Subtypes of Binge Eating Disorder and Treatment

Binge Eating Disorder was the first eating disorder considered a true illness by the psychiatric community besides anorexia and bulimia. It is still underdiagnosed and often unrecognized although the approval of Vyvanse for treatment last year, if questionable, brought needed attention to the disease. 

The classification of BED is still limited due to the lack of thorough research, but the subtypes are varied and the treatment, although similar in ways to other eating disorders, has significant differences. 

The type of symptoms can be very different for patients. Some people binge on large quantities of food very quickly while others will feel the urge to eat normal or large meals, often many times per day, which sometimes is called compulsive overeating. Still other people describe an addictive response to certain foods, usually bread or sugar. Without these foods, their eating is very normal, but these foods can trigger an addictive response that leads to days or weeks of overeating just those addictive foods. 

Most clinical centers do not distinguish BED as a separate illness and instead treat these patients with the same methods used for people with anorexia and bulimia, with limited success. Often people with binge eating seek medical help instead and are led to the same treatment used for obesity. Frustrated with these options, many patients seek help outside the clinical establishment through other programs such as Overeaters Anonymous. 

What people with binge eating disorder need is individualized treatment for their specific symptoms. Creating a legitimate diagnosis and approving a medication for BED brought attention to the illness that hopefully will increase clinical research into new treatment approaches. 

Of the three subtypes mentioned above, people with sizable binges will get the most success from current therapy protocols. The binges are similar to those of bulimia and the treatment tends to be just as effective. 

People with compulsive overeating will get benefit from the standard treatment for bulimia as well but with more limited success. The emotional component of that form of eating is much stronger than for most eating disorders and demands more thorough therapy for those triggers. The symptoms tend to start later than in most eating disorders and have a strong emotional and behavioral drive. Disentangling that drive needs a combination of focus on food and normalizing eating with work on the emotional triggers. 

The addictive subtype of binge eating disorder is the hardest to treat. Often these symptoms start at a young age and the symptoms lead to a chemical high that is very habit forming. The cravings for another high can be overwhelmingly strong. Twelve step programs can be very helpful and mindfulness around the cravings also helps with treatment. The concepts of sobriety and sponsorship used in these programs are also helpful. Not infrequently, medications can be extremely effective in treating the addictive component as well. 

The incidence of binge eating disorder continues to grow and the clinical community needs to learn more about the illness and its subtypes in order to develop successful diagnosis and treatment.