I watched Andrew Thibault’s amazing new film on the harmful effects of stimulants with fascination and horror. This is not an easy flick to watch. For those of you who feel you are seasoned activists familiar with all the grim facts, this film may provide new, even more disturbing information. As I saw the drug Vyvanse featured as highly dangerous, I waited, hoping to see some mention of its indicated use for Binge Eating Disorder. Sure enough, one of the speakers had even self-diagnosed herself with BED, insinuating that BED was yet another pharma-created phony psych disorder. I was further dismayed when the film equated BED with being overweight.
If you never truly had BED, as I have had, then I can see why someone might jump to these conclusions. Eating disorders are rarely discussed in our movement. As a former sufferer of both BED and Anorexia Nervosa I often find myself a lone voice around these parts. Many well-educated people assume BED is nothing but gluttony. Similarly, some equate Anorexia Nervosa with either vanity or rigid perfectionism. These assumptions are either stereotypes or completely false.
Gluttony and vanity do exist, of course. However, many people truly suffer from AN and BED. Anorexia is said to be the most fatal of all “mental illnesses.” This is a grim statistic indeed. People die of starvation, dehydration, electrolyte imbalance, heart attack, refeeding syndrome. Suicide is also common. I have a bit of a conundrum with putting eating disorders in the “mental illness” category, though. I see eating disorders as extremely serious conditions, but I do not see them as primarily psychological, nor do I believe they should be in the category of “mental.” I see ED as a distinct and separate category of its own. Eating disorders need to be taken far more seriously than they are currently.
What is Binge Eating Disorder? To answer this, we have to ask, “What is a Binge?” Perhaps you think you binged last night when you ate at McDonald’s. While the typical McDonald’s meal may contain many calories, more than a person requires, in itself it’s not really a binge.
In my opinion the DSM needs to specify binge quantity, but it doesn’t. The DSM omits this and leaves much room for interpretation of what constitutes a binge. This means people who feel guilty about occasional overeating also qualify as binge eaters. This means that the DSM’s failure to specify quantity has successfully widened the BED umbrella, doing a terrible disservice to those of us who truly suffer from this very real disorder.
If you read the dieting literature in detail (you can find plenty online) you will see that the average adult woman might eat 2,000 calories in a day, or, perhaps, 500 calories for lunch. That 500 calories might be a sandwich and salad.
I’m going to be quite frank here. A typical binge that I used to do might have been a dozen Dunkin Donuts plus a bunch of pastries plus a large bag of M&M’s. My estimate of 9,000 calories is likely a bit conservative here. It wasn’t always sweets. Sometimes it was regular food, not even always “carbs.” Sometimes I ate non-food (this is called “pica”) and I even dived into garbage pails.
I was not capable of vomiting afterward. For me, this meant I was in a lot of pain for a long time following the binge. I was at risk for stomach rupture. I didn’t sleep all night, could barely move, and couldn’t get my clothes on the next day. I couldn’t go out, I lay in bed and felt sick until late afternoon. Sometimes I suffered from gas and belching for hours. When bingeing reoccurred frequently I was out of commission for a week or more.
Many who suffer from binge eating try therapy, with varying results from fair to poor. Therapists have told me of their great success rates but I have yet to hear this from patients themselves. The usual first order of treatment is the “poor coping” approach. This method places primary blame on the patient, focusing on her supposedly incorrect ways of dealing with life, and replacing these with the therapist’s ways, which may, or may not, be any better. The reason why the therapy often fails is that the assumption that binge eating is the result of bad coping is often false, and usually the approach, though interesting at first, isn’t hitting the mark.
The next step might be the chemical approach. Hopefully, by now, the therapist might ask what the patient eats, but you’d be surprised how often this doesn’t happen. I’m surprised at how many therapists don’t even ask what a patient binges on, nor even ask what constitutes a patient-defined binge. Sufferers have reported rude or sarcastic responses to their reports, and many are left feeling shamed or even afraid of bringing it up again.
What causes binge eating? Many say that restrictive dieting or some variant of this precedes the onset of binge eating. I believe this to be true. Even those who have binged since early childhood have reported some form of childhood malnutrition prior to binge eating. This can even happen involuntarily due to physical illness. Many were so young they cannot recall.
After a period of restrictive eating or starvation, the body has very strong cravings. Binge eating often follows recovery from anorexia, or occurs concurrently with AN, as it did for me. We know that starvation or crash dieting leads to irregular eating or even gorging oneself. This researcher (warning, the YouTube video may be upsetting to some) found that binge eating could be induced in starving rats, and it happened more frequently if the rats were stressed out. These cravings and subsequent binges are not driven by bad coping, but by physical need in the body.
Through much self-experimentation I began to realize that the body anticipates many events and prepares for these events. The body gets tired right before bedtime, preparing itself because it knows the person is going to lie down. A person who habitually self-starves will find that her body braces itself for the next famine even if one isn’t coming. The body continues to “expect” a famine even for years after a person has been eating regularly again. This explains why many people continue to have eating irregularities for many years after recovery from anorexia.
If a person binges habitually, upon sensing certain stimuli the pancreas prepares the body with insulin, and simultaneously, the stomach prepares by getting more acidic. For a binge eater, the insulin is suddenly so high that the person is driven to eat a large quantity. I finally found a study that confirmed this.
