When more than 1,500 mental health experts are involved in a decision, there’s bound to be some disagreement.  Such is the case with the American Psychiatric Association’s decision to include binge-eating disorder in the Diagnostic and Statistical Manual of Mental Disorders, widely known as DSM-5.

Allen Frances, M.D., chair of the DSM-IV Task Force, caused a stir when he criticized DSM-5.  Among other things, he questioned the legitimacy of binge-eating disorder and referred to it as “gluttony.”

His remark was both misguided and insensitive, especially considering that he is not a specialist in treating eating disorders.  He made other negative remarks about DSM-5, but his comment about binge-eating disorder caused the greatest response.

Responding to Criticism

Amy Pershing LMSW, ACSW, Chair of the Binge Eating Disorder Association, responded, in part, that:

“BED is NOT about gluttony or ‘overindulgence,’ actions that are normative in a society of relative plenty.  In fact, it is not even principally about food.  Clinical wisdom from decades of treatment and research tells us BED is, like all eating disorders, about a complex dance of biology, genetics, environment, family dynamics, trauma and a culture of weight stigma.”

An anonymous responder wrote that:

“Writing off people who are suffering with BED as gluttons who just can’t get enough cupcakes ’cause they taste so awesome is like saying people with anorexia are just over-dieting out of vanity and simply need to be told to go eat a sandwich.”

Another anonymous person wrote:

“Binge Eating Disorder has been recognized for years by professionals who focus on eating disorders, usually diagnosed under the unspecific label that’s become the most widely used of the eating disorders, EDNOS. Binging is decidedly NOT the same as overeating, as anyone who works with ED patients should know.”

The Opposite of Gluttony

The idea that binge-eating disorder is gluttony stigmatizes the disorder and assumes that people have full control over their behavior.  Nobody is choosing to eat this way.

In spite of Dr. Allen’s comment, binge-eating disorder is the opposite of gluttony.  A glutton takes pleasure in eating.  Conversely, those who have binge-eating disorder are some of the most distressed people on the planet.  Their stress is caused by their inability to control their disorder.

Clinicians have been diagnosing binge-eating disorder for many years.  With the inclusion of binge-eating disorder in DSM-5, they now have the legitimacy of the American Psychiatric Association to back their diagnosis.

Dr. Stuart Koman

Stuart Koman, Ph.D. is President and CEO of Walden Behavioral Care and the nonprofit Walden Center for Education and Research, both in Waltham, Mass. He has 30 years of experience leading and developing behavioral healthcare companies.