Binge-eating is similar to bulimia in that it involves a person binging on food, or overeating. Unlike bulimia, however, there is no purging done, or abuse of laxatives or coffee to try and remove the food from one’s body after over-eating. Binge-eating disorder (BED) is treated in a manner similar to bulimia and other eating disorders, with a focus on psychotherapy as a primary component of successful treatment.
While there are many different routes to treatment, virtually all of them begin with seeing an eating disorder specialist. Usually this individual is a psychologist or other mental health professional with experience and a background in helping a person with binge eating disorder. A physical examination and workup by a medical doctor is also often an initial part of the standard treatment of binge eating disorder. Such a medical checkup is done to better understand and begin addressing any potential physical problems that may have occurred as a result of the disorder.
Psychotherapy for Binge Eating Disorder
Psychotherapy is the most common treatment for binge eating disorder and has the greatest research support. Psychotherapy can involve a significant time and financial commitment, particularly if you are struggling with other issues (sexual abuse, depression, substance use, or relationship problems). Psychotherapy can be very helpful in addressing not only your disordered eating, but also your overall emotional health and happiness. The focus of psychotherapy treatment will be to address the underlying emotional and cognitive issues that result in the disordered eating.
People with binge eating disorder often “binge” — that is, they consume a large amount of food in a very short time. Unlike bulimia, however, they do not then induce vomiting of the food they’ve just eaten. People with binge eating disorder engage in this behavior to help fight off negative emotions, as a coping skill, or to help combat depression.
Cognitive behavioral therapy (CBT) is considered the treatment of choice for people with binge eating disorder. With the support of decades’ worth of research, CBT is a time-limited and focused approach that helps a person understand how their thinking and negative self-talk and self-image can directly impact their eating and negative behaviors.
Cognitive-behavioral therapy will often focus on identifying and altering dysfunctional thought patterns, attitudes and beliefs, which may trigger and perpetuate the person’s pattern of harmful eating behaviors. Cognitive-behavioral therapy used in the treatment of binge eating disorder focuses on the traditional foundations of CBT therapy — helping a person understand, identify and change their irrational thoughts (the “cognitive” part), and helping a person make the changes real through specific behavioral interventions (such as promoting health eating behaviors through goal setting, rewards, etc.).
Cognitive behavioral therapy is the gold standard treatment for binge eating disorder.
Cognitive-behavioral therapy is time-limited, meaning that a person with binge eating disorder will go into treatment for a specific period of time with specific goals in mind. Like all psychotherapy, it can be conducted in either an outpatient (once weekly) or inpatient setting. If done in an inpatient setting, eating disorders are often treated at residential treatment facilities (see below), since eating is such an integral and necessary part of our lives.
CBT for binge eating disorder will focus on helping the person with binge eating disorder break their pattern of unhealthy eating. CBT will help the individual with binge eating disorder monitor their eating habits and avoid situations that make them want to binge. The treatment will also help them cope with stress in ways that don’t involve food and to eat regularly in order to help to reduce food cravings.
Cognitive behavioral therapy will also help the person with binge eating disorder better understand their dysfunctional and broken beliefs about their own self-image, weight, body shape and dieting. This is done through traditional cognitive-behavioral techniques such as challenging black-or-white, all-or-nothing thinking, and the other irrational beliefs commonly held by people with binge eating disorder. CBT also helps a person to better understand the connection between their emotional state and eating — especially eating or turning to food when feeling bad.
According to an article published in 2008 from the U.S. National Guideline Clearinghouse that looked at the treatment research for binge eating disorder, “Our systematic review focused on outcomes related to binge eating and weight change in overweight individuals.
“Selective serotonin reuptake inhibitors (SSRIs) decreased target eating, psychiatric and weight symptoms, and severity of illness. However, studies were often short, and we could not determine whether observed improvements persisted after patients discontinued the medication.
“Cognitive behavioral therapy alone was associated with decreased binge eating. What remains unclear is whether this type of intervention helps with depressed mood, and it apparently does not produce decreases in weight.
