Binge‑Eating Disorder
Recurrent binges (large intake + loss of control) with marked distress, ≥3 features (rapid eating, eating past fullness, eating when not hungry, eating alone from embarrassment, guilt/disgust), without the regular compensatory behaviours of bulimia. The absence of compensation is the defining separator. Commonly comorbid with obesity, depression, metabolic disease. First‑line CBT‑ED; lisdexamfetamine and SSRIs have evidence.
Pica
Persistent eating of non‑nutritive, non‑food substances, developmentally inappropriate. Associations: iron/zinc deficiency, pregnancy, intellectual disability/ASD, psychiatric illness. Investigate rather than assume a single cause; screen for complications (lead toxicity from paint/soil, GI obstruction, parasitic infection) and correct deficiencies.
Discriminators
- BED vs bulimia: compensation present (bulimia) vs absent (BED).
- Pica vs OCD/psychosis‑driven ingestion: context and intent.
Pitfalls
- Assuming "pica = iron deficiency" and missing lead toxicity/obstruction.
Pearls
- 🎯 BED is defined by the absence of compensation.
- 🩺 Pica mandates a cause hunt (Fe/Zn, lead, GI complications), not a guess.
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