A 38-year-old female presents reporting episodes of eating unusually large amounts of food in a short period, feeling unable to stop or control what she eats. These episodes occur at least twice weekly and have persisted for 8 months. She describes eating rapidly, eating until uncomfortably full, eating alone due to embarrassment, and feeling disgusted and depressed afterward. She denies self-induced vomiting, laxative use, excessive exercise to compensate for the episodes, or fasting between episodes. Her BMI is 34.