From the Guidelines
The first line of treatment for binge eating disorder is 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 addressing the psychological factors driving binge eating behaviors, such as negative emotions, rigid thinking patterns about food and weight, and difficulties with impulse control. Some key points to consider when implementing this treatment include:
- Cognitive-behavioral therapy (CBT) typically involves 15-20 weekly sessions with a trained therapist who helps patients identify triggers for binge eating episodes and develop healthier coping strategies.
- Interpersonal psychotherapy (IPT) is also effective as a first-line option, focusing on addressing interpersonal issues that may contribute to binge eating behaviors.
- Medication may be considered, with the SSRI antidepressant fluoxetine (Prozac) at doses of 60mg daily showing benefit, or lisdexamfetamine (Vyvanse) at 50-70mg daily being the only FDA-approved medication specifically for binge eating disorder, as suggested by the American Psychiatric Association 1. A comprehensive approach that includes nutritional counseling to establish regular eating patterns is also important for long-term success, as it helps patients develop a healthier relationship with food and their body. Overall, the goal of treatment is to address the underlying psychological and emotional factors contributing to binge eating disorder, and to help patients develop a more balanced and healthy relationship with food and their body, as recommended by the American Psychiatric Association 1.
From the Research
First Line of Treatment for Binge Eating Disorders
The first line of treatment for binge eating disorders includes:
- Psychological treatments, such as cognitive-behavioral therapy (CBT), interpersonal therapy, and behavioral weight loss, which are recommended as first-line options and are supported by several different meta-analytic reviews 2, 3, 4, 5
- These therapies focus on changing the patient's erroneous ways of thinking about themselves, normalizing food intake, challenging dysfunctional thinking, identifying feelings, and developing non-food coping skills 4
- Cognitive behavior therapy (CBT) is based on changing the patient's ways of thinking and has been shown to be effective in reducing disordered eating behaviors and improving psychiatric symptoms 4
- Interpersonal therapy is also effective in treating binge eating disorder, particularly when used in conjunction with other therapies 4, 6
Medications
- Lisdexamfetamine is currently the only medication approved by the US Food and Drug Administration for the treatment of BED, with robust effect sizes for response, remission, and avoidance of relapse, but its use may be limited by tolerability 2, 5
- Other medications, such as topiramate, have been used "off-label" to treat BED, but additional medication choices approved by the US Food and Drug Administration are needed 2