What are the symptoms and treatment options for Binge Eating Disorder (BED)?

From the Guidelines

Binge eating disorder should be treated with eating disorder-focused cognitive-behavioral therapy or interpersonal therapy, in either individual or group formats, as recommended by the American Psychiatric Association 1. This approach is supported by the most recent and highest quality study, which emphasizes the importance of a comprehensive treatment plan that incorporates medical, psychiatric, psychological, and nutritional expertise. The key components of treatment for binge eating disorder include:

• Cognitive-behavioral therapy (CBT) to help individuals identify triggers and develop healthier coping strategies
• Interpersonal therapy to address interpersonal issues and improve communication skills
• Medications, such as antidepressants or lisdexamfetamine, may be used in conjunction with therapy, especially if there is minimal or no response to psychotherapy alone by 6 weeks of treatment 1
• Regular eating patterns with three balanced meals and planned snacks to prevent extreme hunger that triggers binges
• Self-monitoring through food journals to increase awareness of eating patterns and emotional triggers These treatments work by addressing both the psychological aspects (distorted thoughts about food and body image) and the neurochemical imbalances in the brain's reward and impulse control systems that contribute to binge eating behaviors. It is essential to note that the American Psychiatric Association recommends a comprehensive treatment plan that incorporates medical, psychiatric, psychological, and nutritional expertise, commonly via a coordinated multidisciplinary team 1. In addition, the treatment plan should be individualized and tailored to the patient's specific needs and preferences, taking into account their medical and psychiatric history, as well as their social and cultural context 1. By following this approach, patients with binge eating disorder can achieve significant improvements in their symptoms and quality of life, and reduce their risk of morbidity and mortality associated with the disorder 1.

From the FDA Drug Label

The recommended dose is 60 mg/day, administered in the morning. For some patients it may be advisable to titrate up to this target dose over several days. Only the 60–mg dose was statistically significantly superior to placebo in reducing the frequency of binge–eating and vomiting The recommended dose of fluoxetine for binge eating is 60 mg/day.

• This dose has been shown to be statistically significantly superior to placebo in reducing the frequency of binge-eating and vomiting.
• The dose can be titrated over several days if necessary. 2

From the Research

Definition and Prevalence of Binge Eating Disorder

• Binge eating disorder (BED) is defined by recurrent episodes of binge eating, occurring on average at least once a week for 3 months, and associated with marked distress 3.
• BED is the most common eating disorder, with an estimated lifetime prevalence of 2.6% among U.S. adults 3.
• It can affect both men and women, regardless of their weight, ethnic or racial group 3.

Comorbidities and Health Problems

• BED is commonly associated with comorbidities such as obesity, diabetes, and depression 4.
• Psychiatric comorbidities are very common, with 79% of adults with BED also experiencing anxiety disorders, mood disorders, impulse control disorders, or substance use disorders 3.
• Multiple neurobiological explanations have been proffered for BED, including dysregulation in reward center and impulse control circuitry, with potentially related disturbances in dopamine neurotransmission and endogenous μ-opioid signaling 3.

Treatment Options

• Cognitive behavioral therapy (CBT) is a leading evidence-based psychological therapy for BED, with adaptations and stages of the cognitive behavior therapy-enhanced (CBT-E) transdiagnostic model for eating disorders 4.
• Interpersonal therapy and dialectical behavior therapy are also effective treatments for BED 4, 5.
• Combination therapy, including nutritional, psychological, and pharmacological treatment, may be the most effective treatment for BED patients 6.
• Medications such as lisdexamfetamine, fluoxetine, and fluvoxamine have been used to treat BED, but their effectiveness is still being studied 3, 7.

Treatment Outcomes

• CBT and interpersonal therapy have been shown to be more effective in eliminating binge eating than behavioral weight loss (BWL) in controlled, comparative clinical trials 5.
• BWL has been effective in reducing binge eating and associated eating problems in BED patients in some studies, but its long-term effectiveness is still unknown 5.
• Treatment outcomes, including remission from binge eating and improvement in specific eating disorder psychopathology, are typically well-maintained over 1 to 2 years of follow-up 5.