People who wonder how to stop binge eating often focus on the wrong thing. Being bombarded by cultural messages indicating that the answer to overeating is always to diet caused some people with binge eating disorder to mistakenly believe that they can overcome their condition by dieting.
While dieting can lead to weight loss, it does not address the underlying causes of binge eating disorder. People with Binge Eating Disorder (BED) may experience a cycle of dieting, losing weight, gaining it back and then dieting again. This is often called “yo-yo dieting.” The failure to maintain healthy eating patterns or weight loss can cause people with BED to blame themselves or to believe that they simply lack self-control. This can trigger escalating binges and serious psychological symptoms.
It is common for people with binge eating disorder to have low self-esteem and feelings of shame and self-loathing that persist even during a successful diet. A more effective way to get binge eating help than dieting is therapy. There is no binge eating disorder cure, but getting the right treatment can lead to significant and lasting improvement. Research by Wilfley, Welch and Stein found that 80 percent of people with BED stopped having episodes of binge eating after 20 sessions of cognitive behavioral therapy.
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Therapy Options for Binge Eating Disorder
Binge eating disorder is mostly psychologically driven but has both physical and psychological causes and effects. This makes it important for people seeking binge eating disorder treatment to receive holistic care that addresses nutrition and stress management as well as psychological healing.
Sometimes people only binge on rare occasions when they are under extreme stress, while people with symptoms of depression might binge regularly to try to cope with psychological pain. Unfortunately, binge eating usually lowers a person’s mood. This can lead to a cycle of worsening self-loathing and depression for people with BED.
- Psychotherapy. Binge eating therapy that addresses emotional reasons for overeating is an important part of treatment. One reason that psychotherapy typically works better than diet modification for people with BED is that one addresses the underlying emotional causes of the disorder while the other does not. In psychotherapy, people with binge eating disorder can address issues with self-image while processing trauma and learning different ways to feel what they are trying to feel when they binge. When they start treating themselves better in other ways, like giving themselves permission to make long-desired changes in their lives, they have fewer reasons to binge.
- Cognitive Behavioral Therapy. In cognitive behavioral therapy (CBT), people work with a therapist to identify false or irrational beliefs and thought patterns that trigger painful feelings and negative behavior. A therapist then helps them challenge these thoughts and try to change them. For people with binge eating disorder, CBT may focus on distorted beliefs about appearance, weight and personal worth. The goals of CBT for binge eating disorder are to address negative self-talk and to help people learn how to affirm themselves in ways that don’t trigger binges.
- Acceptance and Commitment Therapy. Acceptance and commitment therapy (ACT) is a variation of CBT that works better for some people. In ACT, people also identify cognitive distortions but learn how to accept them and act independently from them instead of trying to change them. Acceptance and commitment therapy can be a good option for binge eating disorder because it encourages people to take positive actions without judging themselves for having negative thoughts. This can help break the cycle of shame linked with BED.
- Dialectical Behavioral Therapy. Dialectical behavior therapy (DBT) has a similar approach as ACT, promoting self-acceptance rather than self-confrontation. In addition, DBT teaches people skills in four different areas: mindfulness, distress tolerance, emotional regulation and interpersonal effectiveness. These skills can be helpful for people who binge in response to episodes of emotional dysregulation in which they react intensely to interpersonal triggers. In DBT, people with binge eating disorder can learn how to recognize signs of rising emotion and intervene before these feelings trigger a binge eating episode.
- Interpersonal Psychotherapy. What connects CBT, ACT and DBT is their emphasis on developing greater awareness of inner processes and how they affect relationships. Interpersonal psychotherapy focuses closer on social factors that affect mood. In IPT, people work with a therapist to resolve interpersonal issues in one of four areas: complicated bereavement, interpersonal deficits, role transition and role dispute. Addressing these issues can help people with BED improve their self-understanding and self-confidence. By changing the way they function in relationships and the way they think about themselves, therapy can help them address the deeper roots of their disordered eating. Research by Wilson, Wilfley and Agras shows that both CBT and IBT result in higher rates of remission from binge eating than from behavioral weight loss treatment.
- Hypnosis. Binge eating hypnosis can help some people make the initial shift in their thinking and behavior about food. The goal of hypnosis is to reprogram the brain to respond differently to certain thoughts or environmental triggers. For most people, hypnosis works best when combined with a treatment plan that follows hypnosis sessions with CBT or other in-depth methods for changing thinking and behavior.