What does this mean? This means that for many of us, the drive to binge is a physical need. Therapy blames the patient for “bad coping” when all she is doing is responding to her body’s signals. Self-blame, reinforced by therapy, increases the sufferer’s feelings of shame, self-deprecation, and failure each time she binges. She returns to the therapist and the therapist tells her she needs more therapy!
In 1982 my doctors refused to admit my eating disorder was serious. They insisted I was “faking it.” The first method I devised to get myself to stop binge eating was to get myself hospitalized. There was logic to this since I knew confinement would prevent me from bingeing, and then, my body would stop the cycle. “Hospitalization” seemed to work but there was nothing stopping me from starting up the bingeing again once I got let out. I recall asking the doctor, “Can’t you just give me diet pills for this?” During the entire 34 years of coerced psychiatric “care” and multiple diagnoses, I was never prescribed stimulants.
I begged my doctors for “medication” since I’d heard antidepressants sometimes worked. The doctors tried drugs at random and lithium, tried in 1984, actually worked for a while. A study shows that lithium does help some people, but the price of losing my kidneys to that drug was too high to pay. (Drinking gasoline might work, too!) SSRI drugs are sometimes used, and more recently, Topamax, an anticonvulsant, and since then, Naltrexone, an opiate antagonist. None of these were FDA approved for BED. Of course not, since BED wasn’t in the DSM yet, and wasn’t considered a bona fide “disease.” While many of us were suffering, it wasn’t yet profitable for Big Pharma. Not until the publishing of the DSM-V in 2013.
I have to laugh because decades ago I nearly killed myself when my doctors refused to take my struggle with binge eating seriously. I fought for my cause for decades and was ridiculed. In 2013, BED was declared real. It was bittersweet indeed.
SSRI drugs never worked for me, nor did Naltrexone. Topamax did. To this day I don’t know the mechanism, and I don’t think anyone does. Some people experience alteration in their taste sensation or unwanted weight loss from Topamax. Naltrexone only helps if you derive pleasure from binge eating. I sure did not! All of these drugs have a Black Box Warning regarding suicide, homicide, or violent behavior.
I was surprised that Vyvanse was approved for BED and Topamax was not, however, when we consider that BED was only added to the DSM in 2013, it all makes sense. In 2013, Topamax was already in generic. The move to prescribe Vyvanse for BED was solely profit-driven. While men and women both have been suffering for decades from this problem, Vyvanse is new on the market, marketed and timed perfectly for the newly canned “disorder.”
However, what is Vyvanse?
Vyvanse is a wildly expensive stimulant, a re-packaged version of the stuff you buy off the street known as amphetamine. It is a prescribed, controlled drug. Vyvanse is a risky drug that can cause psychosis, paranoia, and even violent behavior in people who have never before experienced such things. Vyvanse is an old diet pill dressed up fancy, packaged now for BED. Were we ED’s from the 80’s right all along when we asked our doctors for diet pills?
But wait! Does it really have to be the latest designer pill with a fancy name? Anorexics have been chugging coffee for decades and getting the same appetite-suppressing effect. Not that it’s a good idea, nor that effective. But caffeine, also an amphetamine, will do about the same thing without the prescription and, I suspect, can be just as risky.
According to Thibault’s film, both NEDA and BEDA have drug company ties. I have suspected this for a long time. (I have stated in my live discussion here at the ISEPP Conference Denver 2017 that NEDA is the NAMI of eating disorders.)
If you are suffering, you don’t have to buy pharma pills, nor get married to a doctor via prescriptions, and frankly, I wouldn’t take the risk. I know in my heart I suffered far too long with BED and AN and didn’t have to. I wish I had followed my gut instinct instead of developing a dependency on my doctors. I believe that within each of us is the answer and we only have to find that answer.
There are indeed alternatives to these risky drugs which have long been known to cause suicide, homicide, and psychosis. There are many non-drug alternatives out there. Different things work for different people. Writer Katherine Hansen’s book Brain over Binge has become wildly popular. Hansen cured her own binge eating after therapy failed her, by studying the Rational Recovery program and adopting the philosophy for binge eaters.
Therapy, especially that directed at eating disorders, can turn into a manipulative game, each trying to outsmart the other. “What did you eat today?” It turns into a cat-and-mouse game that can become fatal. That’s how it was for me toward the end, and I almost died as a result.
I was lucky to put an end to all that nonsense. I have had good results by making very simple changes, starting with becoming independent from my prior doctors and therapists, and making my life decisions entirely on my own. I was surprised at how fast I was able to resolve my eating disorder after that. I would suggest doing your own research and empowering yourself to come up with your own solutions.
One thing I discovered was that each person has to decide for herself which form of exercise is right for her body, and how much. I made my own decisions about what I needed to eat, and when. Being free of the slavery of therapy helped me take a good rational look at what was best for me.
I knew I had to regain a sense of passion in my life, passion about something besides losing weight. Where had that gone off to? What had happened to the young and talented music student who first took herself to therapy in 1981 and then never came back?
Throwing off my belief in the “bipolar” me, and my conviction in the “me” that I truly am helped me regain the passion I had before, that never should have been stolen from me in the first place. I barely even noticed that my ED had became part of the past. What a joy!
Please post here what has worked for you or what you are trying out. I would like to hear about other people’s solutions to what can be a very difficult problem.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.