OBJECTIVES: Binge eating disorder (BED), the most common eating disorder, lacks a specific ICD-9 diagnosis code. With BED subsumed under “eating disorder not otherwise specified (EDNOS),” which includes other disorders, patient identification using medical claims data is problematic. This study used natural language processing (NLP) to identify patients with BED and compared their healthcare costs to patients with EDNOS without BED (EDNOS-only) and to matched-patients without an eating disorder (Non-ED). METHODS: An NLP algorithm identified adults with BED from clinical notes in the Veterans Health Administration electronic health record database from 2005-2011 . EDNOS-only patients were identified using ICD-9 code (307.50) and those with NLP-identified BED were excluded. The first diagnosis date defined the index date for both groups. Non-ED patients were randomly matched up to 4:1 to patients with BED, matched on age, sex, BMI, depression diagnosis, and index month. Total healthcare, inpatient, outpatient, and pharmacy costs were examined and reported in 2011 US$. Generalized linear models were used to compare total one-year healthcare costs while adjusting for patient characteristics, including baseline costs. RESULTS: There were 257 BED, 760 EDNOS-only, and 823 matched Non-ED patients identified. The mean (SD) total unadjusted one-year costs were $33,716 ($38,928) for BED, $37,052 ($40,719) for EDNOS-only, and $19,548 ($35,780) for Non-ED patients. The largest component of costs for each was pharmacy (BED $21,842, EDNOS-only $26,426, and Non-ED $12,062) followed by inpatient (BED $8,483, EDNOS-only $5,892, and Non-ED $4,079) and outpatient costs (BED $3,391, EDNOS-only $4,735, and Non-ED $3,407). When adjusting for patient characteristics, BED patients had one-year total healthcare costs $5,589 higher than EDNOS-only (p=0.06) and $18,152 higher than matched Non-ED patients (p<0.001). CONCLUSIONS: Patients with BED had comparable costs to EDNOS patients and significantly higher adjusted costs than Non-ED patients. BED patients comprise a population with  high clinical burden and healthcare utilization.