Binge Eating Disorder

I've been afk for a while - life has been busy and complicated since my dad's death.  I've been struggling and I finally acknowledged this and decided it was time to fight.  I posted the following on FB (to a select filtered group of people) and wanted to share it here.  

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I'm feeling like a failure right now. I stopped losing weight when my dad was diagnosed with brain cancer in March 2015. I told myself that was okay, that I'd get back on track when life settled down, and as long as I wasn't gaining weight it would be okay. I still had 30 pounds to lose to reach my hard goal. Since my dad died in April 2016, I've gained 10 pounds. (Don't tell me "it's only 10 pounds." This is a trend, and that's a lot of weight to gain in 3.5 months. Especially when I now need to lose 40.)

I don't know if it's grief brain that's taking up too much of my brain process, leaving me too little to exercise willpower. It seems plausible. I'm not entirely sure it matters. What does matter is that I've been eating. A lot. There is no voice in my head that asks, "Are you sure you want to be doing that?" It's just a matter of thinking about food and then finding that food in my mouth. I feel completely helpless and hopeless.

I feel that I've tried everything. I've tried notes on the fridge, a rubber band to snap, only keeping healthy snacks around (I'll binge on those as readily as I'll binge on anything else), therapy, Overeater's Anonymous, and a billion other things too numerous to list. If you think of it, I'm sure I've tried it, so you don't need to suggest it. It's not even a matter of "don't keep food in the house" because, let's face it, unless I become a hermit there's no real way to keep an adult from buying food.

And I am becoming a hermit. I feel so demotivated and depressed right now. I've skipped my exercise classes this week, which makes COMPLETE sense, because my eating habits are making my entire body unhappy. My stomach is constantly in rebellion and I ache all over. If feeling better isn't a good reason to get back on track, I don't know what is, but even that isn't helping my mind to comply.  

Last night I tried to tell Art what was going on. It took me at least 30 minutes to be able to talk since I was crying. He asked if I'd written anything I could share with him instead and I hadn't. So I'm writing this now. He asked what my plans were. I'm planning on calling my PCP today. I don't like to self-diagnose, but I've read about Binge Eating Disorder in at least three of my classes to date and it's absolutely clear to me that this is what's going on.

Here are the DSM-5 criteria:

"A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:

1. Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most people would eat in a similar period of time under similar cir****tances.
2. A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).

B. The binge-eating episodes are associated with three (or more) of the following:

1. Eating much more rapidly than normal.
2. Eating until feeling uncomfortably full.
3. Eating large amounts of food when not feeling physically hungry.
4. Eating alone because of feeling embarrassed by how much one is eating.
5. Feeling disgusted with oneself, depressed, or very guilty afterward.

C. Marked distress regarding binge eating is present.
D. The binge eating occurs, on average, at least once a week for 3 months.
E. The binge eating is not associated with the recurrent use of inappropriate compensatory behavior as in bulimia nervosa and does not occur exclusively during the course of bulimia nervosa or anorexia nervosa."

I can check off every single symptom here. Every. Single. One.

I talked with my therapist about this and she thinks that it's plausible. I attempted to find a psychiatrist but met with a combination of: no longer in practice, not taking new patients, not taking my insurance, not returning my calls, not calling me back after I dropped the paperwork off, not returning any of my follow-up calls. And people think mental health care is easy.

So, like I said, I'm going to call my PCP today. She has a history of willingness to try things, so I'm hopeful that I'll be able to get a prescription for lisdexamfetamine. I have no idea if my insurance covers it, or if I can even afford it, but it's FDA approved for B.E.D. and I feel like it's the only thing I have left to try. I feel like I just need something, anything, to pauses these self-destructive behaviors so I can regroup and get my act together. I'm hopeful that medication would be a temporary measure. 3 months, 6 months, a year tops.

I had lost 140 pounds. Even with B.E.D., I did that. But right now, I'm just stuck in this negative downward spiral and I need something to help reverse the trend.

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At the recommendation of friends, I just printed the above and gave it to my doctor. Since I cried a lot. I've cried a lot since Thursday night. 

Then I posted this follow up, since a few people were confused.

