And one drug can actually treat both.
John Greim / Contributor
Twenty-eight-year-old Toronto resident Katie James* has been binge eating since she was a child. Her mother dieted regularly, and the family had to comply with whatever fad she happened to be on. But when her mom was out, James would stuff herself with the treats that were normally out of bounds. Her eating habits only worsened when she left home. "All of a sudden no one was checking on me so I went wild," she says. But only in secret. "You know it's a bad behavior, so you don't do it in front of other people." Some days James would polish off an entire bag of chips or a box of cookies at one sitting. She binged at least four times a week, and swung from one diet to another. "My life was out of control," she says.
Binge eating disorder (frequently consuming large amounts of food past the point of fullness) is the most common eating disorder, affecting 3.5 percent of women and 2 percent of men in the US, says Toronto-based dietitian Susan Osher. And it exacts a steep toll: up to 80 percent of binge eating disorder (BED) individuals are obese, and many have associated health problems like diabetes, high blood pressure, and heart disease, says Allan Kaplan, psychiatrist at the Centre for Addiction and Mental Health in Toronto. The condition can exist together with depression and anxiety. "It's a difficult disease to live with—you set goals, mess up, and feel like a failure all the time," Osher says.
James struggled with her body image when she was young. "The fact that I was the biggest of all my friends made me feel like an outsider," she says. At age 18, she began a blog—which she posted to for several years—celebrating all body sizes, and this improved her confidence.
James also suffered from another, seemingly unrelated problem. She had always struggled with poor concentration. She got bored easily and had trouble completing tasks, to the point where it disrupted her daily life. "I'd start one thing and go to another, without finishing the first," she says.
It was only a year ago ago that her own psychiatrist put two and two together and diagnosed her with both binge eating disorder and attention deficit disorder. All of a sudden, lifelong patterns began to make sense.
Kaplan and other researchers have shed light on the overlap between binge eating disorder and attention hyperactivity deficit disorder (ADHD)—ADD is a type of ADHD. In Osher's experience, attention deficit disorder is present in 30 percent of people with binge eating disorder—and this contributes to its symptoms. Clients with both conditions are deficient in the pleasurable brain chemical dopamine, responsible for the allure of good sex, the thrill of a runner's high, or the jolt of cocaine, says Kaplan. Dopamine is also required to regulate attention, he says. When levels are low, her clients with ADD have trouble focusing on tasks.
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Some individuals with ADD use drugs to trigger the brain's reward pathways and stimulate the release of the deficient feel-good substance, he says. Those who binge eat rely on food to boost dopamine through the same mechanism. "It's a form of self-medication," Kaplan says. The compulsion to binge tends to worsen when BED clients experience emotional stress, he says.
For James, stress triggered emotional eating. "If I'm bored or have had a really bad day, I graze." Afterwards, she feels soothed.
Not only do BED and ADD share a common chemical disturbance, the troublesome symptoms of ADD can play out in the disordered eating of BED patients. Clients with attention deficit disorder are poor planners, and this can translate into disorganized meal planning, Osher says. Patients with binge eating disorder typically don't pack their fridges with healthy food choices, and end up choosing readily available, high calorie comfort foods like burgers and fries. Impulsivity, another symptom of attention deficit disorder manifests as a lack of restraint in bingers. "If it looks good, they have to have it, regardless of the consequences," Osher says. Finally, distractibility is found in both conditions, and manifests as mindless munching. "Bingers are not in touch with how much they're eating or whether they're hungry or full."
James' eating habits had always been chaotic. She rarely planned meals ahead of time. "Preparing food was always last minute—I'd eat whatever was in the fridge." She also had little ability to say 'no' to temptation. "If I really want a chocolate pretzel, I go after that until I'm sick of it," she says. But James didn't even crave all the food that she ate. Much of the time she ate whatever was around without even consciously wanting it. "When I'm wrapped up in something, and there's food next to me I just keep on going until it's finished."
Luckily the understanding of binge eating disorder has resulted in effective treatments. Cognitive behavior therapy (CBT) helps clients break down the negative thought patterns that can trigger a binge. For James, a seemingly minor argument with her husband could make her "feel crummy" and turn to food for consolation. But since she started CBT a year ago, she's gained insight into what exactly is troubling her. "I vocalize it back to him and resolve it, and the urge to eat dissipates," she says.
Lisdexamfetamine (aka Vyvanse in its generic form), a psychostimulant, increases dopamine in the brain, targeting the key imbalance in both attention deficit disorder and binge eating disorder, Kaplan says. The drug has been used for years in ADD, but was only approved for BED in 2016. It's given James a new perspective and healthier patterns since she began taking it a year ago. At work, she's focussed and organized, completing tasks at a normal pace. And for the first time, she's in control of her eating habits. She now organizes meals in advance, and is able to resist temptation. "When I'm on meds, I'm given the choice to say 'no' to food when I'm not hungry," she says. This has helped her drop two sizes so far, shifting toward a body she feels more comfortable in.
James no longer spends her days preoccupied with her next meal. "Before, I was constantly battling with myself," she says. "Now I hardly think about food—I just function normally."
*Source prefers to use a pseudonym.
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