How Binge Eating Disorder Is Treated

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Binge eating disorder is the most common eating disorder in the United States.

It is marked by episodes of eating large amounts of food in a short period of time without engaging in behaviors to counteract the binge eating, such as inducing vomiting or excessive exercise. People with binge eating disorder feel out of control of their eating and have feelings of guilt or disgust after binge eating episodes.

About 28.4% of people who currently have binge eating disorder are receiving treatment for their condition. Approximately 43.6% of people with binge eating disorder will receive treatment at some point in their lives.

Treatment for binge eating disorder typically involves a form of psychotherapy (talk therapy) such as cognitive behavioral therapy and often includes prescription medication such as antidepressants.

Learn more about the treatment options for binge eating disorder.

A woman sits on the kitchen floor at night eating donuts.

Leland Bobbe / Getty Images

Therapies for Binge Eating Disorder

Psychotherapy is the most common treatment for binge eating disorder. Several types of psychotherapies are available for use in treating binge eating disorder, but cognitive behavioral therapy (CBT) is generally the first one tried.

Cognitive Behavioral Therapy (CBT)

Cognitive behavioral therapy is a type of psychotherapy that focuses on disordered or negative thinking patterns and works on changing them into positive, productive ones.

CBT works on the premise that:

  • Faulty or unhelpful ways of thinking can lead to psychological problems
  • Learned patterns of unhelpful behavior can lead to or worsen psychological problems
  • Better ways of coping with psychological problems can be learned, leading to symptom relief

A form of CBT called CBT-E has been developed to address eating disorders specifically. In one study, CBT-E had a success rate of about 66% across a variety of eating disorders.

With CBT-E, people with binge eating disorder are actively involved in all areas of treatment and have the final say on all decisions. This encourages a feeling of self-control.

CBT-E addresses all eating disorders, not specific types, with the belief that the underlying disordered thinking that causes eating disorders is more crucial than the symptoms of the disorder.

While designed for adults, it can be adapted to be used with adolescents.

CBT-E occurs in four stages.

Stage 1:

  • Twice-weekly 50-minute sessions
  • Works on developing a mutual understanding of the person’s problem eating behavior
  • Focused on helping the person modify and stabilize their pattern of eating
  • Emphasizes personalized education
  • If applicable, a discussion regarding concerns about weight

Stage 2:

  • Brief stage used to "take stock" of and review progress so far
  • Make plans for the main body of treatment

Stage 3:

  • 50-minute sessions become weekly
  • Focus is on the processes that are maintaining the person’s eating problem
  • Discussions about concerns regarding eating and, if applicable, shape
  • Working on enhancing the ability to deal with day-to-day events and moods

Stage 4:

  • Focused on the future
  • Dealing with setbacks
  • Maintaining the positive changes that have been achieved

A 2014 study showed that participants with binge eating disorder showed improvement during their short-term CBT treatment and continued to improve or stayed stable in the four years following treatment.

Guided Self-Help (CBTgsh)

Guided self-help based on the principles and practices of CBT is an option for treatment for binge eating disorder.

CBTgsh is an attractive alternative to CBT-E because it is more cost-effective and can make treatment more accessible.

The shortage of CBT-E providers can make it difficult for people with binge eating disorder to find and access this specialized treatment. CBTgsh means that a wide variety of mental health professionals can provide this treatment through face-to-face contact and over the Internet, even if they do not specialize in eating disorders.

While there isn't a consensus between studies as to the exact effectiveness of CBTgsh, a 2011 study showed that participants with binge eating disorder had positive results from treatment with CBTgsh.

A 2012 study also showed promise for CBTgsh in the treatment for binge eating disorder.

Importance of Weight-Inclusive Treatment

Stigma, fat-phobia, and equating body size with value are all barriers to treatment for binge eating disorder. It is imperative that healthcare providers use language and practices that are weight-inclusive and consider "fat" a neutral descriptor.

Interpersonal Psychotherapy for Eating Disorders (IPT-ED)

A 2018 study confirmed that people with binge eating disorder have significantly more interpersonal problems than those without binge eating disorder, regardless of weight. These interpersonal problems can lead to greater psychological distress.

These interpersonal problems may begin before binge eating disorder develops, or happen as a result of binge eating disorder. Regardless of onset, these problems help maintain the problem behavior that comes with binge eating disorder.

IPT for binge eating disorder can take place in either a group or individual format. It is administered in three phases over the course of approximately 20 weekly sessions.

Phase One

  • Identifying specific interpersonal problem areas
  • Choosing which of these areas to focus on for the remainder of treatment

The four typical interpersonal problem domains are:

  • Role disputes
  • Role transitions
  • Interpersonal deficits
  • Unresolved grief

Phase Two

  • The therapist encourages the person to take the lead in making changes in the area of interpersonal skills
  • The therapist keeps the person focused on the problem areas, clarifies issues raised, and encourages change

Phase Three

  • Maintenance of interpersonal gains
  • Relapse prevention

A 2015 study comparing CBT-E with IPT showed improvement for people with binge eating disorder in both treatment categories, but CBT-E was more effective than IPT.

At the end of treatment, 65.5% of the CBT-E participants reached remission compared with 33.3% of the IPT participants.

In the follow-up period, the CBT-E remission rate was 69.4%, while for IPT it was 49%.

Though it takes longer to see results with IPT and the success rate is lower than with CBT-E for the treatment of binge eating disorder, it is an option for people who are unable to participate in CBT-E, have not responded to it, or would benefit from an interpersonal focus in therapy.

