Effects of reducing the frequency and duration criteria for binge eating on lifetime prevalence of bulimia nervosa and binge eating disorder: Implications for DSM-5


  • S.E.T. was supported by T32MH076694 from National Institute of Health grant (to C.M.B.); 1K01AA 18719-01A1 from National Institute of Health grant (to T.L.R.); and CA-085739 and AI-056014 from the National Institutes of Health. The Swedish Twin Registry is supported by grants from the Swedish Department of Higher Education and the Swedish Research Council.

  • All authors reported no biomedical financial interests or potential conflicts of interest. We thank all participants for their time and effort.



We assessed the impact of reducing the binge eating frequency and duration thresholds on the diagnostic criteria for bulimia nervosa (BN) and binge eating disorder (BED).


We estimated the lifetime population prevalence of BN and BED in 13,295 female twins from the Swedish Twin study of Adults: Genes and Environment employing a range of frequency and duration thresholds. External validation (risk to cotwin) was used to investigate empirical evidence for an optimal binge eating frequency threshold.


The lifetime prevalence estimates of BN and BED increased linearly as the frequency criterion decreased. As the required duration increased, the prevalence of BED decreased slightly. Discontinuity in cotwin risk was observed in BN between at least four times per month and at least five times per month. This model could not be fit for BED.


The proposed changes to the DSM-5 binge eating frequency and duration criteria would allow for better detection of binge eating pathology without resulting in a markedly higher lifetime prevalence of BN or BED. © 2011 by Wiley Periodicals, Inc. (Int J Eat Disord 2012)