So this past week I had a tough interaction with someone who took offense to a Twitter post of a New York Times article we re-Tweeted. The article was about the Attention Deficit Hyperactivity Disorder (ADHD) medication Vyvanse being re-purposed as a Binge Eating Disorder (BED) medication, but that “no one is cheering” about this. This person who took offense is an ADHD advocate and very passionate about educating the public and medical professionals about adult ADHD and how it impacts so many lives.
I agree that adult ADHD is a serious problem and I applaud anyone who takes on the role of personal and professional advocate. However, there was a direct comment that shook me to my core. She asked why medication shouldn’t be the first line of defense since talk therapy is a waste of time and money. Say what now?
Full disclosure, I was on the advisory panel for Shire Pharmaceutical, the maker of Vyvanse, to help them teach doctors how to identify and educate their patients about BED and get them on the road to treatment. I’m also slated to film an educational video for Shire about what BED looks like from a personal and professional perspective. I have no problem with medication being used as a tool for treating BED as directed in moderate to severe cases.
Apparently this is not something this advocate and I agree on. She stated glasses are a tool for seeing, but that Vyvanse is more than a tool, it’s a cure for BED. I highly disagree. And here’s why. If people only had binge eating episodes out of mindlessness or impulsivity, then perhaps there’s some validity to her assertion. But people don’t just binge eat for those reasons. They binge to soothe themselves after experiencing abuse, neglect, shame, guilt, depression, anxiety, fat-phobia induced restriction, and many other co-morbidities. The purpose of a binge can be like cutting (pain from the over-eating leading to a reset of the nervous system), losing secondary sexual characteristics to avoid sexual contact due to trauma history, recreating trauma (i.e. putting something into the body they don’t want there), and countless other reasons. It can enhance and prolong joy, only to lead to shame and guilt after the let down. Others may binge to stop from drinking alcohol or doing some other self-destructive behavior. Recent studies in the military find that nearly one in two military vets turn to binge eating or bulimia upon returning from active duty overseas, mostly likely as a coping mechanism for PTSD.
ADHD is correlated in about a third of BED patients, and should be treated medically no different than depression, anxiety, OCD, or bi-polar. I wouldn’t expect someone with depression and BED to take Prozac and for the binges to stop when the depression lifts. No eating disorder clinician worth a damn would. But let’s put this in line with addiction issues. They are not the same thing.
When heroin addicts take Suboxone to stop the craving and block the high they would get from opiate use, they still go out and get their fix. They do so out of habit, to be with their friends who also use, and for the sheer excitement of copping their drug. And many choose to stop taking Suboxone in order to get high from drugs to stave off their emotional pain, not just physical withdrawal. Same with alcoholics who might take Antabuse to stop drinking. They will go back to the core behavior not out of addiction withdrawal alone, but out of the need to numb out from the hardships of their life. Again, medication is a tool, but not a cure.
In addition, there is fabulous research from around the world on the treatment of BED using psychotherapy. But it does require working with trained clinicians. When a client of mine learns that their binge eating is something they can recover from, how to engage their internal body cues, to self-soothe their deep emotional pain, to stand their physical ailments, to fill their experience with joy and adventure, then they embrace their life. After so much physical and emotional restriction from the world around them due to shame and guilt about their BED behaviors and their body size, they are ready to dive in and dig into the therapy experience. When their underlying psychiatric issue is appropriately treated (like ADHD, anxiety, depression, other mood disorders), they are educated about their eating disorder origins and purpose, and embrace the tools of recovery, then our patients fly.
Nobody, and I mean nobody, can tell me that therapy is a waste of time and money. I’m living proof. My patients in the hundreds are living proof. And we’ll use whatever tool is out there to get to the point of being recovered from BED.
By Andrew Walen, LCSW-C - Founder, Executive Director, Psychotherapist at The Body Image Therapy Center. If you would like to get in touch with Andrew please call 443-602-6515 or email firstname.lastname@example.org.