Compulsive hunger, the patient who eats through obsession-compulsion

appunti del dott. Claudio Italiano

Definition 

In general, the compulsive need to ingest large quantities of food is a symptom perceived on a subjective level and, in practice, is not definable; if it is subjective or not, the physician must decide on the basis of the impression he receives from the patient of his personality. According to a proposal by the American Psychiatric Association, the explosions of uncontrolled food conduits ("binge eating disorder") are characterized by:
• Introduction of excessively large quantities of food in a short time
• Loss of control while eating. At least three of the following criteria must be met:
- Eat very fast.
- Eat up to feel bad.
- Eat large quantities of food even without feeling hungry and away from meals.
- Eat yourself.
- Anxiety, boredom or depression as triggering agents of explosions of uncontrolled food behavior.
- Feelings of guilt, disgust and loss of self-esteem or depression after an attack of uncontrolled eating behavior.
- Continuous fight against food disorder.
- Explosions of uncontrolled food behavior at least two weeks per week over a period of 6 months. Clinical aspect of the predominant symptom:
• Uncontrolled feeding explosions:
• Nighttime eating syndrome: (25-50%) of the daily caloric intake occurs after dinner and overnight. May possibly arise in sleep apnea syndrome following a change in circadian rhythms and mood swings induced by sleep deficits
• Bulimia nervosa: bursts of uncontrolled feeding with the addition of other symptoms: self-induced vomiting, abuse of laxatives or diuretics, taking other drugs, enemas, excessive sports activities fixed thinking about food and body weight.
• Anorexia nervosa: refusal to maintain body weight at least to a minimum level, distorted perception of the weight and proportions of the body, constant anxiety to become "fat". Eventually, disorders of the cycle and amenorrhea arise and a so-called low-T3-syndromc can be increased with laboratory tests; in advanced cases, a low-T / TSH-syndrome also appears.

Epidemiology

Uncontrolled eating habits are the most common eating disorder and occur in up to 30% of overweight and obese people.
- Basic diagnostics
- history

• Inquire about any symptoms of hyperthyroidism: nervousness, diarrel sweating.
• Weight loss? (indication of hyperthyroidism, Addison's disease)
• Weight gain? (indication of bulimia, insulinoma).
• Episodes of uncontrolled psychogenic food behavior: the anamnesis I based on the nutritional status of relatives and relatives, on the eating habits and drinking of the patient, on the possible explosions of uncontrolled feeding and on the attempts at diet carried out until that moment, etc. in addition, the food behavior can be collected on the basis of a questionnaire according to Pudel and Westenhofer (Pudel, MG, Westenhofer J .: Questionnaire on food behavior: instructions Hogrefe, Gςttingen 1989), completed with the drafting of a 7-day food protocol which presupposes, however, the patient's collaboration and sincerity.

Objective examination

• Body-mass-index assessment.
• Obesity? (eunucidus? Cushingoide?).
• Signs of hyperthyroidism (sweating, tremor, hair loss, exophthalmos in Basedow's disease).

Laboratory tests:

 in case of normal / underweight weight: basal TSH, glycemia, stool analysis for the identification of worm eggs.
Specialized diagnostics
Suitable procedures to be implemented in the diagnostic suspect and / or in the differential diagnosis
- exclude bulimia nervosa
- hyperthyroidism
- nervous anorexia
- consider the hunger that arises in hypoglycemia conditions
- adrenal insufficiency
- insulinoma

Provocation test (insulinoma, insulin autoantibody syndrome).
Test with ACTH (Addison's disease).
In case of underweight: other diagnostic measures

Differential diagnosis
Remember: in the case of endocrine diseases such as hyperthyroidism and hypoglycaemia, in cases of insulinoma, primary adrenal insufficiency (Addison's disease) or secondary adrenal insufficiency, episodes of uncontrolled eating behavior may occur

indice di psichiatria