Review Question - QID 220369

This patient with excessive eating and feelings of disgust after binge eating without inappropriate compensatory behaviors most likely has a binge eating disorder.

Binge eating disorder is characterized by eating large amounts of food over a small period of time 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: 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. There cannot be any compensatory behaviors such as purging, and patients cannot have underlying anorexia or bulimia nervosa. Other symptoms include weight dissatisfaction and large weight fluctuations. Treatment is with cognitive behavioral therapy and possibly selective serotonin reuptake inhibitors.

Wilson et al. review the psychological treatments for binge eating disorder including interpersonal psychotherapy, cognitive behavioral therapy, and behavioral weight loss treatments. The authors discuss how 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.

Figure/Illustration A is a clinical photograph demonstrating teeth without discoloration or pitting (red circle). This finding of normal teeth indicates that there are no abnormal purging symptoms and is consistent 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.

Answer 3: Bulimia nervosa is characterized by recurrent binge eating and inappropriate compensatory behavior such as purging by 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: Leptin production disorder can cause overeating because patients never feel full. Patients in this case generally do not feel disgusted by their eating behavior because they are doing it to satiate hunger.

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.

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.