© Springer International Publishing Switzerland 2017
Janna Gordon-ElliottFundamentals of Diagnosing and Treating Eating Disorders10.1007/978-3-319-46065-9_99. Ian, the Guilty Eater
(1)
New York, New York, USA
Keywords
Binge eating disorder (BED)Bulimia nervosa (BN)Overeaters anonymous (OA)DSM-59.1 Case Presentation
Ian is a 41-year-old married father of three, who is referred to psychiatrist, Dr. Jarvis, by his internist, Dr. Tang, for evaluation of depression. Ian had not been receiving routine medical care until he turned 40, when he started seeing Dr. Tang as part of his health evaluation for life insurance. Noted at the time to be in the obese range (weight 210 lb, height 5′9″; BMI 31), Dr. Tang suggested that he lose weight, with some general counseling on weight management and nutritional advice given. Over the following year, despite reporting he wanted to lose weight, Ian’s weight increased to 218 lb. He admits to Dr. Tang that he feels demoralized by this and embarrassed about not being able to lose the weight, despite her recommendation that he do so—“I’m a Type A guy; if there’s something I need to do, I make it happen!”
On evaluation, Ian reports to Dr. Jarvis that he does not think he has ever had mood issues in the past. He reports being very satisfied overall with his life, including his happy marriage of 13 years, his 3 healthy children, and his career as a financial planner at a major bank. He explains that he maintained a stable weight of 180 lb in his 20s and early 30s, but his weight began increasing over the past several years in the context of increasing pressures at home and work. He describes a reasonable diet for most of the day, most days of the week, though with heavy “fast-food” lunches at work; he has been exercising less consistently. When Dr. Jarvis asks more about how his mood and “stress” may be influencing his eating, Ian admits that one or two times a week, he will go down to the kitchen after his wife is in bed and eat all the leftovers from dinner, or perhaps several bowls of the kids’ cereal or a bag or 2 of chips. He reluctantly describes these episodes—“I eat so quickly, like I need the food to disappear fast before my wife catches me… I’m not even sure I taste it!” He reports regretting his eating afterward and waking up the next morning feeling angry with himself. He denies ever compensating for the eating by substantially restricting his calories the next day, or engaging in vomiting, laxative use, or excessive exercise.
9.2 Diagnosis/Assessment
Preferred diagnosis: Binge Eating Disorder
The diagnosis of binge eating disorder (BED) is made when an individual is engaging in at least one binge eating episode per week, accompanied by negative physical and emotional responses (such as feeling uncomfortably full, or shame about the eating), without recurrent compensatory behavior [see Chap. 7, Text Box: Bulimia Nervosa: Terminology], and the symptoms have persisted for at least three months and are causing distress or functional impairment. Specifiers are used to document the degree of remission, if present, as well as the severity of the symptoms. A new addition to the Feeding or Eating Disorders chapter in DSM-5 , BED intends to describe a discrete syndrome of dysfunctional eating behavior with physical and psychological consequences worthy of psychiatric attention [see Text box: Binge Eating Disorder: DSM-5 Diagnostic Criteria; see Text box: Spotlight on DSM-5: Binge Eating Disorder].
Binge Eating Disorder: DSM-5 Diagnostic Criteria
- A.
Recurrent episodes of binge eating
- B.
The binge-eating episodes are associated with three (or more) of the following:
- 1.
Eating much more rapidly than normal.
- 2.
Eating until feeling uncomfortably full.
- 3.
Eating large amounts of food when not feeling physically hungry.
- 4.
Eating alone because of feeling embarrassed by how much one is eating.
- 5.
Feeling disgusted with oneself, depressed, or very guilty afterward.
- 1.
- C.
Marked distress regarding binge eating is present.
- D.
The binge eating occurs, on average, at least once a week for 3 months.
- E.
The binge eating is not associated with the recurrent use of inappropriate compensatory behavior as in bulimia nervosa and does not occur exclusively during the course of bulimia nervosa or anorexia nervosa.
Specify if:
In partial remission: After full criteria for binge-eating disorder were previously met, binge eating occurs at an average frequency of less than one episode per week for a sustained period of time.
In full remission: After full criteria for binge-eating disorder were previously met, none of the criteria have been met for a sustained period of time.
Specify current severity:
Mild: 1–3 binge eating episodes per week.
Moderate: 4–7 binge eating episodes per week.
Severe: 8–13 binge eating episodes per week.
Extreme: 14 or more binge eating episodes per week.
Spotlight on DSM-5: Binge Eating Disorder
Originally appearing as a variant of bulimia nervosa in DSM-III, BED was first identified as a separate entity in DSM-IV, located in Appendix B (Criteria Sets and Axes Provided for Further Study). Prior to DSM-5 , when it was moved into the Feeding or Eating Disorders chapter, patients fulfilling the criteria for binge eating disorder were given a diagnosis of eating disorder not otherwise specified (ED-NOS). The inclusion of BED into the Feeding or Eating Disorders chapter brings the disorder into a central location with other similar conditions; this update also allows more specificity in diagnosing individuals with eating-related conditions, with fewer patients being given the overly broad diagnosis of ED-NOS.