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Original Question
Valentina Guzman (she, her, hers), a 29-year-old Latina woman, presents at your clinic. Vitals Name: Valentina Guzman Sex assigned at birth: Female Gender: Woman Height: 5 ft, 6 inHeight: 5 feet 6 inches Weight: 222 pounds Age: 29 Chief Complaint: “If I had a better handle on my night-time eating, I could lose enough weight to have this bariatric surgery.” HPI Patient complains of unconscious nocturnal eating behaviors that started 10 years ago. Initially, she was able to partially recall the nocturnal binges (reportedly would eat peanut butter and uncooked spaghetti), but over the past year she has no recollection of these episodes the following morning. Has had chronic insomnia for 5 years and has been taking zolpidem (Ambien) for 5 years, which has been helpful. Denies binge episodes during the day. Denies compensatory behaviors such as purging, laxatives, or excessive exercise. History Medical history: GERD, PCOS Surgical history: Gall bladder removal Psych history: Was treated for a single major depressive episode in the past. Took quetiapine (Seroquel) for sleep, which worked well, but weight loss doctor advised against it so stopped. Family psych history: Mother: bulimia Social history: Divorced 10 years ago, no children, works full-time; no current or previous alcohol use, illicit substance use, or tobacco use Reproductive: Has Nexplanon implant, no period in over a year Current Medications Zolpidem (Ambien) 10 mgMilligram at bedtime Omeprazole (Prilosec) 40 mgMilligram daily Tests Overnight polysomnography: Recurrent confusional arousals arising from non-REM sleep and eating binges while asleep with no subsequent recall Thyroid panel: WNL What is the likely diagnosis for Valentina? Nocturnal Eating with Amnesia: Valentina reports unconscious nocturnal eating behaviors, initially with partial recall, but recently with no subsequent recall. This aligns with SRED, where individuals have little or no memory of the eating episodes. Feedback: Sleep-related eating disorder is the most likely diagnosis. What is one differential diagnosis for Valentina?
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