Binge eating disorder hidden behind a wall of anxiety disorders

Abstract

Presents case report of 23-year-old university student was initially seen for symptoms of longstanding social anxiety disorder (SAD). Her primary symptoms included excessive shyness and avoidance of peer-related activities, large family gatherings, speaking with authority figures, public speaking and class participation. She was particularly concerned about being negatively evaluated by others for her body weight, despite not being obviously obese (her body mass index was 28 kg/m2 ). She reported that 2 years prior, she had had a treatment trial of mirtazapine 30 mg/d; however, this resulted in a 25 lbs weight gain. Her current treatment at initial assessment was venlafaxine extended-release (ER) 225 mg/d, which she felt had little benefit for her anxiety. We elected to change her treatment to escitalopram, titrated to 20 mg/d, which substantially improved her social anxiety. She was able to participate in class, stopped avoiding social situations and performed well at school. Our patient was subsequently treated with LDX titrated to 50mg/d. Complete cessation of bingeing occurred within 4 weeks. Over the course of 5 months she lost 30 lbs without changing her diet. Around the 6-month mark, she reported experiencing significant stress from external life circumstances, but did not resume binge eating. BED is easily overlooked by clinicians while treating common comorbid conditions. Unlike the other eating disorders, BED is highly responsive to treatment with stimulants and often results in early, sustained remission. Our patient’s experience highlights the need to screen for BED in patients who struggle with weight management and who present with anxiety and mood disorder symptoms. (PsycInfo Database Record (c) 2022 APA, all rights reserved)