Treatment for Binge Eating Disorder

The most effective tool to treat Binge Eating Disorder (BED) is the food journal combined with Cognitive Behavioral Therapy (CBT). This is an old treatment model developed over twenty years ago that still is not standard of care despite the long history of effectiveness. In a field with a relatively low success rate in treatment, any researched and proven approach needs to be the first line in treatment.

The therapy was first adapted by C. Fairburn in his book Overcoming Binge Eating written in the 1990’s. Patients complete a daily food journal including writing about thoughts and feelings around the time of each meal or snack. The therapist uses this information to take a number of important steps to normalize food, decrease binges and understand how to avoid binges in the future.

First, the therapist points out the long stretches of time a patient does not eat or eats very little. Working to eat regularly through the day decreases how often the patient gets very hungry, the most important trigger for a binge. After years of binging, restricting begins to seem like a necessary compensatory behavior. But regular eating, even when binges do occur, is necessary to regulate hunger.

Second, as the patient eats in a more sustained way through the day, binges decrease significantly for most people. Subsequent binges are almost always triggered by emotional reactions to life. The thoughts and feelings section of the journal can reveal when an emotional trigger begins to surface and how it leads to a binge. CBT helps link the thoughts and feelings with the behaviors and connect how a binge develops for each patient. This knowledge is a critical part of learning how binges come about.

With this new information, a patient can recognize familiar feelings sooner. Then the next step is to find new ways to manage these emotions and not subconsciously end up binging to cope with the feelings. Interventions like journaling more in depth about the feelings, ensuring adequate food when in an emotional state or connecting with people to discuss the feelings can all stop the seemingly inevitable path from emotions to a binge.

For many people, even a few months of CBT can lead to a significant decrease in binging. After this success, typically a patient’s emotional experiences or personal concerns come to the surface. No longer buried under the shame and relentlessness of the binges, the emotions that arise lead to personal growth which was otherwise impossible.

This work does not need to happen in person to be successful either. Virtual work can be just as effective as long as the patient is committed to the therapy.

My hope is that CBT gets more attention as the standard treatment for BED. It really is effective and needs to be a critical part of anyone’s training to help people with this disorder.