Binge eating disorder (BED) is most likely to be diagnosed when the patient visits a physician regarding a related medical condition, such as obesity, high blood pressure or depression. Physicians generally diagnose BED based on the patient’s symptoms and eating habits.

During an initial consultation, a physician will record the patient’s weight and perform a thorough physical examination. The physician will also compile a comprehensive medical history including family history of physical and psychological disorders (e.g., depression, obsessive-compulsive disorder [OCD]) as well as inquire about the patient’s history of dieting and/or eating patterns.

Some of the questions a physician may ask include:

• How long has the binging been occurring?
  
  
• How often do binges occur?
  
  
• Is binging followed by purging?
  
  
• Has the patient gained a lot of weight recently?
  
  
• Is the patient experiencing emotional stress or anxiety?
  
  
• Does the patient avoid socializing and instead spend time eating alone at home?
  
  
• What other symptoms are present?

In addition, a physician may order diagnostic tests to identify any signs of complications of BED.  These tests may include:

• Blood tests. Laboratory analyses – including a complete blood count (CBC) – of blood samples to measure levels of hormones, enzymes, proteins, electrolytes, vitamins and other substances in the blood. Blood tests assess the function of various organ systems including the liver, kidney, thyroid and pituitary glands as well as the ovaries (female reproductive glands).
  
  
• Urinalysis. Chemical examination of a patient’s urine sample to screen for urinary tract infections, kidney disease and diseases of other organs that result in the appearance of abnormal metabolites (break-down products) in the urine.
  
  
• Electrocardiogram (EKG). This test measures the pattern of electrical impulses generated by the heart. During the procedure, electrodes (devices that detect electrical impulses) are attached to the patient’s chest. The electrical impulses are then recorded on a graph. In patients with eating disorders, an EKG can help detect irregular heartbeats and identify the presence of any damage to the heart.

If BED is suspected, a primary care physician may refer the patient to a mental and/or behavioral health specialist (typically a psychiatrist) for further evaluation and treatment. Psychological questionnaires and self-assessment forms may be used to help determine a patient’s attitude about food and physical appearance. The mental health professional will also probe for signs of related disorders, such as depression or anxiety.

To date, BED has not officially been classified as a mental health disorder. Debate remains as to whether binge eating is a medical condition or merely a group of symptoms. Some experts believe it is a form of bulimia. However, the American Psychiatric Association has proposed criteria for BED that include the following:

• Recurrent episodes of discrete time periods in which the patient engages in binge eating. The binge eating is characterized by consuming an amount of food larger than most people would eat in a similar period of time under similar circumstances.
  
  
• Patients must experience an inability to control their eating and feelings of distress related to their eating.

In addition, three or more of the following must be present for diagnosis:

• Eating much more rapidly than normal
  
  
• Eating until feeling uncomfortably full
  
  
• Eating large amounts despite not feeling hungry
  
  
• Eating alone due to embarrassment over amount consumed
  
  
• Feelings of disgust for oneself, depression or guilt after overeating