Centre intégré universitaire de santé et de services sociaux de l’Ouest-de-l’Île-de-Montréal
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Ask the expert

Is medication the only answer to eating disorders?

When a patient suffers from Anorexia, Bulimia or other type of Eating Disorders, treatment does not involve “genetic reconstruction” or giving medication alone; psychotherapy, and nutritional interventions that help people master their terror of eating and their obsessions with weight, are used to treat these diseases.

What kind of treatment is available for binge eaters who don’t purge?

There are known treatments but I have to say that the healthcare system hasn’t developed very good specialized programs for people who have binge eating problems or binge eating disorders. Our program here treats anorexia nervosa and bulimia nervosa. As it is, that means that we are overwhelmed by the need that exists in the community. And those disorders require slightly different treatments from binge eating disorder. Weight loss clinics know something about treating binge eating disorder. The community organization ANEB offers groups support for people with binge eating disorder. Good physicians and people in general hospitals also know how to approach binge eating disorder. As for the ingredients, you’ve got to help someone stop dieting. Dieting sets up binge eating. Helping people introduce structured meals that are well-balanced is important, as is a modest level of exercise. There are certain medications that also help people contain the impulse to binge eat. In extreme cases, medications like topiromate or a mood stabilizer can help people inhibit their appetite until they get things back under control.
-Howard Steiger, Ph. D., Mini-Psych School 2009

How would you motivate someone with an eating disorder to seek help?

It’s again about the idea of not coercing or forcing people. Usually, friends, relatives, and concerned family members need to be courageous enough to be open about their concern. So you might say “It looks to me that around food you seem very scared or it looks like there is a problem. Would you like to talk about it?” If the person is open to it, try to help them become aware that these are things for which there are solutions and help available. So that’s one piece of it.

The other piece of it is to respect and understand the fact that people don’t do things like that until they are ready and they are not going to do it on your agenda. So this sometimes means containing your anxiety and respecting and trusting the person to find their way gradually. The limiting factor on that is when you see somebody really looking in danger, terribly emaciated, or fainting on the living room floor; that’s when you make sure that some kind of professional intervention occurs.

Force feeding people doesn’t accelerate the recovery. It’s a journey that people have to take. For some, it’s painstakingly long – it’s always longer than you want it to be. And so, as a family member, friend, or caretaker, you have to be willing to let that process unfold in full.

-Howard Steiger, Ph. D., Mini-Psych School 2009

Is there any evidence that SSRIs may help people with an eating disorder?

SSRI means Selective Serotonin Reuptake Inhibitors, a type of antidepressant. The first one was Prozac; another example is Celexa. People used to think that these drugs help people with an eating disorder because they make them less depressed. And, that may be partly true. But, then we started to see that you don’t need to be depressed to benefit from using these medications. Being depressed is not a predictor of it. There is tons of evidence to show that the level of serotonin activity has a direct impact on the urge to binge, or to partake in binge-like eating behaviour. We’ve done studies with something called “triptofan depletion”. Triptofan is one of the amino-acids. Your brain makes serotonin out of triptofan. We have used a procedure that was developed by Simon Young at McGill in which the person has to drink a milkshake that blocks triptofan from going into their brain. So, temporarily, it lowers your serotonin activity. If you have bulimia, this makes you have a bigger urge to binge. So in some way, serotonin is directly linked to your appetite.

-Howard Steiger, Ph. D., Mini-Psych School 2009

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