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Binge Eating Disorder

Binge Eating Disorder is an interesting exception to other eating disorders in a variety of ways.  Firstly, it shows no gender preference unlike anorexia and bulimia which are much more highly present in females than males.  Binge eating disorder is approximately equivalent in both genders.   Secondly, it doesn’t have a course of onset in adolescence or early adulthood, but can often strike for the first time when patients are in their mid 30s or even older than that.   It is characterized by the symptoms of eating more rapidly than usual,  eating until feeling uncomfortably full,  eating large amounts of food when to feeling physically hungry,  eating alone because of how much the person is ingesting, and feeling demoralized and depressed after a binge.   In order to meet the criteria for the disorder (to distinguish it from simple over eating)  it has to have occurred on average, at least once a week for at lest three months, and it cannot be associated with other compensatory behaviors such as purging.

The good news is there are many forms of treatment that have shown to be effective in treating this.  In addition to mindfulness and cognitive behavioral therapy — a host of pharmacological agents can be helpful.  These include SSRIS like Lexapro and Paxil, SNRIs like Effexor Fetzima,  stimulants such as Vyvanse or Adderall,  anticonvulsants such as Topomax or Lamictal,  as well as Wellbutrin (an atypical antidepressant).   There’s no one right way to go in treating this disease, but given that the responses to all of these types of medication at this point has been shown to be relatively equal,  it’s more a question of talking with your doctor to see which medication group would have the least risky side effects and would fit in with your lifestyle choices.

David Salvage, MD, FAPM

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