Bulimia/Eating Disorders/topiramate


I've been dealing with eating issues for about 4 years - firstly restrictive AN which has progressed to b/p AN/bulimia. What is your view on the crossover rate between disorders and whether a transdiagnostic approach is more relevant? This is what does my head in.. if one eating disorder doesn't mess with your head enough now I am dealing with basically the opposite problem relating to food as I was initially! Not enough vs. an excessive amount.. I know my family are beyond confused with how to deal with me. I don't understand how my behaviours can change so dramatically and why it seems this is a common transition to make (from the internet-searching I've done). Any thoughts?

So currently my main problem is binging/purging that is severely interrupted, and has for the past year or so, my ability to function normally day-to-day. I am reluctant to try another psychiatrist yet again and just do CBT because of negative first experiences I have had with professionals throughout the earlier stage of all this. I was only 15 when it began so my parents took on a much more authoritative role than they do now. I've also been put on two different SSRI antidepressants, neither of which I've felt were that effective. From again more researching and book-reading I've found out about the use of topirmate (topamax),the anticonvulsant, in treatment the of bulimia. Do you know much about this and what's your/the general opinion on this off-record use? I'm thinking quite seriously about either approaching my old psychiatrist and suggesting this route or maybe going to another or my GP. I'm again at my wit's end with this horrible cycle. Thanks so much for taking the time to read this.


Hi Sophie,

Wow! You've had it rough. What you are describing is, unfortunately, not all that unusual. About 50% of people who have been anorexic develop bulimia or bulimic patterns. The theory behind it goes like this: much like a chronic dieter going on a food binge, anytime you chronically starve yourself, your brain kicks in and makes you crave food like crazy. It's what is known as the deprivation effect. Because your brain thinks that you were starving yourself because there was no food (famine), it will secrete certain hormones that make you more likely to crave high fat/ high carb/ high calorie foods to help you 'recover' from the famine. As a result, when you are around food, you will want to eat as much as possible in an effort to store up before the next fast/famine.

The research on using topamax to treat bulimia is still in its infancy. For this reason and because of its known cognitive side effects, I would not take this drug unless you were under the watch of a psychiatrist. So do not ask your GP to prescribe it. I would either go back to your old psychiatrist and ask him/her about it or consult a new psychiatrist if you are not comfortable with that. Regardless, you need more than medication at this point. While the drugs may help the biological urges to eat, they will not help with the distorted thinking patterns that lead directly to your binging and purging. Keep searching for a therapist that you are comfortable working with. I cannot stress enough the importance of that relationship.

Good luck!

Bulimia/Eating Disorders

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Mary Pritchard, PhD


I can answer questions about the psychology of eating, disordered eating attitudes and behaviors such as drive for thinness, drive for muscularity, binge eating, body dysmorphia, dieting, excessive/obsessive exercise, and body dissatisfaction. I can also answer questions about anorexia and bulimia.


I have a PhD in Psychology and teach courses in the Psychology of Health and the Psychology of Eating. I have been conducting research on disordered eating and exercise behaviors for 15 years.

Midwestern psychological association, rocky mountain psychological association

Over 50 peer-reviewed journal articles in journals such as Eating Behaviors, Eating Disorders, and Eating and Weight Disorders

PhD in Psychology from the University of Denver

Awards and Honors
30 teaching awards, have received funding to conduct my research from academic institutions and state and local government

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