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➤ Screening:
• Screen for Disordered Eating (SDE), Eating Disorders Screen for
Primary Care (EDSPC), Eating Disorder Inventory (EDI) and EAT.
• Sick (vomiting), Control (loss of control), One Stone (loss of ~15
pounds in 3 months), Fat (disturbance in body fat image), Food
(obsession with eating behavior) = SCOFF.
➤ Treatment:
• Cognitive behavior therapy and avoidance of restrictive eating
patterns, possibly in combination with drug treatment.
• Fluoxetine is an FDA-approved pharmacotherapy for bulimia
nervosa.
• Although not FDA-indicated for this use, topiramate and
naltrexone may be eff icacious in treating bulimia nervosa.
NES
➤ Diagnosis:
• At least 25% of daily food consumption (often greater than 50%)
consumed after evening meal.
• Recurrent awakenings f rom sleep that require eating to go back to
sleep, often involving carbohydrate-rich snacks.
• Little interest in breakfast (morning anorexia).
• NES may occur in as much as 1.5% of the U.S. population.
• Awareness of evening or nocturnal ingestions help differentiate
NES f rom SRED.
➤ Treatment:
• Behavioral therapy regarding nutritional timing and content.
• While not an indicated use, selective serotonin re-uptake inhibitors
(e.g., sertraline) or anti-migraine/seizure topiramate may be useful
for NES.
Sleep-Related Eating Disorder
➤ SRED is a parasomnia (undesired events accompanying
sleep) with "sleep-walking" resulting in repeated episodes of
compulsive binge eating and drinking after waking up at night.
• SRED usually occurs while partially awake and often with no
memory of the event afterward.
