Guidelines for hypertension management include defining blood pressure categories as follows (American College of Cardiology, 2017): ● Normal: Less than 120/80 mm Hg ● Elevated: Systolic between 120 and 129 and diastolic less than 80 mm Hg ● Stage 1: Systolic between 130 and 139 or diastolic between 80 and 89 mm Hg ● Stage 2: Systolic at least 140 or diastolic at least 90 mm Hg ● Hypertensive crisis: Systolic over 180 or diastolic over 120 mm Hg Hypertension itself is linked to a number of significant complications, including stroke, heart attack, renal problems, coronary artery disease, and sudden death. Because being overweight or obese can be a consequence of binge eating, hypertension and its complications might also be linked to this eating disorder (Mayo Clinic, 2018f; WebMD, 2017b). Elevated Cholesterol Being overweight or obese is linked to elevated cholesterol. In turn, elevated cholesterol is linked to an increased risk for cardiovascular disease (Gersch et al., 2017). 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 caused by binge eating, contribute to the risk for cardiovascular disease. Research has shown 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 (Gersch et al., 2017). Type 2 Diabetes Type 2 diabetes, formerly referred to as noninsulin dependent diabetes, is the more prevalent form of diabetes. Research has shown that this type of diabetes may develop as a consequence of obesity (Rebar et al., 2019). 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 (Rebar et al., 2019). Additional factors that are 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 can also occur if high-fat, high-carbohydrate foods are frequently ingested without proper dental hygiene (Gersch et al., 2017; Rebar et al., 2019). 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 for clients (Gersch et al., 2017; Rebar et al., 2019). Suicidal Ideation and Depression Clients with binge-eating disorder should be assessed and monitored for depression. Increases in appetite and weight gain are 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 (Gersch et al., 2017; Rebar et al., 2019). Diagnostic Criteria The following statements summarize the diagnostic criteria for binge-eating disorder as identified by the DSM-5 (American Psychiatric Association, 2013):
There are recurrent episodes of binge eating. ● The episodes of binge eating must be associated with at least three 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 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, if the remission is partial or full. The DSM-5 describes remission in the following ways (American Psychiatric Association, 2013): ● 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. ● Full remission: After full criteria for binge-eating disorder were previously met, none of the criteria has been met for a sustained period. The DSM-5 also describes levels of severity based on the frequency of binge-eating episodes (American Psychiatric Association, 2013): ● Mild: 1 to 3 binge-eating episodes per week ● Moderate: 4 to 7 binge-eating episodes per week ● Severe: 8 to 13 binge-eating episodes per week ● Extreme: 14 or more binge-eating episodes per week. 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, 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 (Mayo Clinic, 2018f). Psychotherapy Psychotherapy can be conducted in individual 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 (Videbeck, 2017). 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 (Videbeck, 2017). Some facets of CBT as they relate to binge-eating disorder and other eating disorders include the following initiatives (Mayo Clinic, 2018f; Videbeck, 2017; WebMD, 2018): ● 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 coexisting conditions such as depression ● Learning coping strategies to deal with negative feelings and triggering stressors ● Learning ways to regain a sense of control over one’s life, including binge-eating behaviors Interpersonal psychotherapy concentrates on the individual’s current relationships with other people. 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
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