Mindfulness-Based Eating Awareness Training (MB-EAT)

MB-EAT uses mindfulness practices to create a greater awareness of hunger and fullness cues, sensory-specific satiety (feeling satisfied), and emotional and other triggers that lead to binge eating.

Mindful eating exercises can include:

  • Being aware of hunger cues
  • Chewing food slowly
  • Tuning in to taste
  • Noticing fullness

General mindfulness practices are also included in the treatment.

This approach does not recommend or ban specific foods, but rather advocates for eating with intention.

Eating while distracted, like while watching TV, can lead to overeating. Paying attention to the sensory experience of eating and to the cues given by the body can help a person to eat when they are hungry and stop when they aren't.

The success of MB-EAT is supported by multiple studies.

Multidisciplinary Approach

Treatment for binge eating disorder may involve more than one approach at a time, such as CBT-E and medication, or another combination. A 2015 review indicated that a multidisciplinary strategy shows promising results and should be studied further.

Prescription Medications for Binge Eating Disorder

Prescription medications that are used to treat other conditions such as depression, attention deficit hyperactivity disorder (ADHD), and epilepsy are sometimes used to treat binge eating disorder as well.

A 2015 study showed that second-generation antidepressants, topiramate (Topamax), and lisdexamfetamine (Vyvanse) have a positive effect on binge eating disorder.

Second-Generation Antidepressants

Most second-generation antidepressants fall into two main categories.

SSRIs

Types:

  • Citalopram (Celexa)
  • Escitalopram (Lexapro)
  • Fluoxetine (Prozac)
  • Fluvoxamine (Luvox)
  • Paroxetine (Paxil)
  • Sertraline (Zoloft)

Potential side effects:

  • Agitation
  • Feeling shaky or anxious
  • Gastrointestinal symptoms
  • Dizziness
  • Sexual problems (low sex drive, difficulty achieving orgasm, erectile dysfunction)

SNRIs

Types:

  • Venlafaxine (Effexor)
  • Desvenlafaxine (Pristiq)
  • Duloxetine (Cymbalta)
  • Levomilnacipran (Fetzima)

Potential side effects:

  • Nausea
  • Drowsiness
  • Dizziness
  • Nervousness or anxiety
  • Fatigue
  • Loss of appetite
  • Sexual problems
  • Increased blood pressure (in higher doses)

Topiramate

Topiramate (Topamax) is an anticonvulsant that has been used to treat binge eating disorder.

Side effects might include:

  • Numbness, burning, or tingling in the hands or feet
  • Headache
  • Slowed reactions
  • Nervousness
  • Drowsiness
  • Weakness
  • Weight loss

Lisdexamfetamine

Lisdexamfetamine (Vyvanse) is a stimulant used to treat ADHD that has been shown to decrease binge eating.

In 2015, lisdexamfetamine became the first pharmacological agent to be approved by the Food and Drug Administration (FDA) for the treatment of moderate or severe binge eating disorder in adults.

Side effects might include:

  • Anxiety
  • Trouble sleeping
  • Headache
  • Dizziness
  • Dry mouth
  • Diarrhea
  • Nausea
  • Weight loss

A Warning About Lisdexamfetamine

Lisdexamfetamine can be abused or lead to dependence in some individuals. Follow your healthcare provider's instructions carefully, and see your provider if you experience changes in your behavior or have unusual symptoms.

Lifestyle Approaches for Binge Eating Disorder

Binge eating disorder is best treated under the guidance of a healthcare provider or mental health professional, but there are things you can do on your own to help get the most out of your treatment plan.

Listen to Your Body

Recognize hunger cues such as:

  • Stomach growling
  • Light-headedness
  • Irritability/crankiness
  • Low blood sugar

Eat when you are hungry, but don't wait until you are "starving." Try rating your hunger from 1 (not hungry) to 5 (extremely hungry). Eat when you are at about the 3 mark.

Create a Supportive Environment

  • Identify your triggers: What situations often lead to binging? How can you avoid them?
  • Get rid of "binge foods": If you tend to binge on certain foods, don't keep them in the house. If they aren't readily available, it is easier to avoid them.
  • Meal-plan: Plan healthy meals and snacks ahead of time, and stick to your list when grocery shopping. Your meals shouldn't be restrictive or unsatisfying, but rather well thought out. A dietitian may be able to help you with this task.
  • Ditch the scale: If you find that you weigh yourself frequently, and have a difficult time limiting weigh-ins to about once a week, consider getting rid of your scale and leaving the weight checks to when you visit your healthcare provider or dietitian.

Use Your Time Well

  • Practice mindful eating: Focus on your food and nothing else when you are eating. Avoiding being distracted by things like the TV, your phone, etc. allows you to really experience your food. This can make the experience more satisfying and stops you from absentmindedly overeating.
  • Move your body: Find ways to be active that you enjoy.
  • Keep busy: Feeling bored or anxious can make it tempting to eat when you aren't really hungry. Make a list of activities you find enjoyable and entertaining that you can pull out when you are bored or feel anxiety creeping in.

Where to Find Help

If you or a loved one are coping with an eating disorder, contact the National Eating Disorders Association (NEDA) Helpline for support at 800-931-2237.  For more mental health resources, see our National Helpline Database.

A Word From Verywell

Binge eating disorder is different from overeating. While everyone has times they eat until they are uncomfortably full, people who have binge eating disorder feel they are not in control of their eating.

If you feel you may have a problem with eating, book an appointment with your healthcare provider. They can discuss your symptoms with you and help you find a treatment that is right for you.

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