In its proposed criteria set for Binge Eating Disorder (i.e., the disorder, not just the binge), the APA's Diagnostic and Statistical Manual (IV-TR), includes, in addition to the features of a binge (described earlier), the following points:
A. The binge-eating episodes are associated with three (or more) of the following:
1) eating much more rapidly than normal
2) eating until feeling uncomfortably full
3) eating large amounts of food when not feeling physically hungry
4) eating alone because of being embarrassed by how much one is eating
5) feeling disgusted with oneself, depressed, or very guilty after overeating
B. Marked distress regarding binge eating is present.
C. The binge eating occurs, on average, at least 2 days a week for 6 months.
D. The binge eating is not associated with the regular use of inappropriate compensatory behaviors (e.g., purging, fasting, excessive exercise) and does not occur exclusively during the course of Anorexia Nervosa or Bulimia Nervosa.
It's interesting to me how important the "marked distress" feature is. In fact, if you're not feeling this level of distress, but you're still bingeing (even regularly), you wouldn't meet criteria for BED. And, in my interpretation, this includes distress before/during/after a binge, as well as distress about the overall pattern.
In the July issue of O magazine, writer Anne Lamott describes her experience with a a "classic" binge. Having been largely binge-free for 15 years, Lamott recently succumbed first to the allure of a Safeway apple fritter, triggering a no holds barred journey to binge-land. In my opinion, it's not really about her food choices or how much she consumes. I think it's the emotional report that she nails: "I was so lost, and I couldn't follow the bread crumbs back to the path of mental health, because I'd eaten them all. So I ended up eating junk, off and on, until bedtime. . . . It is hard to remember that you are a cherished spiritual being when you're burping up apple fritters and Cheetos."
Interestingly, Lamott describes a critical feature of a binge (beyond quantity and control) that seems, in my mind, just as relevant to the diagnosis: the aftermath. This is an aftermath filled with guilt, shame, self-hatred and sentencing, promises, punishment, and enough of an emotional charge to knock you (as you might want to be) flat-out unconscious. It's an aftermath so uncomfortable that it can, often, only be soothed by more eating, an irony that fuels the cycle and continues the pain.