Learn Why Therapy is Superior to Medication for The Treatment of Binge Eating Disorder
by Elisha M. Carcieri, Ph.D., Psychologist, and staff therapist
Binge eating disorder (BED) made headlines when the FDA approved lisdexamfetamine dimesylate (Vyvanse) for the treatment of BED.
So, what is BED, how is it treated, and what does this treatment option mean for persons with BED?
What is Binge Eating Disorder?
Binge Eating Disorder (BED) is a condition in which a person engages in recurrent episodes of binge eating at least once a week for three months. Binge eating episodes typically involve eating rapidly until uncomfortably full. Some individuals with BED report feeling unable to stop the episode and describe themselves as being out of control during a binge. Binge eaters often binge alone and make efforts to hide their behavior from friends, partners, or family members.
Episodes of binge eating often evoke feelings of guilt, shame, and depressed mood. Unlike other eating disorders, such as bulimia nervosa, people with BED do not vomit or use other methods (such as excessive exercise or fasting) to shed calories or lose weight after a binge. It should be clear that this is a very different experience than, say, overeating on Thanksgiving, having a second piece of birthday cake, or eating foods that are outside of your normal pattern while on vacation.
History of Binge Eating Disorder
Until 2013, BED was not a diagnosable eating disorder. It was instead grouped in with other unspecified eating disorders that didn’t quite meet criteria to be formally diagnosed. After much research, the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), has included BED as a specific eating disorder distinct from other diagnoses.
Who Struggles With Binge Eating Disorder?
Despite only recently being formally acknowledged, BED is the most commonly occurring eating disorder. Prevalence estimates vary, ranging from 1.6-3.5% of women, 0.8-2% of men, and 1.6% of adolescents. BED occurs as commonly among women from racial or ethnic minority groups as for white women, and is often seen in people with severe obesity. Up to 30% of people seeking bariatric surgery or other interventions for weight loss are suffering from BED.
While it is more common for women to meet all of the criteria for BED, men tend to engage in binge eating as frequently as women. Like all eating disorders, the causes of BED are complex. There is evidence for genetic, biological, and environmental risk factors. BED is associated with significant chronic health problems. It is also common for individuals with BED to struggle with other mental health disorders at the same time, including depression, anxiety, and substance use disorders.
The good news is that there are established treatments that work for BED. Unfortunately, effective psychological interventions for eating disorders don’t get as much press as pharmaceuticals. Nevertheless, those suffering from BED should be aware of what is available.
Treatment for Binge Eating Disorder
Psychotherapy is considered the primary treatment for BED. A psychologist or other mental health professional qualified to treat eating disorders usually conducts psychological treatment for BED on an outpatient basis. Cognitive behavioral therapy (CBT) is the most well-studied and established treatment for BED with demonstrated effectiveness. The treatment involves reducing episodes of binge eating using tools such as establishing regular eating patterns and self-monitoring of food intake and patterns of eating.
CBT also addresses concerns about shape and weight and examines and challenges patterns of thinking that may be keeping a person stuck in a pattern of binge eating. CBT for BED involves discussion and planning of how to maintain progress, and how to recognize and respond to relapse. Studies have demonstrated improvements lasting up to 12 months post-treatment with CBT. Interpersonal therapy (IPT) has also been proven effective for BED with strong research support. IPT involves more of a focus on interpersonal (relationship) difficulties with an understanding of how these problems may have led to BED, or how they might be keeping the BED going. Finally, there is evidence that dialectical behavior therapy (DBT), which focuses on mindfulness, emotion regulation, and distress tolerance, is effective at treating BED.
Pharmacological Treatments for Binge Eating Disorder
In addition to psychological treatments, antidepressants and anticonvulsants have proven helpful in reducing the frequency of binge eating in patients with BED. The newest and only medication specifically approved by the FDA for BED is Vyvanse, a central nervous system stimulant that has been approved to treat ADHD in children and adults since 2007. The approval for BED came after research showed that the average number of binge eating days per week among sufferers was decreased in those who took Vyvanse, compared to those who took a placebo. Sounds promising…but there are other things to keep in mind…side effects, long-term use, and the question of whether a medication can address the complex nature of a serious eating disorder such as BED.
Potential Side Effects of Medication Treatment
The potential side effects of Vyvanse include decreased appetite, dry mouth, increased heart rate or blood pressure, poor sleep, anxiety, gastrointestinal problems, feeling jittery, and even sudden death among people with heart problems. The drug is also particularly risky for individuals with a history of seizures or mania. Vyvanse may cause psychotic or manic symptoms in people with no history of mental illness and has a high potential for abuse, dependence, and overdose.
Vyvanse appears to decrease symptoms over a short period of time (about three months) while taking the medication. However, it is unlikely that the medication will result in long-term changes in complex binge eating behavior once the drug is stopped, meaning that one might expect to take Vyvanse for the rest of their lives in order to keep BED at bay. This is problematic considering the chronic nature of BED, and the fact that the negative emotion, guilt, shame, and weight or shape concerns that are often related to BED would almost certainly remain unaddressed.
