Review Question - QID 218374

This patient presenting with excessive or binge eating, eating large amounts of food quickly, and feelings of disgust after binge eating without inappropriate compensatory behaviors has binge eating disorder.

Binge eating disorder is characterized by eating larger amounts of food over a small period of time than healthy people typically eat and a lack of control over the rate or quantity of food intake. For the diagnosis of binge eating disorder to be made, patients must have episodes of binge eating characterized by at least 3 of the following for at least once a week for 3 months: eating more rapidly than normal, eating until uncomfortably full, eating large amounts even when not hungry, eating alone due to embarrassment, and feelings of disgust, depression, or guilt after eating. Specifically, there are no compensatory behaviors (e.g., purging) and the binge eating must occur outside of the context of anorexia or bulimia nervosa. Other contextual clues include weight dissatisfaction and large weight fluctuations. First-line treatment is with cognitive behavioral therapy. Pharmacologic therapy with selective serotonin reuptake inhibitors is used second-line.

Wilson et al. examined the psychological treatments for binge eating disorder including interpersonal psychotherapy, cognitive behavioral therapy, and behavioral weight loss treatments. The authors found that interpersonal psychotherapy and cognitive behavioral therapy were both more effective than behavioral weight loss treatment in eliminating binge eating. They recommended cognitive behavioral therapy as first-line therapy in patients with binge eating disorder.

Incorrect Answers:
Answer 1: Anorexia nervosa is characterized by restrictive food intake leading to decreased body weight (measured by the body mass index), fear of gaining weight despite being underweight, and a distorted perception of body image and weight. Patients may present with bradycardia, electrolyte abnormalities, and fine, soft body hair known as lanugo. For the diagnosis to be made, patients must have a body mass index less than or equal to 17.5 kg/m^2. Although a binge eating subtype of anorexia nervosa exists, the patient must have both a low body mass index and binge eating for the diagnosis to be made.

Answer 3: Bulimia nervosa is characterized by recurrent binge eating and inappropriate compensatory behavior such as purging (e.g., self-induced vomiting) or excessive exercise. Physical evidence of purging behavior may be present, such as dental caries or dorsal hand calluses from self-induced vomiting. This patient is exhibiting no inappropriate compensatory behaviors to her binge eating and is exercising a normal amount.

Answer 4: Normal adolescent behavior should always be considered to avoid the overpathologizing of illness. However, this patient’s symptoms satisfy the criteria for an eating disorder, which should be treated to prevent associated morbidity. Normal adolescent behavior might be eating more than usual on some days to satisfy increased energy demands from high physical activity, but a loss of control of eating would not be present.

Answer 5: Rumination disorder is characterized by repeated regurgitation of food followed by rechewing, spitting out, or re-swallowing. The symptoms must be present for at least 1 month. In contrast, this patient’s symptoms of losing control over the rate/quantity of food consumption is more consistent with binge eating.

Bullet Summary:
Binge eating disorder is characterized by recurrent binge eating episodes characterized by eating more than usual or more rapidly than usual in an individual with a normal body mass index.