Features of Addiction in Binge-Eating Disorder: Considerations for Screening and Treatment

Figures & data

Table 1 Diagnostic Features for Binge-Eating Disorder, Food Addiction, Substance Use Disorder, and Gambling Disorder

Binge-Eating Disorder	Food Addiction	Substance Use Disorder	Gambling Disorder
Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:  a. Eating in a discrete period of time (2-hour period) an amount that is definitely larger than most people would eat in a similar period of time under similar circumstances b. The sense of lack of control overeating during the episode	Consuming the substance in larger amounts or for longer periods than one intends	Taking the substance in larger amounts or for longer than one intends	Recurrent gambling behavior leading to clinically significant impairment or distress, as  a. Indicated by the individual exhibiting four (or more) of the below criteria in a 12-month period b. The gambling behavior is not better explained by a manic episode
Binge eating episodes are associated with three (or more) of the following:  a. Eating much more rapidly than normal b. Eating until feeling uncomfortably full c. Eating large amounts of food when not feeling physically hungry d. Eating alone because of being embarrassed by what or how much one is eating e. Feeling disgusted with oneself, depressed, or very guilty after overeating	Wanting to cut down or stop consuming the substance but not managing to decrease the behavior	Wanting to cut down or stop using the substance but not managing to decrease use	Needs to gamble with increasing amounts of money in achieve the desired excitement
Presence of marked distress regarding binge eating behaviors	Spending a lot of time getting, using, or recovering from consumption of the substance	Spending a lot of time getting, using, or recovering from use of the substance	Restless or irritable when trying to cut down or stop gambling
Binge eating occurs, on average at least 1 day a week for 3 months	Cravings and urges to consume the substance	Cravings and urges to use the substance	Has made repeated, unsuccessful attempts to control, cut back, or stop gambling
The binge eating is not associated with regular use of inappropriate compensatory behaviors (eg, purging)	Not managing to fulfill obligations at work, home, or school because of substance consumption	Not managing to fulfill obligations at work, home, or school because of substance use	Is often preoccupied with gambling (eg, having persistent thoughts of reliving past gambling experiences)
	Continuing to consume the substance, even when it causes problems in relationships	Continuing to use, even when it causes problems in relationships	Often gambling when feeling distressed
	Giving up important social, occupational, or recreational activities because of substance consumption	Giving up important social, occupational, or recreational activities because of substance use	After losing money gambling, often returning to “get even” (“chasing one’s losses”)
	Consuming substances again and again, even when it puts the user in danger	Using substances again and again, even when it puts the user in danger	Lies to conceal the extent of involvement with gambling
	Continuing to use, even when one knows they have a physical or psychological problem that could have been caused or made worse by the substance	Continuing to use, even when one knows they have a physical or psychological problem that could have been caused or made worse by the substance	Has jeopardized or lost a significant relationship, job, or educational or career opportunity because of gambling
	Needing more of the substance to get the effect one wants(tolerance)	Needing more of the substance to get the effect one wants(tolerance)	Relies on others to provide money to relieve desperate financial situations caused by gambling
	Development of withdrawal symptoms, which can be relieved by consuming more of the substance	Development of withdrawal symptoms, which can be relieved by taking more of the substance
Severity
Mild: 1–3 episodes per week	Mild: 2–3 symptoms	Mild: 2–3 symptoms	Mild: 4–5 symptoms
Moderate: 4–7 episodes per week	Moderate: 4–5 symptoms	Moderate: 4–5 symptoms	Moderate: 6–7 symptoms
Severe: 8–13 episodes per week	Severe: 6+ symptoms	Severe: 6+ symptoms	Severe: 8–9 symptoms
Extreme: 14+ episodes per week

Notes: Diagnostic criteria for binge-eating disorder, substance use disorder, and gambling disorder are defined according to DSM-5 criteria. Diagnostic criteria for food addiction have been defined based on the DSM criteria for substance use disorder. This table is included to illustrate some of the similarities and differences in the diagnostic criteria for binge-eating disorder, food addiction, substance use disorder, and gambling disorder.