Diagnosis
The present case examines the diagnosis of a 21-year-old female patient, Alice, who turned to the mental health practitioner after four months of consecutive binge-eating episodes. The case examines her symptoms and struggles with uncontrolled eating to diagnose the disorder and determine its severity. The second part of the case focuses on the empirically tested treatments for the diagnosed problem, justifying the choice of treatment for Alice with available clinical data.
Case Description
The patient, Alice, is a 21-year-old Black female, a student at a community college working part-time as a nurse in a public hospital. Alice turned to the mental health practitioner after a series of binge-eating episodes experienced over the past four months. Alice reported no history of child abuse, home violence, or substance abuse in her family history. The patient’s mother and grandfather suffered from obesity. Alice’s grandfather suffered from obesity-related hypertension and diabetes, which resulted in his premature death at 52. Alice’s mother was currently diagnosed with hypertension, trying to take her weight under control and keeping to a diet prescribed by her cardiologist. The family medical history does not include any mental health issues.
When talking about the onset of her binge-eating episodes, Alice mentioned a difficult period at college that coincided with the workplace-related stress of new training. As a result of the double workload, Alice had to study and work up to 16 hours every day, sometimes including weekends, and sustained prolonged stress because of a fear of dismissal. The patient reported paying for her tuition from the nurse’s salary she received at the hospital, so preserving that job was essential for her education and future career. Therefore, she confided to the pronounced stress of intense study and work, with no ability to reduce the workload for more than one month.
The patient described eating as a coping strategy for the work- and study-related stress she endured. As Alice did not have enough time for sufficient rest, enough sleep, and home meal cooking, she started abusing fast-food and energy drinks to keep her energy high during long working sessions. The only normal meal she could afford was a late evening dinner at home, where she reported eating literally everything in the refrigerator. With time, Alice found herself craving binge eating after a long study day or a shift at the hospital as a way to relax. She quickly ate two-three times more than she usually ate for dinner, feeling guilty in the morning, when her mother looked at the empty plates with surprise. Alice also started feeling disgusted with herself, saying that she felt like a “pig” when she squeezed all that food into herself “when actually not feeling hungry at all.”
After over two months of regular binge-eating episodes, Alice started noticing a weight gain, which caused additional stress on her self-esteem. The patient decided to keep to a diet and regulate her nutritional intake to restore her healthy weight. That effort coincided with relief at work and the end of exams at college, so Alice could cook healthy food and take care of her nutrition. However, Alice reported feeling anxious without any evident reason one-two times a week, even under these conditions. As she explained, anxiety did not let her fall asleep, and she relaxed only after going to the kitchen and eating everything she could find. Her mother noticed the problem and recommended turning to a mental health expert, which caused a family conflict and aggravated Alice’s self-disgust. Only after two months of helpless dieting, Alice recognized the problem and decided to attend a mental health specialist.
Review of DSM-5 Criteria for the Disorder
DSM-5 contains specific criteria for BED, against which Alice’s case was evaluated to produce the final diagnosis. First, the patient reported excessive and uncontrolled eating episodes that occurred once or twice every week. Second, Alice’s binge-eating episodes met three DSM-5 criteria: rapid eating, eating in the absence of hunger, and a subsequent feeling of guilt and disgust. Third, Alice understood that her binge-eating episodes were not normal and felt guilt and disgust after them. Therefore, in the absence of compensatory behaviors like vomiting or purging, Alice’s condition can be classified as mild BED, with one to three episodes of uncontrollable binge-eating per week.
Evidence of Functional Impairment
The analysis of Alice’s case reveals numerous facts about her functional impairment resulting from BED. First, she experienced a social impairment due to family conflict related to her binge eating. Alice’s mother was concerned about her behavior and recommended seeking mental health assistance, while Alice resisted such a solution. Second, Alice grew dissatisfied with her weight and developed obesity, which is a sign of her health-related impairment resulting from BED.
Rationale for BED Diagnosis
As one can see, Alice exemplified most symptoms associated with BED in line with the DSM-5 criteria for this disorder. She never engaged in compensatory behaviors typical for bulimia nervosa or anorexia nervosa, thus allowing the practitioner to exclude these alternatives during the differential diagnosis. Second, the patient experienced binge-eating episodes at least twice a week for the past four months, meeting the DSM-5 criterion for the duration and frequency of BED occurrence. Rapid eating, eating in the absence of hunger, and the following remorse also meet the DSM-5 criteria for BED.
Treatment
Cognitive-Behavioral Therapy (CBT) as a treatment option for BED
Though pharmacological treatments are popular in the treatment of BED, there is still a broad consensus about the psychosomatic basis of eating disorders. Therefore, a more popular method of approaching BED is cognitive-behavioral therapy (CBT), addressing the problem at a cognitive level and improving the patients’ condition through psychotherapy. Many clinical trials point to the effectiveness of CBT for BED treatment with populations of different demographics. For instance, the randomized controlled trial of Jackson et al. (2018) achieved long-term improvements in binge-eating frequency, weight, and overall functioning in a sample of Italian women with BED. The study’s participants underwent outpatient telemedicine psychotherapy sessions over the telephone and reported sustainable improvements in their BED symptoms at a one-year follow-up. The study of Hilbert et al. (2020) also found CBT effective in a clinical trial with adolescents with BED. Therefore, these findings suggest that CBT is an efficient non-pharmacological treatment option for individuals suffering from binge-eating disorder.
Rationale for Using CBT for BED
When comparing several treatment modalities for BED management, one should note that CBT is the most effective and convenient option for patients with eating disorders. First, it is a non-pharmacological treatment method, suggesting lower risks of non-compliance with the treatment regimen. Second, CBT targets the individuals’ psychopathology through a targeted change of cognition, which may result in sustainable improvements in binge-eating behaviors. Third, CBT is a broad-range therapy improving multiple domains of patients’ lives, such as self-esteem, well-being, and psychological resilience. Therefore, it is chosen as a preferred method for BED treatment due to its proven clinical efficiency, non-invasiveness, and broad outreach in mental health promotion terms.
References
Hilbert, A., Petroff, D., Neuhaus, P., & Schmidt, R. (2020). Cognitive-behavioral therapy for adolescents with an age-adapted diagnosis of binge-eating disorder: A randomized clinical trial. Psychotherapy and Psychosomatics, 89(1), 51-53. Web.
Jackson, J. B., Pietrabissa, G., Rossi, A., Manzoni, G. M., & Castelnuovo, G. (2018). Brief strategic therapy and cognitive behavioral therapy for women with binge eating disorder and comorbid obesity: A randomized clinical trial one-year follow-up.Journal of Consulting and Clinical Psychology, 86(8), 688-701. Web.