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Binge eating disorder: Cognitive-behavioral therapy (CBT)

Robyn Sysko, PhD
Michael Devlin, MD
Section Editor
Joel Yager, MD
Deputy Editor
David Solomon, MD


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 [1]. 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 [5]. 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 [6]. 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 [5].  


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].

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Literature review current through: Nov 2017. | This topic last updated: Nov 14, 2017.
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