Discussion of Eating and Buying

Discussion of “Eating and Buying”

Ms. Farber enters the hospital when she can see no way out of her escalating personal difficulties. She apparently has a Major Depressive Episode, with symptoms of depressed mood, overeating, oversleeping, and loss of energy and interest. In the absence of a history of a prior episode, on Axis I we would diagnose Major Depressive Disorder, Single Episode (DSM-IV, p. 344). However, in this case her depression is only the tip of the iceberg.

She has long-standing problems with eating and spending. The recurrent binge eating, without the compensatory behaviors associated with Bulimia Nervosa, indicate Binge-Eating Disorder, an Axis I diagnosis that is included in a DSM-IV appendix for diagnoses requiring further study (DSM-IV, p. 731), and listed as an example of Eating Disorder Not Otherwise Specified. Like most people with Binge-Eating Disorder, she is overweight and has a history of marked weight changes.

Her financial problems are the result of an inability to resist what she calls “buying binges,” which somehow alleviate her feelings of emptiness and sadness. Although there is an antisocial quality to much of her behavior, she has no history of childhood antisocial behavior or other evidence of Antisocial Personality Disorder. Our official classification does not recognize a pathological spending disorder (perhaps analogous to Pathological Gambling), although there is a self-help group, Debters Anonymous, for people with this problem. Like many people who have trouble controlling impulses, Ms. Farber now has serious legal problems resulting from the consequences of her behavior.

It is likely that an underlying personality disorder fuels her binge eating and binge buying. She has the characteristic features of the Axis II diagnosis of Borderline Personality Disorder (DSM-IV, p. 654): uncertainty about who she is and with whom she wants to be, chronic feelings of emptiness, intense and unstable interpersonal relationships, inappropriate and intense anger, and impulsivity (eating and buying). As is often the case with people with Borderline Personality Disorder, there are memories of childhood physical abuse.

We would note Ms. Farber’s being overweight on Axis III, and her employment and financial problems on Axis IV. Since she has suicidal ideation and has been too depressed to work, we would give an Axis V GAF rating of 35.

Multiaxial Evaluation

Axis IMajor Depressive Disorder, Single Episode

Eating Disorder Not Otherwise Specified (Binge-Eating Disorder)

Axis IIBorderline Personality Disorder

Axis IIIOverweight

Axis IVUnemployed, financial problems

Axis VGAF = 35 (current)

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