Binge eating disorder: Cognitive-behavioral therapy (CBT)
- Robyn Sysko, PhD
Robyn Sysko, PhD
- Assistant Professor of Psychiatry
- Icahn School of Medicine at Mt. Sinai
- Michael Devlin, MD
Michael Devlin, MD
- Professor of Clinical Psychiatry
- Columbia University College of Physicians and Surgeons
Binge eating disorder is more prevalent in the United States than either anorexia nervosa or bulimia nervosa. In a large, nationally representative community survey, the estimated lifetime prevalence of binge eating disorder among women was 3.5 percent and among men 2.0 percent . In addition, binge eating disorder is associated with numerous psychiatric and nonpsychiatric disorders [1,2]. Most patients report some degree of impairment in psychosocial functioning (home, work, personal life, or social life), and 19 percent report severe impairment. There are many treatment options for binge eating disorder, including psychotherapy, behavioral weight loss therapy, and pharmacotherapy.
This topic describes the use of CBT to treat binge eating disorder. Choosing treatment for binge eating disorder is discussed separately, as is the epidemiology and diagnosis. (See "Binge eating disorder in adults: Overview of treatment" and "Eating disorders: Overview of epidemiology, clinical features, and diagnosis", section on 'Binge eating disorder'.)
CBT is one of several psychotherapies that are available to treat binge eating disorder [3,4]. (See "Binge eating disorder in adults: Overview of treatment", section on 'Psychotherapy'.)
Theoretical foundation of CBT — The standard CBT used for binge eating disorder is adapted from the type of CBT that was developed for bulimia nervosa . The CBT model for binge eating disorder emphasizes the critical role of both cognitive and behavioral factors in maintaining binge eating behaviors, and focuses upon regulating food intake and reducing episodes of binge eating. The core psychopathology among patients with binge eating disorder is they over-evaluate (over-value) body shape and weight, meaning that self-worth is largely or exclusively dependent upon shape and weight, and one’s ability to control them . This produces dysfunctional eating and dieting behaviors, which lead to a psychological and physiological vulnerability to binge eating episodes. The recurring binge eating causes distress and low self-esteem, which lead to continued dietary restraint (attempts to limit eating) and binge eating .
INDICATIONS FOR CBT
Reviews and treatment guidelines concur that CBT is effective for binge eating disorder [3,4,7,8]. CBT is indicated for patients who are willing to engage in and perform the work required by CBT, or at least sufficiently motivated to begin the process as motivation can be addressed in the course of treatment. The use of CBT for binge eating disorder is consistent with multiple practice guidelines [8-10].
- Hudson JI, Hiripi E, Pope HG Jr, Kessler RC. The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biol Psychiatry 2007; 61:348.
- Mehler, PS, Birmingham, LC, Crow, SJ, et al. Medical complications of eating disorders. In: The Treatment of Eating Disorders, Grilo, CM, Mitchell JE (Eds), The Guilford Press, New York 2010. p.66.
- Wilson GT, Grilo CM, Vitousek KM. Psychological treatment of eating disorders. Am Psychol 2007; 62:199.
- National Institute for Clinical Excellence. Eating disorders: Core interventions in the treatment and management of anorexia nervosa, bulimia nervosa and related eating disorders. Clinical guideline 9. http://www.nice.org.uk/CG009 (Accessed on October 07, 2010).
- Fairburn, CG, Marcus, MD, Wilson, GT. Cognitive-behavioral therapy for binge eating and bulimia nervosa: A comprehensive treatment manual. In: Binge eating: Nature, assessment and treatment, Fairburn, CG, Wilson, GT (Eds), Guilford Press, New York 1993. p.361.
- Cooper, Z, Fairburn, CG. Cognitive behavior therapy for bulimia nervosa. In: The Treatment of Eating Disorders, Grilo, CM, Mitchell, JE (Eds), The Guilford Press, New York 2010. p.243.
- Vocks S, Tuschen-Caffier B, Pietrowsky R, et al. Meta-analysis of the effectiveness of psychological and pharmacological treatments for binge eating disorder. Int J Eat Disord 2010; 43:205.
- American Psychiatric Association. Treatment of patients with eating disorders,third edition. American Psychiatric Association. Am J Psychiatry 2006; 163:4.
- Hay P, Chinn D, Forbes D, et al. Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of eating disorders. Aust N Z J Psychiatry 2014; 48:977.
- NICE National Institute for Health and Care Excellence. Eating Disorders: Core interventions in the treatment and management of anorexia nervosa, bulimia nervosa and related eating disorders. Clinical guideline 9. January 2004. http://www.nice.org.uk/guidance/cg9/ (Accessed on June 10, 2015).
- Grilo CM, Masheb RM, Wilson GT, et al. Cognitive-behavioral therapy, behavioral weight loss, and sequential treatment for obese patients with binge-eating disorder: a randomized controlled trial. J Consult Clin Psychol 2011; 79:675.
- Barnes RD, Blomquist KK, Grilo CM. Exploring pretreatment weight trajectories in obese patients with binge eating disorder. Compr Psychiatry 2011; 52:312.
- Masheb RM, Grilo CM, Rolls BJ. A randomized controlled trial for obesity and binge eating disorder: low-energy-density dietary counseling and cognitive-behavioral therapy. Behav Res Ther 2011; 49:821.
- Wilfley DE, Agras WS, Telch CF, et al. Group cognitive-behavioral therapy and group interpersonal psychotherapy for the nonpurging bulimic individual: a controlled comparison. J Consult Clin Psychol 1993; 61:296.
- Fairburn, CG. Cognitive behavior therapy and eating disorders, Guilford Press, New York 2008.
- Grilo CM, White MA, Masheb RM, Gueorguieva R. Predicting meaningful outcomes to medication and self-help treatments for binge-eating disorder in primary care: The significance of early rapid response. J Consult Clin Psychol 2015; 83:387.
- Grilo CM, Masheb RM, White MA, et al. Treatment of binge eating disorder in racially and ethnically diverse obese patients in primary care: randomized placebo-controlled clinical trial of self-help and medication. Behav Res Ther 2014; 58:1.
- Sysko R, Walsh BT. A critical evaluation of the efficacy of self-help interventions for the treatment of bulimia nervosa and binge-eating disorder. Int J Eat Disord 2008; 41:97.
- Wilson GT, Wilfley DE, Agras WS, Bryson SW. Psychological treatments of binge eating disorder. Arch Gen Psychiatry 2010; 67:94.
- Fairburn, CG. Overcoming Binge Eating, The Guilford Press, New York 1995.
- Agras, WS, Apple, RF. Overcoming Eating Disorders: A Cognitive-Behavioral Treatment for Bulimia Nervosa and Binge-Eating Disorder, Oxford University Press, New York 1997.
- Schmidt, U, Treasure, J. Getting Better Bit(e) by Bit(e): A Survival Kit for Sufferers of Bulimia Nervosa and Binge Eating Disorder, Psychology Press, East Sussex, UK 1993.