Potential Side Effects of Psychotherapy for BED
While there are no identified side effects to the psychological treatment of BED, these treatments do take time (often around 20 weeks), and not every person will respond to therapy in the same way. It also may take some trial and error to find the right therapist or treatment. However, psychological treatments are superior to medication alone in addressing the binge eating behavior itself, and the different ways binge eating relates to other areas of a person’s life and functioning. Rather than simply masking and reducing symptoms in the short term with medication, evidence-based therapy can offer insight and tools to manage the patterns of disordered eating long-term. Many people with BED may benefit from trying therapy before starting a serious medication like Vyvanse.
Implications for Patients Seeking Treatment for BED
All of these factors should be carefully considered when making a decision about treatment for BED. With all eating disorders including BED, it is important to get help sooner rather than later. For many people, turning to their primary care doctor is the first step. Patients should keep in mind that these conversations can be sensitive and difficult, and many providers may not be familiar with BED. Some doctors may be more familiar with medication than psychological treatments.
If you aren’t getting anywhere with your doctor, it is always appropriate to ask for a referral to a medical provider who is more familiar with eating disorders. Your doctor may also be able to refer you to therapists specialized in eating disorders who can provide one of the therapies discussed above, and to a dietician who treats eating disorders for even more complete support. Remember that it is important to seek help from professionals qualified to treat eating disorders and treatment decisions should be tailored to the unique needs of each person.
If you do see a psychiatrist regarding any medication, we offer some suggestions for how to communicate with a psychiatrist.
Help for Binge Eating Disorder for People in California
Help for binge eating disorder is only an email or phone call away. Psychotherapy can help you stop binge eating and improve your body image and find peace with food. Our Los Angeles, California practice has caring therapists who treat binge eating disorder. We can provide help in person in Los Angeles or online.
1. American Psychiatric Association. (2013). The Diagnostic and Statistical Manual of Mental Disorders: DSM 5. bookpointUS.
2. Hudson, J. I., Hiripi, E., Pope Jr, H. G., & Kessler, R. C. (2007). The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biological psychiatry, 61(3), 348-358.
3. Swanson, S. A., Crow, S. J., Le Grange, D., Swendsen, J., & Merikangas, K. R. (2011). Prevalence and correlates of eating disorders in adolescents: Results from the national comorbidity survey replication adolescent supplement. Archives of General Psychiatry, 68(7), 714-723.
4. Marcus, M. D., & Levine, M. D. (2005). Obese patients with binge-eating disorder. In The management of eating disorders and obesity (pp. 143-160). Humana Press.
5. Kalarchian, M. A., Marcus, M. D., Levine, M. D., Courcoulas, A. P., Pilkonis, P. A., Ringham, R. M., … & Rofey, D. L. (2007). Psychiatric disorders among bariatric surgery candidates: relationship to obesity and functional health status. The American journal of psychiatry, 164(2), 328-334.
6. Brownley, K. A., Berkman, N. D., Sedway, J. A., Lohr, K. N., & Bulik, C. M. (2007). Binge eating disorder treatment: a systematic review of randomized controlled trials. International Journal of Eating Disorders, 40(4), 337-348.
7. Wilson, G. T., Grilo, C. M., & Vitousek, K. M. (2007). Psychological treatment of eating disorders. American Psychologist, 62(3), 199.
8. Wilfley, D. E., Welch, R. R., Stein, R. I., Spurrell, E. B., Cohen, L. R., Saelens, B. E., … & Matt, G. E. (2002). A randomized comparison of group cognitive-behavioral therapy and group interpersonal psychotherapy for the treatment of overweight individuals with binge-eating disorder. Archives of general psychiatry, 59(8), 713-721.
9. Telch, C. F., Agras, W. S., & Linehan, M. M. (2001). Dialectical behavior therapy for binge eating disorder. Journal of consulting and clinical psychology, 69(6), 1061.
10. McElroy S. L., Hudson, J. I., Mitchell, J. E., et al. (2014) Efficacy and Safety of Lisdexamfetamine for Treatment of Adults With Moderate to Severe Binge-Eating Disorder: A Randomized Clinical Trial. JAMA Psychiatry.
About the author
Dr. Elisha Carcieri is a licensed clinical psychologist, currently licensed in California and South Carolina, who provides virtual therapy services. Her focus is on helping individuals who struggle with mental health concerns, such as depression, anxiety, and eating disorders. She believes that a successful therapy experience depends on a collaborative relationship between the client and therapist. Dr. Carcieri tailors her evidence-based treatments to fit the unique needs of each individual. She draws from cognitive behavioral therapy, cognitive processing therapy, and prolonged exposure therapy. She has experience in treating a variety of issues, including insomnia and chronic pain, and values working with individuals from diverse backgrounds. As a Health at Every Size (HAES) informed clinician, Dr. Carcieri respects and accepts size diversity, particularly in the treatment of eating disorders.