Binge Eating Disorder

Finding The Right Treatment

Treatment

The treatment of Binge Eating Disorder involves a comprehensive treatment team including:

• Psychiatrists and/or other medication providers (psychiatric nurse practitioners or physician assistants Internist/Specialists)
• Psychotherapists (clinical psychologists, licensed professional counselors, licensed social workers and licensed marriage and family therapists as it is important that the whole family is involved in treatment)
• Registered Dietitians

Having a complete and collaborative treatment team is the standard of practice for treating eating disorders. All work together. Finding a therapist that specializes in eating disorders is important, as not all therapists may have experience treating eating disorders. Certified eating disorders specialists, by the International Associations of Eating Disorders Professionals (iaedp) are the gold standard of professionals that provide treatment.

To find a trained eating disorders team, visit iaedp.com for resources in your area.

Several types of therapy can be helpful

• Cognitive Behavioral Therapy - uses techniques to replace negative thoughts and all or nothing thinking, such as feelings about one's body along with changing behaviors.

• Dialectical Behavior Therapy – brings in skills to manage emotions around stressful situations and building positive relationships in order to have social support.

• Acceptance and Commitment Therapy – offers competencies to accept thoughts and feelings, stay in the present moment, and choose a valued direction in the recovery process.

• Mindfulness-Based Cognitive Therapy - uses mindful meditation to understand one’s thought process and how the mind becomes entangled by emotions and feelings.

• Body-centered Therapies - integrates talk therapy with techniques that bring the body into counseling as a therapeutic resource to increase awareness of body sensations, behaviors, emotions, and thoughts to learn the relationship between them. Body centered therapies may include yoga therapy, dance, breath work, and meditation.

Depending on the severity of one's condition, a higher level of care may be warranted such as inpatient hospitalization that requires further intervention for symptoms including chest pain and severe hypertension; residential treatment for excessive and daily behaviors that undermine health; partial hospitalization for those with daily behaviors but are able to function in normal social, educational, or vocational situations; or intensive outpatient therapy for those who are psychiatrically stable and have symptoms under sufficient control to be able to function in normal social, educational, or vocational situations, while continuing to make progress in recovery.

It is important to note that weight loss is contraindicated in BED as it fuels the disorder and can negatively impact metabolism. Interrupting behaviors, along with normalizing eating patterns and balanced exercise are most effective for addressing BED and can lead to realistic weight loss as a byproduct versus the failures that result from chronic dieting.

The decision to start therapy

Many people try to cope with their distress on their own, then feel disappointed when they find that this is very difficult to do. Deciding to start therapy can be hard; it takes courage.

For some people, it can take time to warm up to the idea of sharing one’s intimate thoughts or disclosing details of one’s life, especially for those who grew up in a culture where seeking psychological help was frowned upon.

Psychotherapy is increasingly accepted as not only a way to improve mental health symptoms, but also a means for self exploration and personal growth. No problem is too small for a trained therapist: an individual need not worry that others may have it worse. The willingness to reach out for help is increasing: in 2020, one out of every six Americans (men and women) reported seeing a therapist.

Seeing a therapist with whom one feels comfortable, and a sense of connection, and who also participates in their insurance network, is essential. It may take a couple tries to find a therapist who feels like the right fit. If therapy didn't help the first time around, it can be helpful to give another therapist a try because therapeutic styles vary so much from therapist to therapist.

Where to start

Requesting one’s physician to make a referral is often a good place to start. Many health insurance cards have websites or 1-800 numbers to call for a list of in-network providers.

To find a therapist who takes your insurance, the National Institute of Mental Health offers a comprehensive list of resources.

Psychology Today also lists therapists by type, location and insurance.

Determining whether medications will play a role in treatment

Medications often play a role in the lives of people with Binge Eating Disorder. Finding the right medication is not straightforward, as individuals metabolize and react to medications differently.

The only medication FDA indicated to treat Binge Eating Disorder is Vyvanse. This medication works by increasing levels of dopamine and norepinephrine in the brain. Vyvanse been proven to decrease the number and severity of binge eating episodes per week. In clinical trials Vyvanse brought down the mean number of binge episodes from 5 to less than one per week.

Vyvanse is also is used to treat ADHD. Some of the other long acting ADHD medications have been used off label to treat BED, but they have not been comprehensively evaluated. Vyvanse can be associated with appetite suppression, and tightening jaw muscles.

Binge eating disorder often occurs with other conditions, such as anxiety and depression. Commonly anti-depressants are used in tandem with Vyvanse. Not all individuals with BED have an elevated Body Mass Index (BMI) but those with binge eating disorder and obesity may benefit from GLP-1 inhibitors, a class of medication associated with significant weight reduction.

First-line treatment

As a class of medications, antidepressants often take 10 days to two weeks to begin working. The full effect of the medication is not realized for two months.

If one of the “first-line” medications does not initially work, a prescriber has many options. The first is to ensure that the SSRI/SNRI is dosed adequately. Before abandoning a “first-line” treatment, higher doses are usually given a chance. Sometimes, however, high doses are not tolerated due to side effects. And, in those situations, other strategies can be employed.

Second-line medications

If neither lisdexamfetamine nor fluoxetine are effective, and other antidepressants in the selective serotonin reuptake inhibitor (SSRI) class have no effect, one's doctor may try another type of medication. Some possible medications that may be considered are armodafinil or modafinil, both “wakefulness” drugs, which are stimulating. They are also used to treat people with narcolepsy or who have to work late-night shifts.

Another possible second-line treatment option is the anticonvulsant topiramate (Topamax), which is used by some physicians to treat BED.

FDA warning about suicide risk with antidepressants

Some research exists that, occasionally, newly initiated anti-depressants may increase the risk of suicide. If an individual begins to have these thoughts after starting an anti-depressant, please stop this medicine and contact a prescriber immediately. This risk is more evident in children, adolescents, and young adults.

Healthcare providers that can prescribe medications

Psychiatrists, psychiatric nurse practitioners, and physician assistants are practitioners who are trained to diagnose and treat mental health conditions by prescribing medications. Sometimes it's hard to find a psychiatric provider because there are so many people who need them. So, individuals often choose to see a different kind of provider who can prescribe. This could be a doctor they already see, like a primary care doctor, family doctor or OB/GYN, or a new primary doctor.