Recommended Treatments for Binge Eating Disorder

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Binge eating disorder (BED) is the most common eating disorder in the United States. According to the National Eating Disorders Association, it is believed to affect 3.5% of women, 2% of men, and up to 1.6% of adolescents . It is characterized by repeated episodes of binge eating without the compensatory behaviors found in bulimia nervosa. Binge eating disorder was only recently (in 2013 with the publication of the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition; DSM-5) classified as an official diagnosis. As such, knowledge about it lags behind that of anorexia nervosa and bulimia nervosa.

It is important to note that BED is not something new. Prior to the publication of the DSM-5, binge eating disorder was listed in the appendix and could be diagnosed as an "Eating Disorder, Not Otherwise Specified" (EDNOS). Being identified as a distinct eating disorder means that individuals with this condition can receive more support and treatment. It also may result in further research on the condition and help reassure people that others share the same experience.

Although commonly thought to be a “less severe” eating disorder, binge eating disorder can cause significant emotional and physical distress and is associated with significant medical issues and an increased mortality rate.

CBT for Binge Eating Disorder

First-line treatment for binge eating disorder in adults is individual psychological therapy. Manual-based cognitive-behavioral therapy (CBT) is the most researched psychotherapy for BED, and at present, the best-supported among all treatment options.

The most studied form of CBT for binge eating disorder was described in the book Cognitive-Behavioral Therapy for Binge Eating and Bulimia Nervosa: A Comprehensive Treatment Manual. The book was published in 1993 by Fairburn, Marcus, and Wilson and an update of that treatment, CBT-E, was published in 2008 by Fairburn.

According to an extensive review of the literature in 2015, there are also still too few studies to draw conclusions about which formats of CBT might be most effective.

In randomized control trials, CBT consistently shows that it can help many patients achieve abstinence from binge eating. In many cases where abstinence from bingeing is not achieved, it can help reduce both binge frequency and eating-related psychopathology (such as preoccupying thoughts about shape and weight). Greater improvements have been shown in therapist-led CBT than in therapies with less therapist involvement such as guided self-help.

CBT is a time-limited approach that focuses on the interaction between thoughts, feelings, and behaviors. Key components of the treatment include psychoeducation, mindfulness, self-monitoring of key behaviors, cognitive restructuring, and establishing regular patterns of eating. CBT for BED addresses dietary restriction and the incorporation of feared foods. It also tackles thoughts about shape and weight and offers alternative skills for coping with and tolerating distress.

Finally, CBT teaches clients strategies to prevent relapse. It is important to note that the goal of CBT is behavior change, not weight loss—CBT for binge eating disorder do not necessarily lead to weight loss.

Other Psychotherapies 

Additional psychotherapies for binge eating disorder have been studied and have shown promise, although there are at present too few studies to definitively conclude if they are effective.

Interpersonal therapy (IPT), a short term treatment that focuses on interpersonal issues, and dialectical behavior therapy (DBT), a newer form of CBT designed to address impulsive behaviors, are two treatments that have some research support for binge eating disorder. Mindfulness-based eating awareness training (MB-EAT), which blends mindful eating with mindfulness strategies, has also shown promise.

Medications 

Antidepressants, primarily selective serotonin reuptake inhibitors (SSRIs), have shown to be helpful in clinical trials in reducing the frequency of binges as well as eating-related obsessions. Antidepressants also (not surprisingly) reduced comorbid symptoms of depression.

Vyvanse, an ADHD medication that became the first medication to be approved by the U.S. Food and Drug Administration (FDA) for treatment of BED, has been studied in three trials and was associated with reductions in binge episodes per week, decreased eating-related obsessions and compulsions, and reductions in weight. Anticonvulsant medications, particularly Topirimate, have also been studied and there is some limited evidence to suggest its usefulness.

While the research on Vyvanse and recent FDA approval for the treatment of BED is promising, all medications carry a potential risk of adverse side effects not found with psychotherapy. A thorough discussion with your doctor can help you understand the pros and cons and if any medications are right for you.

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Self-Help and Guided Self-Help

Researchers leading the 2015 review study, Management and Outcomes of Binge-Eating Disorder, note that “the number of therapists with expertise in CBT for BED is limited.” Given a large number of afflicted individuals, this limitation poses a challenge. One strategy to bridge the treatment gap has been the development of self-help and guided self-help treatments for binge eating disorder, which show promise. 

Concerns About Weight Loss Treatments

Because a significant percentage of people who have BED are obese, individuals with BED have historically sought treatment for and been treated for weight loss. While some earlier studies seemed to show that behavioral weight loss might be effective for the treatment of BED, many of these studies were small and poorly designed.

A 2010 study found that behavioral weight loss was inferior to CBT in reducing binge eating and also did not result in significant weight loss; they concluded, “effective methods for producing longer-term weight loss remain elusive.”

Many eating disorder professionals now believe that attempts at weight loss among patients with BED may only exacerbate the problem and further entrench the disorder, causing intense shame and resulting in weight gain. While CBT and behavior change tends to result in weight loss, the main focus of these treatments is not on losing weight.

How to Find Treatment 

The Binge Eating Disorder Association (BEDA) maintains an online directory of member providers. Furthermore, some eating disorder specialists have experience in treating BED. It may be helpful to find a therapist who specializes in cognitive-behavioral therapy. Many CBT therapists work with disordered eating behaviors even though they may not specifically list BED. If you are unable to find a local specialist, you may want to consider self-help or guided self-help.

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