Shirah Vollmer MD

The Musings of Dr. Vollmer

Binge Eating Disorder

Posted by Dr. Vollmer on March 4, 2015


DSM 5 has expanded our notion of eating pathology to include a diagnosis of binge-eating, a behavior that almost all of us have experienced from time to time, but as with all of mental health, when the symptom is both intense and frequent, then a diagnosis is made. Along with a new diagnosis, there is now FDA approved treatment for Binge Eating Disorder, Vyvanse, a stimulant medication, typically used for ADHD.

Truth be told, I, and many of my colleagues have been using stimulants to treat bingeing for over 20 years, but now we have support both from the DSM 5 and the FDA. In other words, our treatment went from “off-label” usage to “on label” usage and so for my existing patients this means more security, and for new patients, this means more awareness that there are treatments available. The closet eater can now come out of that closet. This is an exciting step forward, although the concept is simple. Drugs which suppress appetite will suppress the gratification from bingeing. Medical health improves as bodies return to a normal weight range and mental health improves as the patient feels less shame and guilt associated with binge eating.

Since I normally discuss working from the inside out, it might surprise some of my readers that here I am talking about working from the outside in. In essence, both are important. If I could not prescribe medication to help people help themselves, then I would be limited in my toolbox. Likewise, if I could not explore psychodynamic concepts with my patients, I would be even more limited. Binge Eating Disorder is an example of how if we begin to change the behavior first, then we can then proceed to work on the inner workings of the mind which led to this type of self-destructive behavior. Medications change behavior, sometimes, and when we have that tool available, with minimal side effects, then I am happy to prescribe. As with eating, it is the extremes which are a problem, not the middle ground.

2 Responses to “Binge Eating Disorder”

  1. Shelly said

    Yes all of, at some time, binge-eat. The question becomes if the regular Primary Care Provider will use a stimulant to help us control our behaviors and stifle our urges so that we can become healthier and not become burdens on society by taxing the health care system with metabolic syndrome, diabetes, high blood pressure, etc… The main problem is that society thinks of us as simply “lazy” and we are stigmatized. They know nothing of our inner struggles, our daily lives, our private wars, etc…They think that we don’t know how we look, and they fat shame. Truth be told, use of stimulants would be substitutes for food and would give the same feeling of satiation would. I think this is a good idea.

    • Thanks, Shelly. Yes, we live in a judgmental society. Ideas of beauty change over time, and weight used to be a sign of wealth and status and now that has flipped. Inner struggles, by definition, are not seen by others, and so to judge, means to ignore an inner life. It is only by trying to understand that inner life, that true love and appreciation can be obtained. In-depth psychotherapy provides a bridge to that, as it provides a paradigm in which the inner life is privileged as one of the most important aspect of human existence.
      Also, one anonymous reader told me that not everyone binges, and indeed, I agree, and so I stand corrected.

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