The Role of Evidence-Based Treatment in Eating Disorders

Currently the evidence-based treatment for eating disorders is limited to cognitive behavioral therapy (CBT) for bulimia and binge eating disorders. There have been many studies and ample evidence that CBT reduces binge eating episodes by about half for people binging at least daily in research protocols lasting usually around 2-3 months. There is robust and repeated evidence for this benefit which makes CBT the important initial intervention for a patient new to treatment with any form of binging. 

The treatment involves daily food journaling including meals, assessment of binge/purge behaviors and thoughts/feelings. During each session, the therapist and patient review the journal and assess the interplay between the internal experiences of thoughts and feelings with the food behaviors.

Increasing awareness and understanding enables patients to see much more clearly when they are at risk for a binge and to make different decisions to avoid them. This learning process enables more regular eating thereby decreasing starvation as a main trigger for binging. The journaling also starts the process of identifying the emotional triggers for binging, a longer and more involved component of therapy and treatment. 

Typically, CBT remains an important part of therapy for longer than 3-6 months. The treatment helps patients remember the need for normal eating and continue to increase the understanding of how emotions trigger binges. 

Evidence-based research does not track patients for longer than six months. Long-term studies for psychiatric illnesses are much too expensive and involve too many variables to be realistic. Only a few have ever been done for any psychiatric disorders at all. 

Moreover, there is no evidence-based treatment for anorexia despite the fact that patients with anorexia do get better and recover. 

After a few months of treatment, all patients with eating disorders would be left without options if evidence-based treatment was the only reasonable and reliable option for care. 

The reality is that the concept of evidence-based treatment sounds positive but represents a very limited understanding of eating disorder therapy. This approach offers treatment for a subsection of people with eating disorders. It offers short-term symptom relief with no guidance for long-term treatment or for maintenance of those gains once six months are completed.

Effective clinical care takes into account research evidence and uses it as a part of therapy. However, successful recovery involves a combination of all available treatments applied for each individual with the overall goal not as symptom relief but true recovery.