Individuals with binge eating disorder (BED) experience recurrent episodes of eating too much, eating too quickly, and eating until they’re painfully full. They also regularly feel ashamed, disgusted, distressed, and depressed about their bingeing.
BED is the most common eating disorder in both women and men. It can start in late adolescence, though it does affect younger ages, as well.
Thankfully, binge eating disorder is highly treatable.
The first-line treatment is psychotherapy. Medication also might be helpful—but rarely on its own. Something that clearly doesn’t help is weight-loss or weight management programs—even though many resources, including websites and even medical professionals and treatment guidelines, recommend them. Some resources also recommend individuals wait until they’re fully recovered from BED to lose weight.
However, both approaches are harmful. The very methods used to achieve weight loss—restricting food intake, counting calories, weighing yourself, limiting certain food groups—trigger binge eating, along with feelings of shame and self-loathing. This article delves into why weight loss is harmful for BED (and this one explores why promising weight loss to clients is ultimately unethical).
Overall, it’s best to work with a team of professionals, which includes a clinician (psychologist or therapist); psychiatrist; dietitian (who doesn’t subscribe to diets or weight loss); and a primary care physician (if medical complications might be present).
Psychotherapy
Cognitive behavioral therapy (CBT) is considered the treatment of choice for people with binge eating disorder (BED). A specific form called enhanced CBT (CBT-E) has been shown to be effective. CBT-E generally consists of 20 sessions over 20 weeks. The therapist and client focus on understanding BED, reducing bingeing, and reducing concerns about weight and shape. They also focus on reducing or eliminating the factors that maintain BED, such as dieting. In the last few sessions, they delve into how to deal with setbacks and maintain positive changes.
Another effective treatment for BED is interpersonal psychotherapy (IPT), which consists of 6 to 20 sessions. The theory behind this therapy is that interpersonal problems cause low self-esteem, anxiety, and distress, which trigger binge eating. In IPT, therapists help individuals to explore the link between their relationships and symptoms. They pick one out of four problem areas to focus on: grief, interpersonal role disputes, role transitions, or interpersonal deficits. For instance, a therapist might help one client navigate the new transition of motherhood. They might help another client resolve a conflict with their spouse.
Dialectical behavior therapy (DBT) also might be helpful for treating BED. DBT was created to treat individuals with borderline personality disorder and individuals who chronically struggle with suicidal thoughts or attempts. A DBT therapist helps individuals with BED identify what triggers their binge-eating episodes, learn to tolerate these emotions without bingeing, and build a fulfilling, meaningful life.
Research using randomized controlled trials in kids and teens is limited. But preliminary studies show that CBT, IPT, and DBT may be effective in younger individuals.
Medications
In 2015, the U.S. Food and Drug Administration (FDA) approved the medication lisdexamfetamine dimesylate (Vyvanse) to treat moderate to severe binge eating disorder (BED). A 2016 meta-analysis found that lisdexamfetamine reduced binge-eating frequency, obsessive thoughts, and compulsions about binge eating.
(The authors of the 2016 article did note that “Because the U.S. Drug Enforcement Administration classifies lisdexamfetamine as a Schedule II drug, individuals with a history of stimulant or other substance use disorder, suicide attempt, mania, or cardiac disease or abnormality were excluded from the trials; therefore, the results may not generalize to these BED populations.”)
Lisdexamfetamine is a stimulant prescribed for ADHD, and carries a risk of abuse and dependence. Common side effects include dry mouth, insomnia, anxiety, irritability, dizziness, diarrhea, constipation, and increased heart rate.
Antidepressants also are used to treat BED. For instance, your doctor might prescribe fluoxetine (Prozac), a selective serotonin reuptake inhibitor (SSRI), that’s been approved by the FDA to treat bulimia. Other SSRIs that have been found to be effective for BED are sertraline (Zoloft), fluvoxamine (Luvox), citalopram (Celexa), and escitalopram (Lexapro).
Common side effects of SSRIs include: insomnia; drowsiness; dizziness; dry mouth; sweating; upset stomach; and sexual dysfunction (such as decreased sexual desire and delayed orgasm).
If you’ve been given an SSRI, it’s important to take it as prescribed. If you abruptly stop taking the medication, it can trigger discontinuation syndrome, which is essentially withdrawal. You might experience dizziness, insomnia, and flu-like symptoms. If you don’t want to take your SSRI anymore, discuss this with your doctor, so you can slowly and gradually decrease the dose. Sometimes, even doing this can still trigger some withdrawal symptoms.
