to weight. Individuals with BED can be of many different body shapes, sizes, and weight.
Due to a lack of general understanding about BED, Individuals struggling with it can be subject to shaming comments from those around them and experience significant emotional turmoil. One area of confusion is understanding the difference between overeating and binge eating. Binge eating episodes can occur as a survival response to sustained or persistent food restriction. Alternatively, binge eating episodes can also be a recurring cycle as a means of coping with adverse life events or emotional stressors. A defining characteristic of Binge Eating Disorder is the profound sense of lack of control. Episodes of binge eating are often accompanied by overwhelming emotions such as feelings of shame, confusion, or helplessness.
When might seeking a Binge Eating Disorder diagnosis be helpful?
Individuals often contemplate when the right time is to pursue a diagnosis for BED. There is no right answer about when it is time to seek a diagnosis. Determining the best time to seek a diagnosis is a subjective and individualized experience. A diagnosis can be a tool in helping an individual to manage their mental health. However, when symptoms or struggles related to BED start to consistently impact emotional well-being and daily functioning, this could be the time to consider a diagnosis. These situations may include:
- Feeling out of control regarding food consumption and continuously engaging in binge eating episodes
- Difficulty managing behaviour related to food, specifically stealing, hiding, or avoiding foods
- Personally recognizing the amount of food intake in a single sitting is larger than what others would eat under similar circumstances on a consistent basis
- Experiencing significant emotional struggles such as constant sense of shame, helplessness, and loneliness in relation to your relationship with food
- Being stuck in a cycle of continuous food restriction such as cyclic dieting that results in binge eating episodes.
- When binge eating impacts your daily functioning (i.e. scheduling binge eating periods, being preoccupied with thoughts of food throughout the day, difficulty managing intense emotions connected to food)
What is the benefit of seeking a Binge Eating Disorder diagnosis?
Ultimately, the choice to be diagnosed is completely up to the individual. However, there are advantages to consider.
- Self-Validation around the Need for Support: Binge eating episodes can result in significant feelings of loneliness, regret and shame, which can silence individuals who are struggling. Pursuing a diagnosis can dispel some of the stigma and myths around binge eating, which validates the individual’s experience and acknowledges the need for support.
- Access to Proper Supports: A formal diagnosis can also be a crucial step in connecting to the appropriate support. Once individuals receive a diagnosis, they can connect with professionals or tailored services who specialize in working with Binge Eating Disorder.
- Presenting for services with a formal diagnosis can guide mental health professionals in creating an individualized treatment plan.
- A diagnosis can provide a greater sense of understanding of BED symptoms, which can increase capability in managing symptoms and triggers.
How does the diagnosis process work for Binge Eating Disorder?
For individuals seeking a diagnosis, it is common to experience a mix of emotions such as feelings of fear and uncertainty. Seek support from those you trust about the decision to pursue a diagnosis. For some, it can be helpful to understand what to expect.
- The initial assessment: In this first step, you will meet with a qualified mental health professional (typically a Psychologist or a Psychiatrist) to discuss information about individual symptoms, history, and experiences.
- Reference to the DSM-5: It is important to understand that all diagnoses are made based on specific criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The assessing professional compares your information and symptoms against a checklist of criteria outlined in the DSM-5. The symptoms in the DSM-5 for BED are related to eating habits and patterns, emotional distress related to food, as well as frequency and length of time of such experiences.
- Clinical Interview: Following the initial assessment, a clinical interview will be conducted. The purpose of the clinical interview is for the assessing professional to gain a deeper understanding of your thoughts, emotions, and behaviors and how this is impacting your daily life. If a professional is assessing for BED, many of the questions will be related back to current struggles with binge eating.
- Psychometric testing: To diagnose BED, mental health professionals may use standardized questionnaires to understand the severity, duration, and nature of one’s symptoms. The questionnaires are used to gather specific information that cannot always be clearly expressed in a clinical interview. Psychometric testing is not always necessary, it can be a useful tool to supplement the diagnostic process.
- Collaboration: The diagnostic process should be a collaborative approach. While the assessing professional leads with questions and provides information, you are an active member in your healthcare journey. You should feel comfortable expressing your thoughts, asking questions, and advocating if you disagree with something that is being proposed. This communication is a crucial aspect of receiving a proper diagnosis. If you do not feel this comfort with the professional you are working with, it is worth considering if they are the right match for you.
Tips for Navigating the Diagnostic Process:
While there are benefits to seeking a diagnosis, it is equally crucial to determine if pursuing a diagnosis aligns with your mental health needs. Remember, the absence of a diagnosis does not mean you are unable to access services. The diagnostic process does require individuals to share experiences related to emotions, thoughts, reactions and sometimes challenging life experiences. Finding the right professional to work with and being well-informed about the process are important steps in the diagnostic journey.
- Consider your Choices: There are numerous mental health professionals who are qualified to provide a diagnosis. However, establishing trust and feeling comfortable with the professional you choose to work with is perhaps the most important aspect of the therapeutic partnership. Search for professionals who have specifically worked with eating disorders and have valuable experience in specifically working with Binge Eating Disorder. If possible, talk to a few different professionals to make an informed decision of who you would like to work with.
- Ask Questions: Remember, feeling shy or nervous while discussing vulnerable topics is quite normal, so take your time when answering the questions. Given there is still a lot of stigma surrounding BED, going through the diagnostic process can be emotionally challenging. At any point if you are uncertain about the purpose of a question being asked or how the information will be used, you have every right to seek clarification, and should expect to receive a reasonable response.
- Be Open & Honest: In the course of these discussions, it is important to acknowledge that you will need to be ready to explore topics related to your personal history and daily functioning. Part of forming a BED diagnosis is gaining a comprehensive understanding of personal history related to food and eating patterns, family history and experiences of trauma. Honesty and openness is essential to ensure an accurate diagnosis.
- Clarify Next Steps: A crucial part of the diagnostic process is understanding ‘where do I go from here’. The assessing professional will review the diagnosis with you and can also provide information on the next steps for mental health management.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
Bulimia Anorexia Nervosa Association. (n.d.). Binge eating disorder. BANA - Bulimia Anorexia Nervosa Association. https://bana.ca/binge-eating-disorder/
Cleveland Clinic. (n.d.). Binge eating disorder. https://my.clevelandclinic.org/health/diseases/17652-binge-eating-disorder
Bremer, M. F., Garnweidner-Holme, L., Nesse, L., & Molin, M. (2023). Experiences of living with binge eating disorder and facilitators of recovery processes: a qualitative study. Journal of Eating Disorders, 11(1), 1-8. https://doi.org/10.1186/s40337-023-00929-2