Treating the Most Common Eating Disorder

Bret S. Stetka, MD; Denise E. Wilfley, PhD


April 27, 2015

In This Article

Treating BED

Medscape: What therapeutic approaches are used to treat the condition?

Dr Wilfley: There are treatment options available for BED and there need to be more efforts to educate healthcare providers on the treatments available. Cognitive-behavioral therapy (CBT) and interpersonal psychotherapy (IPT) have been shown to be especially effective in treating BED. Both of these treatments have demonstrated robust long-term outcomes for binge eating and associated eating disorder psychopathology. Studies comparing these two approaches have shown that they are equally effective over the long term.

CBT for BED is based on cognitive-behavioral theory, which posits that disordered eating is caused by overevaluation of one's shape and weight, which leads to strict dietary restraint which results in disordered eating behaviors. Accordingly, CBT utilizes behavioral strategies (eg, self-monitoring) to encourage normalization of eating patterns in conjunction with teaching cognitive skills. These skills work to restructure cognitions and counter identified negative thoughts that precipitate binge eating.

Relapse prevention techniques like problem-solving and coping with high-risk situations are also taught to help maintain changes.

While the focus in CBT is on changing disordered eating thoughts and behaviors, IPT focuses on identifying and altering maladaptive interpersonal patterns associated with disordered eating. IPT is based on the theory that social relationships are at the center of psychological well-being. Negative self-evaluation, resulting from actual or perceived negative social interactions, increases negative affect, which leads to binge eating, And binge eating can lead to withdrawal or social isolation which further negatively affect interpersonal relationships. The IPT therapist works with the individual to break this cycle by identifying these problematic patterns, by connecting identified negative social interactions to the onset and maintenance of the binge eating.

Once identified, the therapist and client can systematically work on modifying the problematic interactions related to the binge eating by collaboratively setting interpersonal change goals. Then the individual is supported in the development of skills to modify these negative interpersonal patterns and develop healthy interpersonal relationships. As interpersonal relationships become more satisfying, the problematic pattern disappears, the individual develops a more positive self-image, and disordered eating behaviors decrease.

Medscape: Are there any promising investigational treatments being looked at that you feel have potential?

Dr Wilfley: There are several promising investigational treatments for BED. These include dialectic behavior therapy and appetite awareness training. However, these approaches have not yet been studied in numerous randomized clinical trials.

Furthermore, pharmacologic treatments have shown promise but have not been studied as extensively or for as long of a term as the psychological treatments. Lisdexamfetamine dimesylate (Vyvanse®) recently became the first drug to receive FDA approval for the treatment of BED in adults. About half of the individuals who took the drug for 11 weeks experienced no binging for the last 4 weeks. Studies that replicate these findings and explore the long-term effects of the medication are needed.


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