RESEARCH ARTICLE Binge Eating in Interview Versus Self-Report: Different Diagnoses Show Different Divergences Andreas Birgegård * , Claes Norring & David Clinton Department of Clinical Neuroscience, Resource Center for Eating Disorders, Stockholm Center for Psychiatry Research and Education, Karolinska Institute and Stockholm County Council, Stockholm, Sweden Abstract Objective: Binge eating (BE) is diagnostically important for eating disorders (EDs) but difficult to measure validly and reliably. The study compared interview and questionnaire formats regarding the proportion of patients in each diagnostic group who reported BE. Method: Data came from the clinical Stepwise ED database (N = 3508 adults and 1354 children/adolescents), representing the full range of ED diagnoses. Methods used were the Structured ED Interview and the ED Examination Questionnaire. Results: Opposite discrepancies were observed between methods depending on ED diagnosis, such that a higher number of restrictive patients reported BE on the questionnaire than the interview, whereas the opposite was true for bulimic patients. Discussion: The findings have important clinical and theoretical implications and suggest that BE assessment is more complex than pre- viously believed. Copyright © 2014 John Wiley & Sons, Ltd and Eating Disorders Association. Keywords binge eating; diagnostics; assessment *Correspondence Andreas Birgegård, PhD, Department of Clinical Neuroscience, Karolinska Institute, Resource Center for Eating Disorders, Stockholm Center for Psychiatry Research and Education, Norra Stationsgatan 69, SE-113 64 Stockholm, Sweden. Email: andreas.birgegard@ki.se Published online in Wiley Online Library (wileyonlinelibrary.com) DOI: 10.1002/erv.2289 Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, (American Psychiatric Association, 1994) eating disorder (ED) criteria for binge eating (BE) require the consumption of objectively large amounts of food accompanied by loss of control (LOC) over eating, called objective binge episodes (OBE). OBE presence is a central criterion for both subtypes of bulimia nervosa (BN) [BN purging type (BN-P) and BN non-purging type, (BN-nP)] and for binge ED (BED), previously a ‘not otherwise specified’ example but a formal diagnosis in DSM-5 (American Psychiatric Association, 2013; Wonderlich, Gordon, Mitchell, Crosby, & Engel, 2009). It can, however, be present in all ED diagnoses, and the full list includes seven possible ED ‘categories’ besides the three mentioned: anorexia nervosa of restricting (ANR) and binge/purge type (ANBP) and five other examples of ED not otherwise specified (EDNOS). The latter are, for example, briefly described as fulfilling some but not all of the criteria for AN or BN. Lacking in previous research is an overview of the number of patients in each diagnostic group who reports each of these behaviours, and such an overview is the first aim of the current study, using both questionnaire and interview data. We include a similar overview of purging behaviour for comparison. This issue is not uncomplicated however. OBE has been in recent research focus due to its central diagnostic importance but problematic in nature concerning both definition and mea- surement (e.g. Wilson & Sysko, 2009; Wolfe, Baker, Smith, & Kelly-Weeder, 2009). A recent review (Berg, Peterson, Frazier, & Crow, 2011) recently found that among the behaviour items, the concordance between questionnaire (Fairburn & Beglin, 1994) and interview (Fairburn & Cooper, 1993) forms of the ED Exami- nation was the poorest for frequency of OBEs (as well as subjective BE, not involving a large amount of food but with LOC; this will not be in focus in the present study). Agreement was good, however, for purging behaviour (vomiting and laxative use). Examples of OBE discrepancies in research are higher frequen- cies on the EDEQ than the EDE in a normal and clinical sample (Fairburn & Beglin, 1994) and similar results in a substance abuse sample (Black & Wilson, 1996) and a BN sample (Carter, Aime, & Mills, 2001). In contrast, Wilfley and colleagues (Wilfley, Schwartz, Spurrell, & Fairburn, 1997) found lower binge frequencies on the EDEQ than the EDE in a BED sample, whereas Reas and colleagues (Reas, Wisting, Kapstad, & Lask, 2011) recently found no significant difference between methods in a university sample. These findings indicate that differences between interview and questionnaire data exist and may be due to assessment setting, order of the assessment methods, type of symptom, study sample or other factors. An intriguing idea is that ED diagnosis may also systematically affect the form of these discrepancies, as suggested by one study (Binford, Le Grange, & Jellar, 2005) on an adolescent sample, where the correspondence between interview and ques- tionnaire data was different for different diagnostic groups concerning, for example, OBE frequency. Specifically, agreement between the interview and the questionnaire was better for ANBP and partial-syndrome BN than for BN. The present study did not, however, concern the frequency but the diagnostically primary 170 Eur. Eat. Disorders Rev. 22 (2014) 170–175 © 2014 John Wiley & Sons, Ltd and Eating Disorders Association.