Binge eating disorder (BED) is perhaps one of the most widely misunderstood mental disorders despite the fact that it affects as many as 3.5 percent of American women and 2 percent of American men. This illness, which is characterized by compulsive, out-of-control episodes of eating followed by shame, guilt and depression has long been underdiagnosed or misdiagnosed as a mental health issue, due in large part to BED's classification as only a provisional eating disorder diagnosis in the Diagnostic and Statistical Manual (DSM).
However, this serious mental illness, which can significantly impact quality of life and is often accompanied by serious medical and psychiatric conditions, will be included as an official diagnosis in the fifth edition of the manual that mental health professionals use to diagnose and treat mental disorders, due out this month. This important change to the DSM -- the first significant update to the eating disorders section of the manual in almost 20 years -- will clearly define diagnostic criteria for BED and validate the illness as a treatable behavior pattern.
Previously, clinicians that observed the symptoms of BED in their patients had to assign a diagnosis of eating disorder not otherwise specified (EDNOS), a "catch-all diagnosis" referring to abnormal eating without all the symptoms needed to be diagnosed with anorexia nervosa or bulimia nervosa. For example, a person with EDNOS may binge eat and purge afterwards, but does so with less frequency or intensity than the criteria outlines for a diagnosis of bulimia. The new classification of BED in the latest edition of the DSM confirms that binge eating is a separate issue people struggle with, and validates destructive eating behaviors and patterns of thinking that professionals in the healthcare community have seen become increasingly prevalent.
It is clear that the inclusion of BED as an official diagnosis in the DSM-5 provides important validation and definition to an illness that impacts the health and quality of life of so many men, women and children. However, it remains to be seen how the official designation of BED as an eating disorder diagnosis will impact access to care for the patients and families that need it, particularly with regard to insurance coverage for specialized BED treatment.
The issue of insurance coverage for BED treatment has to do with mental health parity laws. Mental health parity laws mandate that coverage for treatment of biologically based mental illnesses is no less extensive than the coverage provided for any other physical illness. However, parity laws vary by state and often differ with regard to the specific parity requirements for eating disorders; in other words, what conditions are considered "equal" and qualify for coverage. In fact, while more and more state mental health parity laws require that insurers cover treatment for anorexia and bulimia as well as several common psychiatric conditions (including depression, anxiety and bipolar disorder), EDNOS -- the umbrella, "catch-all diagnosis" previously used to diagnose BED -- has not traditionally been included on the parity law list of conditions to be covered.
However, the mental health community is optimistic that the inclusion of BED in the DSM-5 is the first step in moving toward better insurance coverage standards. Historically, designation as an official diagnosis is generally followed by widespread educational campaigns as well as lobbying efforts, led by both experts in the eating disorders treatment field and non-profit organizations like the Eating Disorders Coalition, the National Eating Disorders Association (NEDA) and the Binge Eating Disorder Association (BEDA).
For more by Kenneth L. Weiner, M.D., FAED, CEDS, click here.
For more on eating disorders, click here.
If you're struggling with an eating disorder, call the National Eating Disorders helpline at 1-800-931-2237.