“Self-help led to decreases in binge eating and negative psychological features, and rates of abstinence from binge eating were comparable to those in face-to-face psychotherapy.”
Another form of psychotherapy is known as family therapy. Family therapy helps a person with binge eating disorder see and understand the often-times dysfunctional role they play within the family, and how their eating behaviors maintain that role.
Family therapy is usually conducted with the person who has binge eating disorder and their family. However, in some instances, a few family therapy sessions may involve therapy without the person who has binge eating disorder present. This may help the family understand the roles they are playing in supporting the disordered eating, and suggest ways the family can help the person with binge eating disorder acknowledge the problem and seek out treatment.
Medications for BED
While many medications may be prescribed for symptoms related to binge eating disorder, only two drugs — fluoxetine (Prozac) and lisdexamfetamine dimesylate (Vyvanse) have been approved by the Food and Drug Administration for the treatment of binge eating disorder. These medications have been found to decrease the number of binge episodes in people with moderate to severe binge eating disorder. They are often prescribed in conjunction with psychotherapy, because medications can help in a synergistic, complementary manner to other treatment methods.
Some doctors may also prescribe medications like sertraline (Zoloft) or paroxetine (Paxil), which are approved for depression and obsessive compulsive disorder (OCD). These drugs are prescribed to help decrease feelings of depression and the obsessive thoughts toward food or a person’s weight that sometimes occur in people with BED,
At appropriate doses (similar to those used for OCD treatment), antidepressants have been found to decrease the strength of urges to binge for some individuals. Individuals with a positive response to these medications have reported a lessening of their carbohydrate cravings, which appears to help prevent binging.
Residential Treatment Facilities for Binge Eating Disorder
Residential treatment facilities offer a complete array of treatment services in one place.
One place where all of the above treatment options are available is called a residential treatment center. Such treatment centers are located throughout the United States and in many other countries as well, and focus on the treatment of all the different types of eating disorders (including binge eating disorder). Such facilities usually include a wide range of specialists — psychologists, medical doctors, nutritionists, meditation and relaxation professionals, and fitness experts. They help a person learn all of the skills necessary (through the cognitive-behavioral techniques outlined above), and put them into daily practice in a safe, relaxed setting.
Often these kinds of treatments may be paid for by an individual’s private health insurance, for up to a certain period of time (often 30 days). Check with your health insurance provide to see if such coverage is available for you.
There is little scientific research that demonstrates residential treatment centers improve patient outcomes for people with binge eating disorder. The disorder is just as properly treated in an outpatient setting.
Self-Help for Binge Eating Disorder
There are a variety of self-help methods available for eating disorders, including binge eating disorder. Self-help support groups are a great way of getting emotional support while trying to make changes in one’s life to support a healthier self-image and eating behaviors. Self-help books on binge eating disorder can be a great place to start to gain some insights and tips on changing one’s self-image and disordered eating.
Since many people with binge eating disorder use food as a coping skill for dealing with negative emotions, finding other, healthier coping skills may be a good place to start.
Our positive self-image and eating issues blog Weightless is a great place to find more tips on improving your coping skills and self-image. However, you can also start with these tips about how to improve your body image from the Something Fishy website:
- Wear clothes you feel comfortable in – Dress to express yourself, not to impress others. You should feel good in what you wear.
- Stay away from the scale – If your weight needs to be monitored, leave that up to the doctors. How much you weigh should never affect your self-esteem.
- Stay away from fashion magazines – Unless you can look through these magazines knowing they are purely fantasy, it’s just better to stay away from them.
- Do nice things for your body – Get a massage, a manicure, or a facial. Pamper yourself with a candlelight bath, scented lotion, or a new perfume.
- Stay active – Movement therapy helps improve your sense of wellbeing. Take up Yoga or Tai’ Chi, play volleyball with the kids, or bike ride with friends. Make angels in the snow or sandcastles at the beach. Be active and enjoy life!
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