How binge eating disorder is diagnosed

When to seek medical assistance

Signs of binge eating disorder do not resolve on their own. A person with such an eating condition does not typically have their habitual eating patterns under control. Symptoms must be evaluated and treated by a medical professional (mental healthcare provider and primary healthcare physician) as soon as possible. Untreated, compulsive behaviours and triggering influences may worsen and lead to more serious emotional and physical complications.

A person with binge eating disorder may become an expert at practicing secretive (sometimes manipulative) behaviours, and thus will not always seek medical intervention themselves. It can happen, that loved ones miss the first signs of a problem. If behaviours do become concerning, it is best to confront the situation and affected person with honesty, encouragement and support. As with any other eating disorder, a person with binge eating disorder must receive medical intervention in order to get the better of their condition and avoid harmful consequences.

Physical and psychological consequences which may require immediate medical attention / intervention include:

• Sudden weight gain or weight loss that is significant in a short period of time
• Harmful (self-inflicted physical harm) or suicidal behaviours or thoughts
• Substance abuse (drugs and or/ alcohol) – often as a coping mechanism for emotional triggers
• Uncontrolled binge eating (even if under treatment)

How is a diagnosis made?

It is fairly common for binge eating disorder to only be diagnosed when a person seeks helps for other suspected conditions, such as the effects of weight problems (obesity) or a mental health concern, such as anxiety or depression. In many instances, a person may become so clouded by denial and secrecy that other emotional and physical conditions concern them more than their excessive eating habits.

Help is at hand for binge eating disorder and the never-ending cycle can be broken. Once triggers are identified, the most beneficial means of treatment can be applied to help the affected person claim back control of their life.

A person may consider consulting with their family physician (general practitioner or GP) for treatment of any physical ailments resulting from the condition, as well as a mental health professional to help deal with its psychological impact.

A general practitioner will assess all symptoms, taking emotional and psychological problems into account, and conduct checks for the various health consequences related to binge eating disorder.

During a physical exam, a doctor will assess all vital signs (i.e. the lungs and heart), and also measure a person’s height and weight.

Checks as part of a physical examination will include blood pressure and cholesterol level measurements, as well as assessing any signs of heart related, diabetic, sleeping and digestive conditions. The physical examination will also include a check of the abdominal area, and general condition of a person’s skin, teeth, hair and nails (which can sometimes become dry, brittle or decayed).

Some of these checks may involve blood (complete blood count) and urine (urinalysis) samples for testing. Laboratory test checks will specifically look at digestive enzyme levels, electrolyte levels (sodium concentrations in the bloodstream) and functioning of the liver, kidneys and thyroid. If necessary, a doctor may recommend an electrocardiogram (ECG / EKG) to determine any heart irregularities.

A mental health professional will recommend a psychological evaluation and potentially a consultation at a sleep disorder centre if necessary. The primary goals of an evaluation are to better understand a person’s overall attitude towards food (i.e. to determine the type of relationship with food – good or bad) and eating habits, as well as how they perceive their body (i.e. body image). This is crucial for an accurate diagnosis of the type of eating disorder they are dealing with.

During a psychological evaluation (comprehensive medical, mental health and family history assessment), a doctor may ask relevant questions to help determine a diagnosis. The evaluation helps a doctor to screen details that are specific to binge eating disorder and assess signs of other possible emotionally related conditions. A mental-status examination may also be conducted for this purpose.

It can be a somewhat challenging process for a medical professional to diagnose an eating disorder as a person generally displays signs of secrecy, shame and even denial during a consultation. The consulting professional will be well aware of these characteristics and conduct an evaluation in such a way that it helps the patient get to the root of the issue, weed out elements that are not relevant and determine factors which are most true.

An evaluation will be a very personal process. It’s important for the person being evaluated to also be honest during their consultation. A person may feel an inclination to downplay or lie – this will not be helpful in achieving treatment goals.

Questions a doctor may ask can include:

• Do you feel you have an unhealthy relationship with food?
• When it comes to food consumption, what does a typical day look like?
• How would you describe your meal portions? (i.e. unusually large?)
• Do you eat only when you are hungry or at regular meal times?
• Do you find it difficult not to eat even when full (not hungry)?
• After you have eaten, do you feel uncomfortably full?
• How often do you think about food?
• Do you find that you generally eat very quickly?
• Do you enjoy eating with others or do you prefer eating in secret?
• Do you find that you are inclined to lie to others about how much you eat?
• Does your overall appearance or weight concern or upset you?
• Have you ever tried dieting to lose weight?
• Have you tried other means to lose weight? If so, what have you tried?
• Do you ever participate in exercise activity? If so, how often?
• Would you describe your eating habits as out of control?
• How do you feel about the amount of food you consume?
• Do you experience negative feelings related to your eating? (i.e. shame, disgust or guilt)
• Have you ever felt the need to rid your body of food consumed? (e.g. by purging)

There is no definitive test for binge eating disorder. Using the comprehensive psychological evaluation and physical check-up reports, a diagnosis will generally be made based on the below criteria for binge eating disorder:

• Signs or evidence of recurrent binge eating episodes at least once a week for a minimum of 3 consecutive months (consumption of excessively large quantities to the point of physical discomfort)
• Signs of a lack of control in relation to quantity consumed, urge to binge and the need to stop eating (especially when no longer hungry)
• Signs of secretive eating habits and negative emotions concerning what was eaten
• Signs of binging that includes rapid eating behaviours
• Lack of compensating behaviours, such as purging, excessive exercise or laxative use

Recurrent binge eating may be diagnosed as:

• Mild: Binge occurrences happen between 1 and 3 times a week.
• Moderate: Binge occurrences happen between 4 and 7 times a week.
• Severe: Binge occurrences happen between 8 and 13 times a week.
• Extreme: Binge occurrences happen more than 14 times a week.