Binge eating disorder (BED) is the most common eating disorder in Canada. According to eating disorder statistics of Canada, binge eating disorder occurrence for all people is at 2%.
The disorder 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.
This article discusses some of the treatments for binge eating disorder including cognitive behavioral therapy, interpersonal therapy, and medication.
It is important to note that binge eating disorder 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 recognised as a distinct eating disorder means that people with this condition can receive more assistance & treatment. It also may result in further research on the condition and help encourage 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.
The first-line treatment for binge eating disorder in adults is individual psychological therapy. While there are a number of approaches that might be used depending on an individual’s situation and needs, some of the most common include:
CBT for Binge Eating Disorder
Manual-based cognitive behavioral therapy (CBT) is the most researched psychotherapy for BED, and at present, is the best-supported among all treatment options. 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 people strategies to prevent relapse. It is important to note that the goal of CBT is behavior change, not weight loss. When used for treating binge eating disorder, CBT doesn’t necessarily lead to weight loss.
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 therapies also supported by research for treating binge eating disorder.
Research suggests that people who have BED tend to have more interpersonal problems, which can contribute to feelings of psychological distress. While such problems predate the onset of the eating disorder, they often contribute to it.
While IPT shows promise in the treatment of binge eating disorder, one study found that it was less effective than CBT.
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.
Mindfulness-based eating awareness training (MB-EAT), which blends mindful eating with mindfulness strategies, has shown promise. This approach utilizes mindfulness practices to help people become more aware of hunger cues and alter eating behaviors in order to avoid binge eating.
Family therapy and group therapy may also be options, although little research exists to evaluate the potential efficacy of these treatment modalities.
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 (lisdexamfetamine), an ADHD medication that became the first medication to be approved by the 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 topiramate (available as Trokendi XR, Qudexy XR, and Topamax), have also been studied and there is some limited evidence to suggest its usefulness.
While the research on Vyvanse and FDA approval for the treatment of BED is promising, all medications carry a potential risk of adverse side effects not found with psychotherapy alone.
Self-Help and Guided Self-Help
Researchers leading a 2015 review study 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.
Professional counseling that helps people learn more about nutrition can also be helpful in the treatment of binge eating disorder. Because many people with BED have a history of trying to lose weight, this counseling should not be focused on weight loss until the eating disorder has been treated.
Nutritional counseling can help people learn more about healthy eating habits and the essential nutrients they need to be healthy. It can also help people establish eating habits that will help them avoid binge-eating behaviors.
Concerns About Weight Loss Treatments
Because a significant percentage of people who have BED have obesity, people 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; the study researchers concluded that “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.
Binge eating disorder is a serious condition that can have serious health consequences. Effective treatments are available, including cognitive behavioral therapy. Other options including interpersonal therapy, family therapy, medications, and self-help can also be beneficial. It is important to note that the focus should be on treating BED and not on weight loss.
A Word From Experts
Binge eating disorder can disrupt your life, create distress, and have serious consequences on your health. If you are experiencing episodes of binge eating, talk to your doctor. Getting a diagnosis can help you get the treatment that is right for you.