What is the best treatment for binge eating disorder?

Best Treatment for Binge Eating Disorder

The best treatment for binge eating disorder is eating disorder-focused cognitive-behavioral therapy (CBT) or interpersonal therapy (IPT), delivered in either individual or group formats. 1

First-Line Treatments

Psychotherapy Options

• Cognitive-Behavioral Therapy (CBT)

  • Focuses on normalizing eating patterns
  • Addresses distorted thoughts about food, weight, and body image
  • Teaches coping skills to manage triggers for binge eating
  • Demonstrates durable benefits after treatment completion 2
  • Available in traditional format or guided self-help (CBTgsh)

• Interpersonal Therapy (IPT)

  • Focuses on interpersonal issues that may trigger binge eating
  • Addresses relationship problems, role transitions, grief, and interpersonal deficits
  • Shows similar efficacy to CBT in long-term outcomes 3
  • Particularly effective for patients with high negative affect 3

Treatment Selection Algorithm

1. For most patients: Start with CBT or CBTgsh as first-line treatment
2. For patients with high eating disorder psychopathology and low self-esteem: Consider IPT as first-line treatment 3
3. For patients with significant interpersonal difficulties: IPT may be particularly beneficial

Second-Line Treatments

Medication Options

For patients who prefer medication or have not responded adequately to psychotherapy alone:

• Lisdexamfetamine

  • FDA-approved specifically for moderate-to-severe binge eating disorder 4
  • Shows modest effect on binge eating reduction 5
  • May provide modest weight loss benefits 5
  • Caution: Avoid in patients with cardiovascular disease, uncontrolled hypertension, or history of substance abuse 4

• Antidepressants (particularly SSRIs)

  • Fluoxetine has shown efficacy in bulimia nervosa at 60mg/day 6
  • May help with comorbid depression and anxiety
  • Limited evidence for long-term efficacy 5

Special Considerations

Treatment Monitoring

• Regular assessment of binge eating frequency and severity
• Monitoring of eating disorder psychopathology
• Assessment of comorbid conditions (depression, anxiety)
• For patients on medication: vital signs, weight, and side effects

Common Pitfalls to Avoid

1. Focusing solely on weight loss rather than addressing the core eating disorder psychopathology

   • Primary goal should be reducing binge eating episodes and improving eating disorder psychopathology 4

2. Inadequate treatment duration

   • Psychological treatments should be continued long enough to ensure durable remission
   • Limited data on long-term medication efficacy 5

3. Overlooking comorbid conditions

   • BED frequently co-occurs with mood disorders, anxiety disorders, ADHD, and substance use disorders 4
   • These may influence treatment selection and outcomes

4. Not addressing high levels of shame and stigma

   • Many patients suffer in silence and shame 2
   • Therapeutic alliance is crucial for treatment success

Emerging Treatment Options

• Dialectical Behavior Therapy (DBT)

  • Focuses on emotional regulation and distress tolerance
  • Shows some efficacy for BED, particularly for those with emotion regulation difficulties 7

• Behavioral Weight Loss (BWL)

  • Emerging evidence suggests effectiveness comparable to CBT for reducing binge eating
  • Additional benefit of modest weight loss 2
  • May be suitable for BED patients without high levels of specific eating disorder psychopathology 7

In summary, CBT and IPT remain the gold standard treatments for binge eating disorder, with medication as an adjunctive or alternative option for those who don't respond to psychotherapy. Treatment should be tailored based on the severity of eating disorder psychopathology, presence of comorbidities, and patient preferences.