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And one thing I feel I need to clarify, since it's confusing to people even in my own home - my weight is not the issue here. My weight is a symptom of the issue. The issue is that I can't seem to control what I put in my mouth. If I had gained 10 pounds after my dad's death because I felt that I was consciously in control of my eating, that would be okay. The issue is that I don't. And, for me, this is old behavior. Surgery helped me to course correct for a number of different reasons, and I truly believed that I was "cured" of my mental illness, but I was wrong and I've been in denial for the last 16 months.

Now that I've learned how to manage my body, it's time for me to address my brain. I'm not turning to medication to lose weight, I'm turning to medication to try to correct the illness.

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If you made it through all that, kudos to you!  If you've had experience with Vyvanse - how do you know if the dosage needs to be increased?  What signs should I be looking for?  

I am so sorry that you are going through this.  I have been thinking of you lately.  You have so much going on right now.  I have gained.  Couldn't seem to find anything to turn it around. I connect with OA. I don't go to meetings but listen to podcasts. But what seem to make it click was a $90 pair of pants grew too small.   

I feel you are on the right path. You are involving your friends and your whole medical team.  Sometimes just saying it out loud to a large group of people online is a pivotal moment.  

My thoughts are with you.

Thank you, I appreciate the thoughts.  That's great that OA podcasts have been beneficial to you!  

I'm also experiencing clothing getting tighter - not tight enough that I can't wear it, but we all know how easily "tighter" can turn into "too tight" if we do nothing to change our patterns.  I've spent too much month on clothing I love to let that happen.  And, seriously, I've spent too much time and effort working to improve myself to give in now.  

(((Hugs))) to you Gwen. When I was first starting my journey you were one of my weight loss heroes and you still are today. Kudos to you for recognizing your need for a brain re-set, not a metabolic re-set. I wish you the very best!

Thank you very much.  I'm not feeling very heroic right now, but I do feel hopeful!

Dear Gwen,

I am so sorry you've had to go through all that.  I can't imagine how difficult it's been for you.

I have very severe BED.  I've also treated people with all eating disorders, including BED.  It was horrible to get diagnosed for me, and I was angry and in denial for quite some time (this was many years ago).  Our weight is definitely a symptom of the issue.  You are absolutely right with what you say above. Eating disorders are more than disorders of emotion regulation.  They are disorders of personal control.  It is very common for them to flare up during these times.  You are not weak at all for having gone through this; it takes great strength and courage to admit it and get the care you need.

I'll put on my counselor hat briefly here.  Vyvanse is currently the only approved medication for BED, however it's a pro-drug of dextroamphetamine, which is cheaper and in generic form.  Truthfully, other stimulants might work just as well, especially if they have a similar mechanism of action.  Any competent psychiatrist would be able to talk about options if the vyvance is financially burdensome.  They also have drug assistance programs you can apply for with the company.  As a counselor, I always suggest a psychiatrist instead of a PCP, particularly a psychiatrist that is familiar with EDs, since many psych meds can cause us to gain weight or trigger other eating issues.  They often will medicate BED with SSRIs or SNRIs in conjunction, too.  It's not always just a stimulant.

I remember seeing a psychiatrist for the first time.  It was very hard for me to do this, so I know first-hand how difficult it can be.  It really makes a difference, though, because we often have special needs with eating disorders.  Counseling and medication both give a huge boost to treatment outcomes when they are done together.

I'm always happy to answer questions or talk whenever you need it.  Hang in there, Gwen!  I am rooting for you

Thank you - as you can see my first course was also to pursue a psychiatrist, but months of trying left me without an appointment.  

I have spent months finding one and I'm still searching.  So few have experience with BED still.  I've had pharmacology classes so I am able to...aggressively advocate for myself, so to speak.  I know what a pain in the butt it is.  I'm sorry that it didn't go very well.  You might want to check university centers.  I found out much better care in one location.  No matter what, good luck,  Gwen :)

Hi Gwen,

Its good to hear from you again.  I'm so sorry that you are having such a hard time with binge eating behavior. 

My first advice is be gentle with yourself.  It is common to resort to old behavior patterns when we are stressed.  We have to leave room for our vulnerability and humanity. 

Second, I've seen your efforts, and commitment over the past year or more, and I have complete faith that you will turn this around.  You bring a strong commitment, and wisdom to the process.  Trust yourself.  You'll figure this out and get back on track.

Best wishes,

Carol

Thank you.  I appreciate the kindness and support.