How are Benzodiazepines Prescribed in Eating Disorder Treatment?

There are numerous psychotropic medications being considered for use supporting eating disorder treatment. Most of these do not eradicate eating disorder beliefs and symptomatology completely, however, they can support in the reduction of certain mediating eating disorder symptoms.

One such psychotropic drug family are benzodiazepines, which research shows might have benefits in treating not only co-occurring anxiety or panic symptoms related to eating disorders but eating disorder behaviors themselves such as binge eating or purging.

Even so, benzodiazepines are highly controversial due to their sedating and highly addictive properties [1]. The following is intended to explore the benefits and potential drawbacks of using benzodiazepines in eating disorder treatment, however, one should always inform themselves via the support of a professional before making decisions on what psychotropic medications they would like to use.

What are Benzodiazepines?

Benzodiazepines belong to the prescription sedative class of drugs and are often used to treat anxiety disorders, panic disorders, and insomnia symptoms [1] [2]. They might also be prescribed for “muscle spasticity, convulsive disorders, pre-surgical sedation, involuntary movement disorders, detoxification from alcohol and other substances, and anxiety associated with cardiovascular or gastrointestinal conditions [2].”

The following are the drug as well as brand names of popularly prescribed Benzodiazepines:

• Alprazolam (Xanax)
• Clonazepam (Klonopin)
• Diazepam (Valium)
• Lorazepam (Ativan)

These medications “generally produce almost immediate effects, and thus may be prescribed for short-term, intermittent, ‘as-needed’ use [2].” With chronic use, however, these drugs are highly addictive, as will be discussed below.

As an article in American Family Physician specifies, “anxiety disorders wax and wane over time, patients with these disorders often prefer benzodiazepines because these agents can be taken intermittently, when patients feel the need to take them, and most patients can use benzodiazepines judiciously [2].”

Using Benzodiazepines for Eating Disorder Treatment

When prescribed for support in eating disorder treatment, Benzodiazepines are prescribed “mostly when a comorbid anxiety disorder is present or to treat anxiety related to food/body issues, severe insomnia, or excessive physical exercise [3].”

A side effect of Benzodiazepines that might also impact eating disorder recovery involves “their tendency to increase the palatability of food and its ingestion” which might lead to weight gain [3].

Most of the time, Benzodiazepines are prescribed for co-occurring symptoms, not eating disorder symptoms themselves. One study makes a point of clarifying that “no clear indications about whether, when, or how to use BDZs (Benzodiazepines) in patients with eating disorders are available. Further investigation is needed to explore the full potential of the use of BDZs in eating disorders [3].”

Interestingly, Benzodiazepines have been proven effective in treatment of Night Eating Syndrome, as this disorder “is consistently related to mood and anxiety disorders” which Benzodiazepines are helpful in treating [3].

What are the Potential Side Effects of Benzodiazepines?

Despite the possible helpful benefits mentioned above, there are a lot of drawbacks related to chronic Benzodiazepine use that should be considered, the main one being their addictive properties.

Studies emphasize that, while Benzodiazepines rarely result in death due to overdose, this does not mean they are “safe [2].” Used long-term and chronically, Benzodiazepines develop what is called “therapeutic tolerance [4].” This means that their effectiveness decreases over time unless the dosage is increased [4]. Essentially, the body becomes tolerant of a particular dosage and is no longer impacted by the effects of the medication, requiring increases in dosage. This can lead to individuals continually increasing dosage to experience the effects of the drug and can lead to reliance and addiction.

These addictive properties can be particularly dangerous for an individual with an eating disorder, as eating disorders and addictive disorders share similar symptoms of lack of impulse control as well as reliance. One study emphasizes that “any off-label use of BDZs in a patient with an eating disorder should be carefully evaluated and individually planned, and in light of the specific risks for addiction and drug abuse, particularly when marked addictive personality characteristics are present [3].”

Individuals that struggle with eating disorders often use eating disorder behaviors to experience a sense of control, to cope with emotional dysregulation, or to numb/disconnect from the physical body to cope with a history of trauma or other disorders. This makes these individuals vulnerable to reliance on anything, medication or behavior, that allows them to continue doing this easily.

For this reason, Benzodiazepine use in eating disorder treatment should be thoroughly explored and discussed, as the long-term solution for eating disorder treatment requires an individual to cease all avoidance behaviors and face what is beneath their disorder.

Other negative side effects of Benzodiazepines include:

• Withdrawal symptoms upon ceasing use.
• Psychomotor impairment [4].
• Disinhibition [4].
• Memory impairment.
• Poor judgment or thinking [1].
• Suicidal ideation [2].
• Emotional blunting [2].
• Dependence of fetus if taken when pregnant [2].
• Depressive symptoms [2].

Psychiatric professionals are aware of all of these potential pitfalls of Benzodiazepine use and will support an individual in fielding these, as the use of these medications is not something that should be done in a cavalier manner.

Resources

[1] Unknown (2021). Benzodiazepine addiction: symptoms and signs of dependence. American Addiction Centers. Retrieved from https://americanaddictioncenters.org/benzodiazepine/symptoms-and-signs.

[2] Longo, L. P., Johnson, B. (2000). Addiction: part I: benzodiazepines: side effects, abuse risk, and alternatives. American Family Physician, 1:61)7).

[3] Dell’Osso, B. et al. (2015). Bridging the gap between education and appropriate use of benzodiazepines in psychiatric clinical practice. Neuropsychiatric Disease and Treatment, 11.

[4] Rosenbaum, J. F. et al (2005). Benzodiazepines: revisiting clinical issues in treating anxiety disorders. Primary Care Companion to the Journal of Clinical Psychiatry, 7:1.

Author: Margot Rittenhouse, MS, LPC, NCC
Page Last Reviewed on March 28, 2022, and Updated By: Jacquelyn Ekern, MS, LPC