When I was completing my clinical and academic training (not so long ago), there was no such thing as binge eating disorder. The diagnosis did not exist. Shortly thereafter, the DSM-5 Task Force, led by the chairman of psychiatry at my home institution, made the decision to include binge eating disorder as a psychiatric diagnostic entity. It has since become the most commonly diagnosed eating disorder in the country.
The public has been led to believe that the inclusion of so-called binge eating disorder in the DSM was a decision made for medical or scientific reasons, but nothing could be further from the truth. In reality, the addition of binge eating disorder as a psychiatric diagnosis was a political and economic decision, as all such decisions are. There was, of course, no demonstrable pathophysiological finding to support the addition of this new disease. No blood test or X-ray or MRI. There was only a committee of psychiatrists who voted to make such a determination—an inherently political event.
I submit that the addition of binge eating disorder to the diagnostic manual is representative of the process of medicalization in psychiatry.
This is not to say that people do not engage in binge eating and that binge eating is not a real problem. Obesity is an epidemic in our country, and the rates of obesity-related disease have been skyrocketing for years. But it is a logical and semantic error to call overeating itself a disease—erroneous attempts to distinguish overeating from binge eating disorder notwithstanding.
I encourage readers to watch this lecture by Allen Frances, M.D., chairman of the DSM-IV Task Force and listen closely to his comments on the addition of binge eating to DSM-5.
What were the factors that led to the inclusion of binge eating disorder to the manual? First and foremost, there was incredible profit to be made by the pharmaceutical industry and American psychiatry with such an addition. We have long known that a side effect of the stimulant drugs used to treat so-called ADHD is appetite suppression and weight loss. This, in fact, can be a major problem for patients who take stimulants. Armed with this knowledge, Big Pharma and organized psychiatry knew that the only way to prescribe a drug for a particular problem is to have a diagnostic label for it. Binge eating disorder was the long-awaited solution.
An Internet search for “medication for binge eating disorder” reveals that the stimulant drug Vyvanse is heavily advertised online for its FDA indication as a “treatment” for binge eating disorder. One doesn’t have to look far to find similar advertisements on television and in magazines. In fiscal year 2015 alone, Vyvanse earned $1.7 billion (Dabney, 2016), and the numbers are only rising.
A second contributor to the medicalization of problem eating is the appeal of the diagnosis to those who seek a medical explanation for their behavioral choices. When overeating becomes medicalized, eating behavior is removed from one’s volitional control. A person doesn’t choose to have a disease. Personal responsibility is negated. A drug becomes the only answer. Given the rates of obesity in America, the market for such medicalized solutions represents millions.
While binge eating disorder is the most recent example of psychiatric medicalization, it would be unwise (and incorrect) to assume that it is the exception to the rule. Medicalization occurs across the board in psychiatry; in fact, as the famous psychiatrist Szasz (2007) pointed out, psychiatry is medicalization, through and through.
I contend that what we call binge eating disorder is to be solved not by medical diagnosis and pharmacological treatment but rather by an empathic understanding of human beings and their problems in living. A diagnostic label for these problems offers us absolutely nothing at all.
Dabney, J. (2016). Shire at discount on price-to-earnings basis: A good opportunity? Market Realist. Retrieved from https://marketrealist.com/2016/04/shire-discount-price-earnings-basis-good-opportunity
Szasz, T. S. (2007). The medicalization of everyday life: Selected essays. Syracuse, NY: Syracuse University Press.