This patient's recurrent episodes of binge eating (ie, consuming an excessively large amount of food in a discrete period) associated with a sense of lack of control are consistent with binge eating disorder (BED).  In BED, feelings of disgust, guilt, or depression commonly follow a binge, and this patient's report of weight dissatisfaction is typical.  BED is differentiated from bulimia nervosa by the absence of compensatory behaviors (eg, self-induced vomiting, fasting, misuse of laxatives, excessive exercise) (Choice D).

BED is the most common eating disorder and occurs more commonly in women.  Although patients with BED are more likely to be obese, it also occurs in those with normal weight, such as this patient.  Treatment approaches include psychotherapy, behavioral weight loss therapy, and pharmacotherapy.

(Choice A)  Anorexia nervosa is characterized by significantly low weight, intense fears of being fat despite being underweight, and distorted body image.  The disorder can be subtyped as restricting or binge/purge type.

(Choice C)  Patients with body dysmorphic disorder are obsessively preoccupied with nonexistent or slight defects in physical appearance.  It is not diagnosed in patients whose main concern is weight and who also meet criteria for an eating disorder.

(Choice E)  Although cannabis use is associated with increased appetite, this patient smokes marijuana only once a week, whereas her binges occur several times a week.

Educational objective:
Binge eating disorder is the most common eating disorder.  It is differentiated from bulimia nervosa by the absence of compensatory behaviors (eg, self-induced vomiting, excessive exercise).