The Role of Medications to Treat Binge Eating Disorder

Unlike people with other eating disorders, those with Binge Eating Disorder often contact me solely to talk about medications. Sometimes they want to meet to discuss medication options or even, if they live outside of New York, ask to speak on the phone for a few minutes. 

There is a widely accepted view that medications are unlikely to be a significant part of treatment for other eating disorders, but the idea that medications can temper, if not cure, binge eating is pervasive. 

From a clinician's point of view, treating binge eating is similar to treating other eating disorders. The focus on a combination of normalizing eating patterns while zeroing in on the emotional and psychological manifestations of the illness is paramount. There is no evidence that medications help binge eating any more than other eating disorders. 

Seemingly, the media and lay knowledge of eating disorders categorize binge eating as something different. It represents, in our current culture, a flaw or a sign of weakness. As medication has become more central to psychiatric treatment, it is natural to assume there must be medication to fix this core craving or, as some falsely describe it, lack of willpower. 

The reality is that binge eating is one of a variety of biological and psychological adaptations to chronic undereating. We are all programmed to respond to prolonged starvation, i.e. dieting, in different ways. For some people, the starvation mechanism cascades into compulsive starvation and leads to anorexia. For some, the diet ends abruptly and leads to normal eating. For others, it triggers binge eating which can lead to bulimia, binge eating disorder or a variety of compensatory mechanisms to deal with overeating. 

Ultimately, the course of treatment needs to be the same. And a key component of treating binge eating disorder is to take the shame away from binge eating and follow a comprehensive treatment plan rather than a pharmacological magic fix. It's not a flaw but part of an illness.

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