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Treatment of Binge Eating Disorder

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Treatment of Binge Eating Disorder

Levels of Care for Binge Eating Disorder

The level of care an individual with binge eating disorder requires depends on the severity of their illness and their stage of recovery.

Inpatient

While rare, sometimes it may be necessary for a person with BED to be admitted for inpatient treatment, if they are psychologically or medically compromised. A person may need inpatient treatment if: (1)

  • They have severe depression and/or anxiety, or have suicidal thoughts
  • BED has caused serious medical problems, such as an unstable heart rate
  • Lab tests indicate an acute health risk
  • The eating disorder is severe with worsening BED behaviors
  • Other forms of treatment have been unsuccessful

Care and monitoring is provided around the clock, usually in a hospital setting or a unit specialized in the treatment of eating disorders. 

Treatment is individualized to each patient and includes psychotherapy (both group and family therapy) and nutrition counseling. Medical intervention may be required, such as IV fluids and medications to improve mood.

Residential

Round-the-clock care is also available in residential treatment, but only for medically stable BED patients. Multidisciplinary treatment is provided, and there is monitoring at mealtimes to prevent harmful eating behaviors and rituals. (2)

Residential treatment may be required if a person is still struggling with intrusive thoughts and requires a structured environment to control their bingeing episodes.

Partial Hospitalization Program (PHP)

A partial hospitalization program (PHP) enables a patient to sleep at home but still get support and structure by going to a treatment center during the day. Patients are required to be psychologically and medically stable but may still struggle with disordered eating patterns and social situations.

Patients go to a center several days a week for many hours, where most meals are provided under supervision. Patients also receive medical care, individual and group therapy, and nutritional counseling.

Intensive Outpatient (IOP)

When a person with BED is at the point in their recovery when they can step down from residential treatment, they will usually enter an intensive outpatient program.

A few days a week, patients will attend a specialist clinic that provides structure and control, helping patients maintain self-control over bingeing episodes. As no overnight stays or lengthy visits are required, patients can go to work or school.

Outpatient

As the lowest level of care for BED, outpatient care requires patients to be able to control their harmful eating behaviors. Patients attend weekly sessions with a dietician and therapist to monitor progress and address concerns.

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Psychotherapy for Binge Eating Disorder

Acceptance and Commitment Therapy (ACT)

Acceptance and commitment therapy (ACT) teaches people with BED to focus on changing their behaviors, instead of focusing on their thoughts and feelings. During treatment, people are asked to identify their core values and then develop goals that help satisfy these values. (3)

The main aim of ACT is to accept and acknowledge all feelings, even the negative ones, and work to change their actions so they come in line with their core values. The six processes of ACT for BED are:

  • Defusion: Reframes unhelpful eating behaviors and thoughts to defuse them of their power, helping someone with BED be more flexible.
  • Acceptance: Teaches tolerance and acceptance of all thoughts and feelings to help prevent resorting to bingeing to escape negative emotions.
  • Mindfulness: Teaches techniques to help someone stay invested in the present moment.
  • Detaching: Enables a person to see they are not defined by their disordered thoughts and eating behaviors
  • Clarity: Sets values outside of binge eating disorder.
  • Action-focused: The final stage where patients practice what they have learned throughout their ACT sessions.

Cognitive Behavioral Therapy (CBT)

Cognitive behavioral therapy (CBT) for binge eating disorder (BED) focuses on the relationship between negative thoughts, emotions, and behaviors associated with eating, body weight, and body shape. (4) By identifying the triggers of these negative feelings and patterns, strategies can be developed to challenge and change them. Components of CBT for BED include: (5)

  • Changing thoughts about weight and self-image
  • Encouraging healthy coping strategies for negative emotions
  • Learning healthy eating habits
  • Self-monitoring
  • Working toward regular eating patterns using a personalized meal plan
  • Homework tasks and food diaries

Guided Self-Help

This form of CBT involves using materials, such as a workbook, someone with BED can work through in their own time at home. Through guided self-help, a person living with binge eating disorder will learn how to recognize things that trigger bingeing episodes, improve body image, and how to prevent a relapse. (5)

Patients will have regular brief meetings with a therapist to track progress, complete the workbook, and help develop attainable goals. (6)

Dialectical Behavior Therapy (DBT)

Dialectical behavior therapy (DBT) is a form of talking therapy that’s adapted for those who feel emotions intensely. It teaches people living with BED to regulate their emotional responses, so they can deal with negative thoughts and situations without resorting to bingeing. (6)

During DBT sessions, a therapist uses a balance of acceptance and change techniques, which help a person accept themselves as they are and motivates them to change their negative coping behaviors.

