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Difficulty: EasySomatic Symptom and Eating Disorders

A 32-year-old man comes to the primary care clinic seeking advice on weight management. He reports a long history of fluctuating weight and significant distress regarding his body size. His body mass index is 35 kg/m². During the interview, he describes frequent episodes where he consumes unusually large amounts of food, such as eating an entire family-sized pizza and a large carton of ice cream in less than an hour. During these times, he feels a complete loss of control over his eating. These episodes occur at least twice a week and are followed by intense feelings of guilt and self-disgust. He explicitly denies inducing vomiting, using laxatives, fasting, or engaging in excessive exercise after these eating episodes. Which of the following is the most likely diagnosis?

  1. Binge-eating disorderAnswer
  2. B
    Bulimia nervosa
  3. C
    Anorexia nervosa, binge-eating/purging type
  4. D
    Night eating syndrome
  5. E
    Major depressive disorder with atypical features

Answer

Binge-eating disorder
The correct answer accurately identifies binge-eating disorder. This diagnosis is characterized by recurrent episodes of binge eating (eating an amount of food that is definitely larger than what most people would eat in a similar period, with a sense of lack of control) that occur at least once a week for 3 months. Crucially, these episodes are accompanied by marked distress (guilt, self-disgust) and are not followed by the recurrent use of inappropriate compensatory behaviors such as purging, fasting, or excessive exercise.

Step-by-Step Solution

1
Analyze the patient's eating behavior and psychological response.
The patient has episodes of eating unusually large amounts of food in a short period, accompanied by a loss of control, guilt, and self-disgust.
Identifying the core pattern of eating helps narrow down the psychiatric differential diagnosis of eating disorders.
2
Assess for the presence of compensatory behaviors.
The patient explicitly denies vomiting, laxative use, fasting, or excessive exercise.
The presence or absence of compensatory behaviors is the primary way to differentiate bulimia nervosa from binge-eating disorder.
3
Evaluate the patient's body mass index (BMI).
The patient's BMI is 35 kg/m², indicating obesity rather than a significantly low body weight.
A BMI above the normal or underweight range rules out anorexia nervosa.

Key Concept

Binge-eating disorder is diagnosed when a patient has recurrent episodes of binge eating associated with a lack of control and severe distress, but notably lacks the inappropriate compensatory behaviors seen in bulimia nervosa.
Estimated Time:1m 0s
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Topics

Somatic Symptom and Eating Disorders

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