Ian is a 41-year-old married father of three, who is referred to psychiatrist, Dr. Jarvis, by his internist, Dr. Tang, for evaluation of depression. Ian had not been receiving routine medical care until he turned 40, when he started seeing Dr. Tang as part of his health evaluation for life insurance. Noted at the time to be in the obese range (weight 210 lb, height 5′9″; BMI 31), Dr. Tang suggested that he lose weight, with some general counseling on weight management and nutritional advice given. Over the following year, despite reporting he wanted to lose weight, Ian’s weight increased to 218 lb. He admits to Dr. Tang that he feels demoralized by this and embarrassed about not being able to lose the weight, despite her recommendation that he do so—“I’m a Type A guy; if there’s something I need to do, I make it happen!”

On evaluation, Ian reports to Dr. Jarvis that he does not think he has ever had mood issues in the past. He reports being very satisfied overall with his life, including his happy marriage of 13 years, his 3 healthy children, and his career as a financial planner at a major bank. He explains that he maintained a stable weight of 180 lb in his 20s and early 30s, but his weight began increasing over the past several years in the context of increasing pressures at home and work. He describes a reasonable diet for most of the day, most days of the week, though with heavy “fast-food” lunches at work; he has been exercising less consistently. When Dr. Jarvis asks more about how his mood and “stress” may be influencing his eating, Ian admits that one or two times a week, he will go down to the kitchen after his wife is in bed and eat all the leftovers from dinner, or perhaps several bowls of the kids’ cereal or a bag or 2 of chips. He reluctantly describes these episodes—“I eat so quickly, like I need the food to disappear fast before my wife catches me… I’m not even sure I taste it!” He reports regretting his eating afterward and waking up the next morning feeling angry with himself. He denies ever compensating for the eating by substantially restricting his calories the next day, or engaging in vomiting, laxative use, or excessive exercise.

Preferred diagnosis: Binge Eating Disorder

The diagnosis of binge eating disorder (BED) is made when an individual is engaging in at least one binge eating episode per week, accompanied by negative physical and emotional responses (such as feeling uncomfortably full, or shame about the eating), without recurrent compensatory behavior [see Chap. 7, Text Box: Bulimia Nervosa: Terminology], and the symptoms have persisted for at least three months and are causing distress or functional impairment. Specifiers are used to document the degree of remission, if present, as well as the severity of the symptoms. A new addition to the Feeding or Eating Disorders chapter in DSM-5 , BED intends to describe a discrete syndrome of dysfunctional eating behavior with physical and psychological consequences worthy of psychiatric attention [see Text box: Binge Eating Disorder: DSM-5 Diagnostic Criteria; see Text box: Spotlight on DSM-5: Binge Eating Disorder].