Page 79 Complete Your CE Test Online - Click Here is definitely larger than what most people would eat in a similar period of time and under similar circumstances. Affected persons feel a lack of control over their binge-eating behaviors. They believe that they cannot stop eating or control what or how much they eat. ● ● The episodes of binge-eating must be associated with at least three or more of the following: ○ ○ Eating much more quickly than normal. ○ ○ Eating until feeling uncomfortably full. ○ ○ Eating large amounts of food when not feeling physically hungry. ○ ○ Eating alone because of feelings of embarrassment over how much is being eaten. ○ ○ Feeling disgusted, depressed, or very guilty after binge-eating. ○ ○ Affected persons feel marked distress regarding their binge- eating. ● ● Binge-eating occurs, on average, at least once a week for three months. ● ● Binge-eating is not associated with the repeated use of compensatory behaviors as is found in bulimia nervosa. Binge- eating does not occur exclusively during the course of bulimia nervosa or anorexia nervosa. ● ● In addition to meeting the preceding diagnostic criteria, it is important to determine if the disease is in remission, and if it is, the remission partial or full. The DSM-5 describes remission in the following ways[1] : ○ ○ Partial remission: After full criteria for binge-eating disorder were previously met, episodes of binge-eating occur at an average frequency of less than one episode per week for a sustained period of time. ○ ○ Full remission: After full criteria for binge-eating disorder were previously met, none of the criteria have been met for a sustained period of time. The DSM-5 also describes levels of severity based on the frequency of binge-eating episodes[1] : ● ● Mild: There are one to three binge-eating episodes per week. ● ● Moderate: There are four to seven binge-eating episodes per week. ● ● Severe: There are eight to 13 binge-eating episodes per week. ● ● Extreme: There are 14 or more binge-eating episodes per week. Nursing consideration: Characteristically, persons with binge-eating disorder are ashamed of their eating behaviors and try to conceal their symptoms[1] . This concealment can make recognition of the disease a challenge. Healthcare professionals must be on the alert for behaviors, signs and symptoms that indicate the existence of binge- eating disorder. Treatment The treatment goals for persons suffering from binge-eating disorder are to reduce eating binges, improve emotional well-being and self-esteem, and, as needed, to lose weight. Because binge-eating is so often linked to negative self-image and other psychosocial issues, it is important to address the emotional as well as the physical impact of binge eating[22] . Psychotherapy Psychotherapy can be conducted in individual and/or group therapy sessions. Therapy may also include family members as indicated. Cognitive behavioral therapy (CBT) is generally recommended as a treatment initiative for persons with eating disorders[12] . Cognitive therapy concentrates on immediate processing of thoughts and feelings. Emotions of sadness, depression, anxiety, and anger are reactions to the environment in which the person lives[12] . Some facets of CBT as they relate to binge-eating disorder and other eating disorders include the following initiatives: ● ● Identification of issues that trigger binge-eating episodes. Examples of such issues are negative feelings about one’s body, work, school, or family-related stressors, or co-existing conditions such as depression[12,20,21,22] . ● ● Learning coping strategies to deal with negative feelings and triggering stressors[1,20,22] . ● ● Learning ways to regain a sense of control over one’s life, including binge-eating behaviors[12,20,21,22] . Interpersonal psychotherapy concentrates on the individual’s current relationships with other people including family, friends, and co-workers. The goal of interpersonal psychotherapy is to improve interpersonal skills, meaning how one relates to others. This type of therapy may help to reduce binging that is triggered by poor communication skills, unhealthy patterns of interaction, and poor interpersonal relationships[22] . Dialectical behavior therapy focuses on techniques to help increase stress tolerance, and is aimed to improve relationships and regulate emotions. This may help to decrease binge-eating episodes, since triggering factors are often negative emotions and unhealthy relationships[22] . Medications Antidepressants such as selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) may be prescribed. These kinds of drugs may help to reduce feelings of depression and negative thought patterns. For persons who have a co-existing diagnosis of depressive disorder, antidepressants may be a form of long-term therapy. Children, adolescents, and young adults should be monitored for suicidal ideation, which has been linked to antidepressant therapy in these age groups[7,12,21,22] . The first FDA approved medication for the treatment of moderate to severe binge-eating disorder is lisdexamfetamine (Vyvanse), which acts by curbing the binge-eating episodes. This medication is taken in conjunction with the interventions of a psychologist or psychiatrist[20] . Another medication that has been used with some success for treatment of binge-eating disorder is Topamax. Topamax (topiramate) is an anticonvulsant normally used to control seizures. However, clinical findings indicate that this medicine can also decrease the urge to binge in people who have binge-eating disorder. It may also reduce appetite and assist with weight loss[24] . FDA has issued a warning for Topamax and some other seizure medications about the risk of suicide and suicidal ideation. It is recommended that clients taking these drugs be monitored closely for warning signs of suicidal thoughts and behaviors[24] . Self-help initiatives Self-help initiatives such as self-help books, self-help manuals, DVDs, online programs, and support groups may prove to be helpful for some people. Some of these initiatives can be used independently, while others may need guidance from mental health professionals[20] . Nutritional intake Clients should avoid attempting to change their nutritional intake without help. The assistance of a professional nutritional counselor (in conjunction with medical supervision) can help clients learn how to eat in a healthy manner and to lose excess weight without triggering binge eating[20] . Nursing consideration: Self-help initiatives should not be used in isolation. Professional treatment with psychotherapy and/or medications is usually needed as well[20] .