Binge-Eating Disorder
Definition: Binge-eating disorder is characterized by eating, in a discrete period (for example, within any 2 hours), an amount of food that is larger than what most people would eat in a similar period under similar circumstances (American Psychiatric Association, 2013, p. 350). Moreover, a person suffering from the disorder feels that he/she loses control over the eating process.
Risk factors: Risk factors can be both genetic and physiological. Binge-eating disorders seem to be related to other forms of maladaptive emotion regulation strategies, such as substance abuse and self-harm (Dingemans et al., 2017, Abstract). The disorder often runs in families, which proves the importance of the genetic factor.
Pathophysiology: People suffering from the disorder consume an excessive amount of food and fail to recognize that while eating. These people typically eat much more rapidly than normal and do not stop until they feel uncomfortably full. Consuming large amounts of food when feeling physically hungry is also an important feature of the disorder. Moreover, such periods of excessive consumption are then followed by feeling embarrassed and depressed afterward.
Types:
- 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)
Diagnostic Criteria: Recurrent episodes of binge eating that occur, on average, at least once per week for 3 months (American Psychiatric Association, 2013, p. 350).
Clinical presentation: Binge-eating typically begins in adolescence but can also start later. The disorder typically occurs in individuals with normal weight or overweight and obese individuals. Loss of control over consuming excessive amounts of food and abandoning efforts to stop it is one of the most important indicators.
Workup: Medical workers should ask the person about his/her eating patterns and note the frequency of binge-eating. Moreover, they should perform a mental status examination.
Management: Restoring a normal nutritional state by providing a plan and encouraging patients is a vital part of treatment. Treatment aims to reduce the binge-eating frequency and disordered eating-related cognitions, improve metabolic health and weight, and regulate mood (Brownley et al., 2016, Abstract). Eating behaviors should be changed in a way that helps accept a more sustainable diet. Altering patients’ perceptions of food, weight loss, and body shape/size are instrumental in ensuring the long-term effect of clinical management (Black & Andreasen, 2020, p. 268).
Complications: Hormonal abnormalities, sensitivity to temperature, dental problems.
Prognosis: Studying the severity of binge-eating, physiological reasons behind such eating patterns, and all the disorders which are typically initiated by binge-eating provides basic data that allows for prognosis.
Pica Disorder
Definition: Persistent eating of nonnutritive, nonfood substances over at least 1 month or the eating behavior is not part of a culturally supported or socially normative practice (American Psychiatric Association, 2013, p. 330). When eating behavior is inappropriate to the development level of the individual, it is also considered a pica disorder.
Risk factors: Lack of supervision, neglect and developmental delay are the main risk factors.
Pathophysiology: The disorder most commonly occurs in childhood, although adolescence and adulthood onset are also reported. People suffering from the disorder eat nonnutritive and nonfood substances on a persistent basis for at least one month. Such practice may lead to numerous medical emergencies of all types, from acute weight loss to poisoning.
Diagnostic Criteria: Eating nonnutritive and nonfood substances, including paper, soap, cloth, hair, string, wool, soil, chalk, talcum powder, paint, gum, metal, and other types. Generally, for all people who are 2 years old and older, consuming such substances is developmentally inappropriate, given that it is not a part of culturally supported normative practice.
Clinical presentation: Eating non-food substances is generally the only feature that supports the diagnosis. There are generally no biological abnormalities associated with such practice. In many cases, the occurrence of pica becomes vivid only after an emergency, such as poisoning. Ultrasound, abdominal flat plate radiography, and other scanning methods can reveal consumed objects. Moreover, blood tests can point to poisoning or infection.
Workup: Examining the objects that are typically consumed by the patients and analyzing the frequency and the reasons behind such practice.
Management: Helping alter eating patterns and the perception of certain nonfood substances, preventing new cases.
Complications: Often leads to emergencies due to the consumption of potentially dangerous nonfood substances.
Prognosis: Realizing the underlying medical condition, emotional state, or disorder allows for a comprehensive understanding of the nature of pica disorder and ensures an accurate prognosis.
Clinical scenarios
Scenario 1: Binge-Eating Disorder
An obese female presents to the office and states that she has a sense of lack of control over the amount of food she consumes. Eating excessive food, according to her, is followed by embarrassment and depressing thoughts. She says that currently, she does not try to influence her weight.
Differential diagnoses
Symptoms presented in the scenario may correspond to several diseases, such as bulimia nervosa and obesity. Bulimia nervosa typically features recurrent inappropriate compensatory behavior, which is absent in the case of binge-eating disorder. Moreover, people with bulimia nervosa are generally enthusiastic about their sustained dietary restrictions, which are meant to influence their body shape or weight. Although patients with binge-eating disorder may also make some attempts at dieting, they are typically not as frequent do not have certain restrictions. Therefore, the means based on dietary restrictions represent a major feature of bulimia nervosa but do not correspond to binge-eating disorder.
Obesity shares a few characteristics with binge-eating disorder as well. Nevertheless, some features help to distinguish between the two. For instance, obese individuals with the disorder show higher levels of overvaluation of body weight and shape. Moreover, long-term treatment more often leads to a successful result in the case of binge-eating disorder than in the case of obesity. Bipolar and depressive disorders may lead to an increase in appetite. Nevertheless, they do not necessarily lead to a loss of control over the amount of food eaten. Borderline personality disorder symptoms include binge-eating, however, several other criteria are to be met to give such a diagnosis.
Scenario 2: Pica Disorder
A mother and her 8-year-old son were present at the office. The boy consumes chalk and paper on a persistent basis. The boy is very talkative, open, honest, and does not have any intentions to injure himself. He also enjoys eating various types of dishes and is not concerned with his weight.
Differential diagnoses
Several disorders have symptoms that are similar to those of pica disorder. For instance, some people who suffer from anorexia nervosa may consume nonfood substances in an attempt to control appetite. In such cases, anorexia nervosa should be considered the primary diagnosis. Nevertheless, only this initial reasoning behind consuming nonfood objects can point to anorexia nervosa. People suffering from the factitious disorder may intentionally ingest objects as part of the pattern of falsification of physical symptoms (American Psychiatric Association, 2013, p. 331). Nonsuicidal self-injuries and nonsuicidal self-injury behaviors sometimes include episodes in which people deliberately swallow harmful objects. Therefore, understanding the original motivation is instrumental in giving the right diagnosis.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®) (5th ed.). American Psychiatric Pub.
Black, D. W., & Andreasen, N. C. (2020). Introductory textbook of psychiatry (7th ed.). American Psychiatric Pub.
Brownley, K. A., Berkman, N. D., Peat, C. M., Lohr, K. N., Cullen, K. E., Bann, C. M., & Bulik, C. M. (2016). Binge-eating disorder in adults: a systematic review and meta-analysis. Annals of internal medicine, 165(6), 409–420. Web.
Dingemans, A., Danner, U., & Parks, M. (2017). Emotion regulation in binge eating disorder: A review. Nutrients, 9(11), 1274. Web.