- Nutrition Counseling. Rather than focusing on calorie counting, the aim of nutrition counseling for someone with binge eating disorder is to help them plan meals so that they feel fuller for longer periods of time, especially during the times of day when they are prone to binging. Establishing a regular schedule of meals and snacks doesn’t completely remove the risk of binges but can significantly reduce it. A nutrition counselor can also help people interested in overcoming binge eating by helping them find different ways to feel full and nurtured by food. For example, people can learn to snack on foods that keep them feeling satisfied longer. They can also learn how to pay closer attention when they eat so they feel more nourished. Nutrition counselors can also help clients establish designated times and places for eating so that they can stop associating certain contexts with food.
- Group or Family Therapy. The feelings of shame and self-loathing that often accompany binge eating disorder can cause people to make social concessions that they don’t want to make but don’t feel permitted to refuse, even without direct pressure from others. Group and family therapy can address these issues. In group treatment, people with BED can learn coping strategies from others with similar challenges and receive emotional validation for their experiences. They can have their distorted beliefs about themselves and their social capacities challenged by positive interactions and supportive feedback. In family therapy, people with binge eating disorder or other conditions attend sessions with parents, children or intimate partners. In these sessions, they usually work on communication and conflict resolution skills. Family members can learn how to support loved ones by learning more about the conditions affecting them and actively working to reduce their part in conflicts.
Medications Used for Treating Binge Eating Disorder
There is no consensus on the best medication for binge eating disorder. However, research has revealed that a wide range of medications can help, particularly the following three types:
Prescription stimulants like Vyvanse have been found to reduce impulsive eating, possibly because they help people maintain steady levels of the neurotransmitter dopamine, which is part of the reward system triggered by binge eating.
The Food and Drug Administration (FDA) approved Vyvanse for the treatment of BED in 2015. However, Vyvanse and other stimulants may not be recommended for people with co-occurring substance use disorders because of their addictive properties.
Another medication with significant research support for the treatment of binge eating disorder is topiramate. This anticonvulsant drug was developed to treat epilepsy and migraines but has also been found to be effective as a mood stabilizer that can reduce impulsive behavior and regulate mood. A range of research studies shows that topiramate reduces the frequency of binge episodes and helps people who are obese control or lose weight.
The best medications for binge eating disorder may be selective serotonin reuptake inhibitors (SSRIs), a popular class of antidepressant medications. Research by McElroy, Guerdjikova, Mori and O’Melia found that SSRIs can improve mood and reduce the frequency of binge eating episodes. The SSRIs most commonly prescribed for binge eating disorder include:
- Sertraline (Zoloft)
- Paroxetine (Paxil)
- Fluoxetine (Prozac)
- Fluvoxamine (Luvox)
- Escitalopram (Lexapro)
In addition to being effective for treating binge eating disorder, SSRIs can work well in a wide range of treatment plans. They are safe to use with many other medications and are a natural choice for people who have BED and co-occurring depression or anxiety. The side effects of SSRIs are relatively mild for most individuals, and this class of drugs lacks addictive properties that can interfere with the treatment of co-occurring substance use disorders.
For people with severe eating disorders, inpatient treatment is sometimes recommended or even required. Binge eating disorder treatment centers address immediate psychological and medical risks by providing a structured environment where people can receive interventions that may include therapy, nutritional counseling and medical supervision.
Many rehab facilities offer complementary therapies that help people cope with and heal from stress or emotional pain, including art and movement therapies. Activities like yoga promote improved body awareness and positive self-regard through gentle exercises.
A misconception about binge eating disorder rehab is that this form of treatment is all a person needs to get better. In most cases, it is only the first step in a full course of treatment.
The purpose of inpatient treatment is stabilization and establishing new norms. In rehab, people learn more about their disorders and practice new behaviors in an environment with significantly fewer stressors and triggers than they face at home.
An important part of inpatient treatment is aftercare planning. Many rehab centers help clients establish behavioral strategies to address environmental triggers at home. They also usually make referrals to outpatient care providers and peer support groups so that clients can continue to receive support and treatment as they progress through recovery.
Treating Binge Eating and Co-Occurring Conditions
People with binge eating disorder frequently have other behavioral health conditions. Research by Javaras, Pope and others reveals that the most common co-occurring disorders for people with BED include:
- Bipolar disorder
- Anxiety disorders
- Major depressive disorder
- Substance use disorders
- Body dysmorphic disorder
- Irritable bowel syndrome
It’s important for people with co-occurring disorders to receive treatment that addresses all of their conditions. Medical conditions should be monitored and treated while people with BED make recovery-oriented lifestyle changes. It is also important for people to try to cope with symptoms of anxiety and depression as they change their eating behaviors. Fortunately, many of the preferred interventions for binge eating disorder are also effective in treating several co-occurring conditions.
It can be daunting to address co-occurring eating and substance use disorders at the same time, but help is available. The Recovery Village operates treatment centers that provide treatment for addictions and co-occurring mental health disorders. Contact The Recovery Village today to learn about treatment options that can meet your needs.