Page 77 Complete Your CE Test Online - Click Here anxiety. Gloria feels that she has little or no control over her life or over her eating habits. Like many of her family members, Gloria frequently overeats. Lately, her over-eating has reached unhealthy proportions. Gloria has begun to binge in secret. The exact cause of binge-eating disorder, like other eating disorders, is unknown. However, experts are beginning to identify the issues that lead to its development. These issues are a combination of psychological, biological, and environmental factors[20] . Binge-eating disorder tends to run in families[20,21] . Therefore, a family history of the disorder makes someone more vulnerable to its development. Although genetics may very well play a role in the development of binge-eating disorder, it is also likely that people with the disease come from families that overeat or place unusual or unnatural emphasis on food. For instance, food may have been used as a reward, a way to provide comfort, or as a means of coping with problems, stress, and anxiety[20,21] . Other factors that increase risk and are being investigated as contributing to the development of binge-eating disorder include[1,20,21] : ● ● Age: Binge-eating disorder often starts in a person’s late teens or early 20s, but people of any age can develop binge-eating disorder. ● ● Brain chemicals and metabolism: Researchers are studying how brain chemicals and metabolism may affect the development of binge-eating disorder. ● ● Dieting: Many people affected by binge-eating disorder have a history of frequent dieting, sometimes starting in childhood. Dieting may increase the need to binge eat. This seems to be especially true if the client has a history of depression or substance abuse. ● ● Psychological issues: The majority of people with binge-eating disorder are overweight and quite self-conscious about their appearance. They may use binging as a way to deal with stress, but they feel that they have little or no control over these inappropriate behaviors. Affected persons do not have healthy ways of coping with anger, stress, worry, anxiety, or even boredom. They may also have a history of depression and/or substance abuse. ● ● Family history: A family history of eating disorders increases risk. There may be genetic influences that contribute to the development of eating disorders. Nursing consideration: Some clients with eating disorder have been victims of emotional or physical abuse or have a history of substance abuse[20] . Nurses must be aware of the danger of eating disorder development in persons with these issues. Healthcare professionals, some of which are experts in the field of eating disorders, question whether or not it may be possible to prevent the development of binge-eating disorder. Although prevention may not be possible, teaching and encouraging healthy eating habits and realistic attitudes about food, body image, and self-perception at an early age (and continuing throughout school and college years) may help to prevent the development or exacerbation of the disease[1,20,21] . Clinical presentation Gerald has been slightly overweight since he was a child. He is now 30 years old, and his wife, who is an RN, is encouraging him to lose weight. She is concerned that he is gaining weight and often eats excessively large meals at a rapid pace. Gerald’s wife has heard colleagues discuss binge-eating disorder and she asks them to explain the essential characteristics of the disease. The DSM-5 describes several characteristics or features that are seen in people who suffer from binge-eating disorder[1] : ● ● Recurrent episodes of binge eating. ● ● Binge-eating is associated with eating more rapidly than normal, until feeling uncomfortably full, eating large amounts of food when not actually hungry, eating alone, and feeling disgusted by binging behaviors. ● ● Significant distress associated with binging. ● ● Binge eating occurs at least once a week for three months. ● ● Purging behaviors are not present. OTHER DISORDERS AND BINGE-EATING DISORDER It is important to be able to differentiate between binge-eating disorder and other diseases or problems. Binging may be part of other health issues, but not necessarily part of the diagnostic criteria for binge-eating disorder. Obesity and binge-eating disorder Binge-eating disorder is associated with being overweight and obesity. There are several features that nurses should be aware of as they relate to binge-eating disorder[1] : ● ● Intensity of over-valuation of body weight and shape are higher in obese persons with binge-eating disorder than in obese persons without the disorder. ● ● Rates of co-existing psychiatric disorders are significantly higher among obese individuals with the disorder than in those without it. ● ● The long-term successful outcomes of evidence-based psychological treatments for binge-eating disorder can be contrasted with the absence of effective long-term treatments for obesity. Bulimia nervosa It is important to be able to distinguish between bulimia nervosa and binge-eating disorder. Here are some distinguishing characteristics[1] : ● ● Purging behaviors (i.e. self-induced vomiting, laxative abuse) present in bulimia nervosa are not present in binge-eating disorder. ● ● Unlike those persons with bulimia nervosa, individuals who suffer from binge-eating disorder typically do not show “marked or sustained dietary restriction designed to influence body weight and shape between binge-eating episodes[1] .” However, they may report frequent attempts to diet. ● ● Response to treatment also differs among those who have bulimia nervosa and those who have binge-eating disorder. Rates of improvement are consistently higher among individuals with binge- eating disorder than among those with bulimia nervosa[1] . Bipolar and depressive disorders Both appetite increase and weight gain are part of the criteria for major depressive episode and in the atypical features specified for depressive and bipolar disorders. Binge eating and other symptoms of disordered eating are found in association with bipolar disorders. If complete criteria are met for both disorders, both diagnoses are given and the disorders are considered to co-exist[1] . Borderline personality disorder Binge eating is included as part of the impulsive behavior criterion that is part of the definition of borderline personality disorder. If all criteria are met for both disorders, both diagnoses are given[1] . Nursing consideration: Binge-eating disorder is associated with significant co-existence of other mental health disorders (as are anorexia nervosa and bulimia nervosa). The most common co- existing disorders are bipolar disorders, depressive disorders, anxiety disorders, and to a lesser extent, substance use disorders. Note that the co-existence of other conditions is linked to the severity of the binge eating and not to the extent of the obesity[1,21] .