Anorexia, Bulimia and Binge Eating

Green and Rau, American Journal of Psychiatry (1974),1097 found PHT highly effective in treating ten patients who had three distinct types of symptoms of compulsive eating. One group was extremely underweight. Sometimes they ate nothing, yet they constantly thought about food. Frequently they would overeat and then would overcorrect this condition by forcing themselves to vomit. Thus they stayed underweight. These patients were considered by the authors to come under the category of primary anorexia nervosa. The second group consisted of persons of normal weight. They were also preoccupied with food and they had a compulsive wish to eat. Their entire lives were structured to avoid exposure to food through various and complicated maneuvers. They occasionally went on eating binges that lasted for hours or days. They would then diet back to normal, unlike group one, who always dieted back to below normal. Group three consisted of patients who gave in to their strong compulsion to eat. They became overweight over a period of years, some rapidly, some slowly. They were from 150 to 250 pounds above normal weight. Of the ten patients, nine had abnormal EEGs but none was epileptic. PHT was highly effective in nine of these patients including the one with a normal EEG. In two cases PHT was withdrawn and symptoms returned. When PHT was reinstated, the symptoms disappeared. The authors say that compulsive eating is usually accompanied by other undesirable symptoms, including depression. Improvement in these other symptoms was usually observed.

1097. Green, R. S. and Rau, J. H., Treatment of compulsive eating disturbances with anticonvulsant medication, Amer. J. Psychiat., 131: 428-432, 1974.

Rau and Green, Comprehensive Psychiatry (1975),2037 report on an additional eight patients with the syndrome of compulsive eating. These patients had abnormal EEGS. They were treated with PHT and five of them responded dramatically. Three had questionably positive responses. The authors give as an example the case of an emaciated twenty-five-year-old female who weighed seventy-nine pounds. Her compulsive eating episodes were followed by feelings of guilt, vomiting and sleeping difficulties. She was a compulsive stealer. After two weeks’ treatment with PHT, 100 mg t.i.d., she reported a “miracle.” She had no further episodes of compulsive eating, was less obsessed with thoughts of food and there were no episodes of stealing. After six months she remained symptom-free and was approaching normal weight. The authors state that their investigations suggest that compulsive eating has a neurologic etiology. In a further study, Rau, Struve and Green (1979),2896 report that twenty-seven of forty-seven patients (some without abnormal EEGS) responded to PHT therapy. (See also Ref. 2038.)

2037. Rau, J. H. and Green, R. S., Compulsive eating: a neuropsychologic approach to certain eating disorders, Compr. Psychiat., 16: 223-31, 1975.
2896. Rau, J. H., Struve, F. A., Green, R. S., Electroencephalographic correlates of compulsive eating, Clin. Electroencephalogr., 10: 180-9, 1979.
2038. Rau, J. H. and Green, R. S., Soft neurological correlates of compulsive eaters, J. Nerv. Ment. Dis., 166(6): 435-7, 1978.

Wermuth, Davis, Hollister and Stunkard, American Journal of Psychiatry (1977),2117 based on the findings of Green and Rau conducted a double-blind crossover study, using placebo, to test the efficacy of PHT in treating “binge eating.” After careful screening, medical, psychiatric and EEG evaluations, nineteen female patients, who had suffered for two to twenty-four years with episodes of binge eating, were selected for study. Six patients markedly improved, two moderately improved, and six slightly improved during PHT treatment. Improvement in six of the patients who had EEG abnormalities was similar to that observed in other patients, and the authors concluded that treatment response did not correlate with EEG abnormalities. Subjects whose binge eating was markedly reduced during PHT treatment reported better self-control, marked improvement in self-esteem, less preoccupation with eating, and more normal eating habits.

2117. Wermuth, B. M., Davis, L. K., Hollister, L. E. and Stunkard, A. J., Phenytoin treatment of the binge-eating syndrome, Am. J. Psychiat., 134(11): 1249-53, 1977.

Szyper and Mann, Neurology (1978),2100 reported a case of classical anorexia nervosa in a sixteen-year-old girl whose weight loss was greater than 16 kg (30% of body weight) over a two-year period. The patient also suffered partial complex seizures uncontrolled by barbiturates. PHT treatment was begun, resulting in seizure control, EEG improvement and dramatic weight gain.

2100. Szyper, M. S. and Mann, J. D., Anorexia nervosa as an interictal symptom of partial complex seizures, Neurology, 28(4): 335, 1978.

Moore and Rakes, Journal of Clinical Psychiatry (1982),2804 describe a twenty-one-year-old student with disabling symptoms of binge eating, difficulty in concentrating and feelings of frustration and guilt.PHT, 100 mg t.i.d., was started and, by the fourth day, the compulsion to eat had entirely disappeared. Problems with concentration and feelings of guilt and frustration also disappeared. The patient remained symptom-free for a year. PHT was discontinued and another episode of binge eating developed, which again responded to PHT. The patient remained symptom-free on 300 mg of PHT a day.

2804. Moore, S. L., Rakes, S. M., Binge eating-therapeutic response to diphenylhydantoin; case report, J. Clin. Psychiatry, 43: 385-6, 1982.

Parsons and Sapse, Journal of Orthomolecular Psychiatry (1985),2849treated forty-two patients with anorexia nervosa with PHT along with psychotherapy and other medications considered cortisol antagonists. After four to five days the patients exhibited marked improvement in attitudes towards food and they started eating more normally. Feelings of hostility and fear were diminished and feelings of confidence were improved.

For further references see 1869, 2116, 2304, 2556, 2625, 2656, 2800.

2849. Parsons, J. M., Sapse, A. T., Significance of hypercortisolism in anorexia nervosa, J. Orthomol. Psychiatry, 14(l): 13-18,1985.

1869. Green, R. S. and Rau, J. H., The use of diphenylhydantoin in compulsive eating disorders; further studies, Anorexia Nemosa, 377-82, Vigersky, R. A., Ed., Raven Press, New York, 1977.
2116. Weiss, T. and Levitz, L., Diphenylhydantoin treatment of bulimia, Am. J. Psychiatry, 133(9): 1093, 1976.
2304. Balboa De Paz, F., Campos Castello, J., Olivan Palacios, J., Espino Hurtado, P., Vela Bueno, A., Anoretic syndrome associated with convulsive seizures, Psiquis, 2(5); 56-61, 1981.
2556. Greenway, F. L., Dahms, W. T., Bray, G. A., Phenytoin as a treatment of obesity associated with compulsive eating, Curr. Ther. Res., 21(3): 338-42, 1977.
2625. Johnson, C., Stuckey, M., Mitchell, J., Psychopharmacological treatment of anorexia nervosa and bulimia. Review and synthesis, J. Nerv. Ment. Dis., 524-.34, 1983.
2656. Kennedy, S., Garfinkel, P. E., Anorexia nervosa, American Psychiatric Association Annual Review, Vol. 4, Hales, R. E. and Frances, A. J., Eds., American Psychiatric Press, Washington, D.C., 438-63, 1985.
2800. Mitchell, J. E., Pyle, R. L., Eckert, E. D., Bulimia, American Psychiatric Association Annual Review, vol. 4, Hales, R. E. and Frances, A. J., Eds., American Psychiatric Press, Washington, D. C., 464-80, 1985.

See also Ref.

3157. Hudson, J.I. and Pope, H.J., The role of anticonvulsants in the treatment of bulimia, Use of Anticonvulsants in Psychiatry: Recent Advances, 141-54, McElroy, S.L. and Pope, H.G., Eds., Oxford Health Care Inc., Clifton, NJ, 1988.