Several treatment guidelines and reviews also recommend topiramate (Topamax), an anticonvulsant, to treat BED. Like the medications above, topiramate has been shown to decrease binge-eating frequency, increase abstinence from binge eating, and reduce eating-related obsessions and compulsions. Topiramate’s common side effects include: drowsiness; dizziness; nervousness; numbness in hands or feet; confusion; and problems with coordination, speech, and memory.
It’s critical to have a thorough discussion about the medication your doctor is prescribing. Bring up any concerns and questions about side effects, interactions (if you’re taking other medications), and anything else you want to know. The decision to take medication should be a collaborative, thoughtful, and well-informed one.
More Intensive Interventions
For most people with binge eating disorder (BED), outpatient treatment is best. However, for some, residential or inpatient treatment at an eating disorder facility might be necessary. This might be the case if individuals are also struggling with significant depression or anxiety; are suicidal; have severe BED; or if no other treatments have helped.
If medical complications are present, a person might need to stay at a hospital to get stabilized.
After individuals complete inpatient treatment, they might begin attending an outpatient program at an eating disorder facility. Some individuals might attend various therapies—such as individual therapy, group therapy, and nutrition counseling—several times a week for several hours. Others might attend the entire week for up to 10 hours a day and go home to sleep (though this tends to be rare for individuals with BED).
Self-Help Strategies for BED
Learn about Health At Every Size (HAES). The basic tenets of this empirically supported paradigm focus on celebrating body diversity; finding joy in movement; and eating in a flexible and attuned way that values pleasure and honors internal cues of hunger, satiety, and appetite (instead of promoting eating plans that push on weight control). Instead of focusing on losing weight, HAES focuses on helping individuals cultivate healthy, joyful, genuinely nourishing habits.
You can learn more about HAES at the Association for Size Diversity and Health and in the book Health At Every Size: The Surprising Truth About Your Weight.
Learn about intuitive eating. Intuitive eating is defined as “a self-care eating framework, which integrates instinct, emotion, and rational thought.” It was created by Evelyn Tribole and Elyse Resch, who are both dietitians. It consists of 10 principles, which include rejecting the diet mentality, honoring your hunger, making peace with food, and honoring your feelings without food.
You can learn more about intuitive eating at this website and check out the book Intuitive Eating and The Intuitive Eating Workbook.
Process your emotions. Difficult emotions often trigger binge eating. Learning healthy ways to process emotions can help. For instance, you can try to gently sit with your emotions by noticing them, validating their presence, and focusing on the present moment. You can also express your emotions through creative ways. Effectively processing your emotions is a skill that requires practice and time.
Find enjoyable ways to move. Our bodies are meant to move. The key, however, is to find physical activities that are enjoyable, which will be different for different people. They also might be different for you on different days depending on what you need. Some days, you might want to take a short walk. Other days you might want to dance, try a new yoga class, or ride your bike.
You can find more self-help strategies and information on managing BED in this article, which includes insights from BED experts.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Bohon, C. (2019). Binge eating disorder in children and adolescents. Child and Adolescent Psychiatric Clinics of North America, 1-7. DOI: https://doi.org/10.1016/j.chc.2019.05.003.
Brownley K.A., Berkman N.D., Peat C.M., Lohr K.N., Cullen K.E., Bann C.M, Bulik, C.M. (2016). Binge-Eating Disorder in Adults: A Systematic Review and Meta-analysis. Annals of Internal Medicine, 165, 409–420. DOI: 10.7326/M15-2455.
Crow, S.J. (2019). Pharmacologic treatment of eating disorders. Psychiatric Clinics of North America, 42, 253-262. DOI: 10.1016/j.psc.2019.01.007.
Hilbert, A., Hoek, H.W., Schmidt, R. (2017). Evidence-based clinical guidelines for eating disorders: international comparison. Current Opinion in Psychiatry, 30, 423-437. DOI: 10.1097/YCO.0000000000000360.
Karam, A.M., Fitzsimmons-Craft, E.E., Tanofsky-Kraff, M., Wilfley, D.E. (2019). Interpersonal psychotherapy and the treatment of eating disorders. Psychiatric Clinics of North America, 42, 205-218. DOI: 10.1016/j.psc.2019.01.003.
