Medical treatment and support for binge eating disorder

Did you know? Binge eating disorder was originally identified by researcher and psychiatrist Albert Stunkard in 1959 but it was only in 2013 that this disorder was considered a formal diagnosis in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders.

Since then more awareness has been raised and specialised training has become available for those who develop and suffer from the disorder. This means that recovery is possible and more people may now receive effective treatment plans.

The nature of a binge eating disorder can be quite debilitating, breaking down a person’s quality of life, and in extreme circumstances, is potentially life-threatening. This is why a professional diagnosis and personalised treatment plan is essential.

Treatment will involve a combination of approaches conducted individually and in a group setting, with the focus being both medical and nutritional needs based. A team of healthcare professionals may also be recommended. A person will be closely monitored and treated by their primary physician (GP), psychotherapist (or psychiatrist) and a nutritionist.

All professionals involved will work to assist a person in:

• Ceasing binge eating
• Understanding, managing and coping with the emotional, psychological and physical effects of binging
• Developing achievable steps to attaining long-term recovery

For many, initial treatment may be done on an outpatient basis. For others, intensive inpatient therapy is required at a specialised treatment facility for eating disorders, especially for those with severe signs of depression who may be battling with suicidal thoughts.

Treatment may involve the following options:

• Cognitive behavioural therapy (CBT): Talk therapy sessions may be recommended to help a person to focus on how to handle their condition, manage healthy coping mechanisms and better understand how they feel. Sessions will be structured to work through changing negative thought patterns (personally and in relation to food consumption) and get to grips with triggering elements that result in binge episodes. This can help a person to gain a better sense of control over their own behavioural patterns and learn to develop healthier eating patterns. A doctor may also recommend interpersonal psychotherapy (also known as attachment-focussed psychotherapy) sessions which are structured to focus on resolving interpersonal problems in order to achieve symptomatic recovery. Sessions strive to assist in healthier relationship building with others and improve overall interpersonal skills in the home, workplace, school and among friends. This is especially beneficial if a person is strongly influenced by unhealthy communication skills and poor-quality relationships, resulting in binge urges. Behavioural skills targeted at helping a person cope with and tolerate stress can also be achieved with dialectical behaviour therapy sessions. This can also help to improve a person’s ability to manage and maintain relationships with others by gaining better control of their emotions.
• Medications: There are no FDA (U.S Food and Drug Administration) approved medications specifically for binge eating disorder alone. A doctor may likely prescribe medications, such as antidepressants (selective serotonin reuptake inhibitors / SSRIs) which can help with symptoms of mental health conditions, such as anxiety or depression (alleviating negative mood effects). Antidepressants can thus assist in managing a person’s urge to binge by targeting brain chemicals associated with emotional and psychological triggers. Brain chemicals are closely linked with mood, appetite and impulse control. Binge eating urges may also be treated with anticonvulsant medications, normally prescribed to control seizures. If a person’s excess weight is of serious concern (i.e. is medically classified as obesity), medications such as Contrave (a combination of naltrexone and bupropion medications) and other appetite suppressant drugs may be prescribed for a short period of time. Medication prescriptions will need to be carefully managed. Drugs such as Contrave, for instance can help with weight loss goals and also treat signs of depression, but do carry warnings for neuropsychiatric problems and an increased risk of suicidal thoughts. Side-effects will be taken into account and carefully weighed against the potential benefits. These can be discussed in detail with the treating doctor to ensure safety and comfort levels when using medications for the treatment of binge eating disorder.
• Weight loss programmes: Excess body weight or multiple failed attempts to lose weight independently can prompt a doctor to recommend a weight loss programme. These are typically recommended once binge eating urges are sufficiently under control and being carefully monitored so as not to place a person at risk of developing further eating disorder problems. Changes in diet and routine can trigger more binge eating or other eating disorders in order to achieve weight loss. This is why those that are recommended may very well be done under medical supervision. The programme is tailored to meet necessary nutritional requirements and also continue to address binge triggers. The healthcare team will likely advise against the use of dietary supplements and herbal products which suppress appetite or claim to promote weight loss as these can easily be abused by an individual with an eating disorder. Negative health interactions with any medications being taken will also be stressed by a doctor, advising against taking anything without prior consent and ongoing monitoring.
• Support groups and counselling: Although a person’s habits will have been focussed on eating (binging) in secret and avoiding others, a doctor will encourage dealing with the effects and consequences of the disorder with the help of others. A support group consisting of others suffering an eating disorder and loved ones can often be very beneficial for someone learning to cope and manage triggers and sources of stress. Including loved ones (family) in counselling sessions or support groups can also help them to better understand the nature of an eating disorder and how best to provide support to an affected person.

Can binge eating disorder be effectively treated with ADHD medication?

The medication lisdexamfetamine (Vyvanse®) has been approved by the FDA to be prescribed for the treatment of mild, moderate and severe binge eating disorder. This controlled substance, which is classified as a central nervous system stimulant (CNS), is also commonly used for the treatment of attention deficit hyperactivity disorder (ADHD).

One of the main reasons lisdexamfetamine (Vyvanse®) is approved for the treatment of binge eating disorder is because of its effects on the brain chemicals, dopamine and norepinephrine. Researchers have established that these chemicals have a direct link to food cravings. Excessive eating results in an abnormal level of dopamine in the brain. The medication helps to create balance between how dopamine is used in the brain and thus curb the urge to binge.

Doses are carefully controlled (30, 50 or 70 milligrams a day) to suppress binge urges and thereby curb binge eating occurrences. Doses may initially be high (or gradually increased) and then slowly decreased to curb the frequency of binge urges.

Benefits of taking the medication, as with any prescription drug, will be carefully assessed with the nature of risk and side-effects of use. Side-effects range from dizziness and drowsiness to behavioural changes (hostility, aggression, or suicidal thoughts), to stroke or heart attack. The medication also carries a warning for potential abuse and dependency (another reason doses will be carefully controlled).