Page 78 Complete Your CE Test Online - Click Here General signs and symptoms Leslie works as a nurse practitioner in a busy family practice setting. One of her clients, a 16-year-old adolescent named Marcie, is moderately overweight. Marcie’s parents are concerned about their daughter’s eating habits. They tell Leslie that Marcie often eats to the point that she complains of stomach pains. They also point out that Marcie continues to eat even though she tells them she is full. Leslie decides to meet privately with Marcie. She suspects that Marcie may have an eating disorder, most likely binge-eating disorder. Unlike anorexia nervosa or bulimia, there are no obvious physical signs or symptoms (at least initially) of binge-eating disorder, especially if the affected individual is of normal weight or is only slightly overweight. Here are some types of behaviors that are characteristic of binge-eating disorder[1,20,22] : ● ● Frequent episodes of eating abnormally large amounts of food. ● ● Feelings of not being able to control what or how much is eaten. ● ● Eating when full or not hungry. ● ● Eating very rapidly. ● ● Eating until uncomfortably full, sometimes to the point of having epigastric and gastric pain. ● ● Often eating alone because of feelings of embarrassment over the amount of food that is being eaten. ● ● Feelings of embarrassment, disgust, depression, or guilt after binging. ● ● Feelings of isolation and loneliness. ● ● Having difficulty talking about the feelings associated with binging as well as the feelings that may trigger binging. ● ● Having low self-esteem. ● ● Having frequent fluctuations in weight. ● ● Frequent dieting, but often without losing weight. ● ● Repeatedly losing and gaining weight. ● ● Loss of sexual desire. Nursing consideration: These symptoms are not readily apparent during a routine physical examination. Affected persons may simply be told to lose weight and are placed on a weight reduction diet. Nurses must delve deeper into the reasons behind weight gain. A thorough physical and mental health assessment may reveal the existence of serious eating disorders[20,21,22] . Assessment of persons suspected of having binge-eating disorder should address the following issues. Although these issues are not signs and symptoms, they may provide clues as to how great is the risk for binge- eating disorder or other eating disorders. It is important that nurses and other healthcare professionals have open, honest discussions about the issues surrounding binge-eating disorder and other eating disorders. It should be determined if[1,20,22] : ● ● There is a family history of eating disorders. ● ● There is personal history of physical or sexual abuse. ● ● Family eating habits encourage the intake of large meals or if food is used as a source of comfort or reward. ● ● Family members are overweight or obese. PATHOPHYSIOLOGY AND COMPLICATIONS RELATED TO BINGE-EATING DISORDER The pathophysiology of binge-eating disorder is primarily related to complications associated with weight gain. Here are some complications that may be caused by, or associated with, excessive weight due to binge-eating disorder[20,22] . Hypertension Hypertension is defined as an intermittent or sustained elevation in diastolic or systolic blood pressure[9] . About 25% of adults in the United States have hypertension, which if left untreated is associated with a high mortality rate. Obesity is a significant risk factor for hypertension [9] . Hypertension itself is linked to a number of significant complications such as stroke, heart attack, renal problems, coronary artery disease, and sudden death. Since being overweight or obese can be a consequence of binge-eating, hypertension and its complications may also be linked to this eating disorder[20,22] . Elevated cholesterol Being overweight or obese is linked to elevated cholesterol. In turn, elevated cholesterol is linked to an increased risk for cardiovascular disease[9] . Cardiovascular disease Obesity has long been recognized as a contributing factor for the development of heart disease. Hypertension and elevated cholesterol, already mentioned as part of the pathophysiology of obesity due to binge eating, contribute to the risk for cardiovascular disease. Research shows that abdominal fat deposits increase this risk even more. Risk is correlated with a waist measurement greater than 40 inches in men and greater than 35 inches in women[23] . Type 2 diabetes Type 2 diabetes, formerly referred to as non-insulin dependent diabetes, is the more prevalent form of diabetes. Research shows that this type of diabetes may develop as a consequence of obesity[23] . Gallbladder disease The development of gallbladder disease is associated with obesity as well. Intake of high-fat, high-calorie foods may precipitate or trigger various types of gallbladder disease[9,23] . Additional factors that may be looked upon as pathophysiology related to binge eating include the following issues: ● ● Diet concerns: Binge eating may involve the intake of foods that are high in saturated fats, carbohydrates, and salts. All of these kinds of foods contribute to weight gain. They also contribute to heart disease and elevate the risk of developing type 2 diabetes. Dental problems may also occur if high-fat, high-carbohydrate foods are frequently ingested without proper dental hygiene[9,23] . ● ● Sleep disorders: Feelings of concern about weight and physical appearance, disgust with their own binge-eating behaviors, and the stress extra weight can put on respiratory muscles all combine to make sleep disorders a possibility[9,22,23] . ● ● Suicidal ideation and depression: Clients with binge-eating disorder should be assessed and monitored for depression. Increases in appetite and weight gain are included in the criteria for major depressive disorder, as previously noted. Feelings of depression and self-disgust are quite common in persons who suffer from binge- eating disorder[1,20,22] . Diagnostic criteria The following statements summarize the diagnostic criteria for binge- eating disorder as identified by the DSM-5[1] : ● ● There are recurrent episodes of binge-eating. Binge-eating is defined as eating in a specific period of time an amount of food that