NU671 Unit 2 Binge Eating Developmental Course Example

From Skipped Lunches at Thirteen to Night-Shift Binges at Twenty-Four: A Developmental Course Summary of Binge Eating Disorder

[Student Name]

Purdue University Global

NU671: PMHNP Psychopathological Disorders and Psychotherapy

Unit 2 Developmental Course Summary

[Instructor Name]

[Date]

The patient is composite; ages and details are bracketed. Evidence strength is noted at each stage.

The Patient Today

Ms. [T.], [24], stocks shelves on the overnight shift at a discount store. Two or three times a week, after her shift ends at [07:00], she buys food on the way home and eats rapidly, alone, until she feels painfully full, then sleeps through the afternoon. She describes the episodes as "a switch flipping" and feels disgusted with herself afterward. She does not vomit or use laxatives, and she does not exercise to compensate. Her body mass index is [34]. She meets criteria for binge eating disorder: recurrent episodes of eating an unusually large amount with a sense of loss of control, marked distress, and no regular compensatory behavior.

She sought help not for the eating but for low mood and poor sleep. Like most people with the disorder, she had never been asked about binge eating. In a national survey of American adults, binge eating disorder had a lifetime prevalence of [3.5] percent in women and [2.0] percent in men, was associated with severe obesity and with many other psychiatric disorders, and only a minority of people with it had ever sought treatment for it (Hudson et al., 2007).

Stage One: Early Risk, Ages Eight to Twelve

At [eight], classmates called her names about her size, and at home her mother and older sister were often dieting. She remembers being told to have a smaller portion than her brothers. At [11] she began eating in secret at her grandmother's house after school.

Evidence note: weight-related teasing and a family focus on dieting are commonly described in the histories of people with binge eating, but most of that evidence comes from retrospective reports and cross-sectional studies, so these are best treated as risk markers rather than established causes. The stage is included because it shapes how she came to see food and her body, not because it predicts the disorder with any precision.

Stage Two: Dieting, Ages Thirteen to Fifteen

At [13] she began skipping breakfast and lunch to lose weight, eating little until dinner. She lost [5] kg that year, regained it the next, and started again. This pattern of restriction followed by regain continued through high school.

Evidence note: this is the stage with the strongest prospective support. In Project EAT, adolescents followed for five years, those who used unhealthful weight-control behaviors such as skipping meals were at about six times greater risk of later binge eating with loss of control than those who did not, with an odds ratio of [6.4] in girls; they also gained more weight (Neumark-Sztainer et al., 2006). Her skipped lunches were intended to prevent weight gain, and the best prospective evidence suggests they did the opposite, setting up the binges that followed.

Stage Three: Onset, Ages Sixteen to Nineteen

At [16], after a breakup, she ate most of a family-size box of cereal and a sleeve of cookies late at night and felt unable to stop. Episodes like this happened every few weeks through the rest of high school, usually after a restricted day or an emotional event. By [19], after moving out, they happened weekly.

Evidence note: in an eight-year prospective study of young women, the peak age of onset for binge eating disorder was [18 to 20], and a notable share of those with subthreshold binge eating went on to the full disorder, [28] percent, suggesting an escalation process for binge eating in particular (Stice et al., 2013). Her course, from occasional episodes to weekly ones by [19], fits that pattern. The strength here is moderate: the study followed young women in one community, and progression rates may differ elsewhere.

Stage Four: Maintenance, Ages Twenty to Twenty-Four

Several things now keep the pattern going. She restricts during her shift, eating little because she is busy and self-conscious in the break room. She arrives home exhausted and hungry at the time of day when her mood is lowest. Night work disrupts her sleep and appetite, and she is isolated from friends who keep day hours. After a binge she feels ashamed, resolves to eat less the next day, and the cycle restarts.

Evidence note: the same prospective study found that one-year remission was common for binge eating disorder, but that recurrence was also high, about a third (Stice et al., 2013). That fits a disorder that comes and goes with circumstances, which her history also shows: she had a four-month period without binges during a daytime job at [21].

What the Timeline Suggests for Care

Reading her history as a timeline changes the plan in three ways. First, restriction is part of the problem, so advice to diet, which she has received from two clinicians, is likely to make it worse; regular eating across the night shift, including a planned meal at [02:00], is a first target. Second, the episodes cluster at a predictable time, after work, when she is tired and alone, which gives treatment a specific place to intervene. Third, her low mood and sleep problems are intertwined with the eating and deserve treatment alongside it, not after it.

Cognitive behavioral therapy for binge eating, which begins by establishing regular eating and then addresses triggers and self-evaluation, is the treatment most consistent with this course. Her weight should not be the main measure of progress; the frequency of binges and her sense of control are.

How the Timeline Was Built

The history was gathered over two sessions. The first used open questions about her eating at each school stage, prompted by landmarks she remembered well: her grandmother's house, the move to high school, the first job after graduation. The second checked the timeline against a few external anchors, such as the year of the breakup and the months of the daytime job, because retrospective accounts of eating are easily compressed or rearranged. Her sister, with her permission, confirmed the family dieting and the teasing. Building the timeline together also had a clinical effect: seeing the pattern laid out, she said for the first time that the binges "make sense," which she found less shaming than thinking of them as a lack of willpower.

Limits of the Summary

Each stage draws on different kinds of evidence, and the early stages are the weakest. A developmental timeline also risks making the course look inevitable, when many teenagers who diet never develop the disorder and many adults recover. The summary is a way of organizing her history for treatment planning, not a proof of how her disorder arose.

References

Hudson, J. I., Hiripi, E., Pope, H. G., Jr., & Kessler, R. C. (2007). The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biological Psychiatry, 61(3), 348-358. https://doi.org/10.1016/j.biopsych.2006.03.040

Neumark-Sztainer, D., Wall, M., Guo, J., Story, M., Haines, J., & Eisenberg, M. (2006). Obesity, disordered eating, and eating disorders in a longitudinal study of adolescents: How do dieters fare 5 years later? Journal of the American Dietetic Association, 106(4), 559-568. https://doi.org/10.1016/j.jada.2006.01.003

Stice, E., Marti, C. N., & Rohde, P. (2013). Prevalence, incidence, impairment, and course of the proposed DSM-5 eating disorder diagnoses in an 8-year prospective community study of young women. Journal of Abnormal Psychology, 122(2), 445-457. https://doi.org/10.1037/a0030679