There are four main areas of treatment in DBT:

  • Mindfulness: A set of skills that focuses your attention on the present moment, as opposed to negative thoughts about the past or future.
  • Distress tolerance: Learning techniques to deal with stress, without engaging in harmful BED behaviors, like bingeing and purging.
  • Interpersonal effectiveness: Developing skills to build and maintain positive relationships.
  • Emotional regulation: Understanding and recognizing emotions, to gain better control over them.

Exposure Therapy

A form of CBT, exposure therapy addresses anxiety often associated with eating disorders like BED. 

Through exposure to situations that cause a patient fear and distress, people living with BED can gradually let go of the irrational beliefs they have about eating, food, and certain situations. 

For example, a person may be exposed to a food they regularly binge on in a controlled situation and talk through their feelings throughout the exposure. As well as bingeing on food, exposure therapy can help address other anxiety-driven behaviors such as eating alone or certain food rituals. (5)

Family Therapy

In family therapy, the loved ones of someone living with BED learn how to support them during their recovery. Partners or parents of teenagers or children with BED may find family therapy particularly useful in helping restore healthy eating behaviors at home.

Group Therapy

Attending group therapy can be very useful for those living with BED. It provides a safe place to share experiences and connect with other people who have BED. Learning they are not alone in their struggle with BED can be incredibly reassuring and healing.

Group therapy sessions are usually led by a psychologist or other mental help professional who guides conversations. This can help bring positive changes to a person’s thoughts, ease emotional distress, and provide the opportunity to form deep connections with their peers.

Interpersonal Psychotherapy (IPT)

Interpersonal psychotherapy (IPT) works on the theory that binge eating disorder develops as a coping mechanism due to unresolved issues in a person’s personal life, like relationship conflict, grief, social problems, and significant life changes. (4)

IPT aims to identify the specific life problems linked to the bingeing episodes, acknowledge them, and take the steps to resolve them through group therapy or one-to-one sessions.

This form of therapy is likely to be particularly effective for people with lower self-esteem or who are living with a more severe case of BED.

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Nutrition Counseling and Meal Support

Nutrition counseling helps individuals with BED learn more about healthy eating habits and the essential nutrients the body needs for proper functioning and to remain healthy. (8) It can also teach those with BED to establish healthy eating habits, which may help them avoid binge episodes.

As many individuals with binge eating disorders often have a history of trying to lose weight, nutrition counseling for BED won’t focus on weight loss, but instead on getting the disordered eating behaviors under control. The goals of nutrition counseling for BED are to: (9)

  • Explore the triggers of bingeing episodes and learn ways to replace these maladaptive coping mechanisms
  • Introduce more variety into the diet, if nutrition deficiencies are present
  • improve disordered eating behaviors with a personalized meal plan
  • Regulate blood sugar levels with portion redistribution
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Experimental Treatments for Binge Eating Disorder

Art Therapy

Creative self-expression through art therapy can help individuals living with BED to engage with difficult emotions and externalize them visually, giving a greater sense of perspective.

Mindfulness-Based Eating Awareness Training (MB-EAT)

MB-EAT, which combines mindful eating with mindfulness strategies has shown promise in treating BED. (10) Using mindfulness techniques, people with BED learn to become more aware of hunger cues and change eating behaviors to reduce bingeing episodes.

Psychodynamic Psychotherapy

The goal of psychodynamic psychotherapy is to help a person understand the underlying causes of their binge eating disorder. (3) 

This type of therapy is based on the principle that symptoms of BED are a result of unresolved wants, needs, and internal conflicts. By understanding these unresolved issues, bingeing episodes can be addressed and the risk of relapse may be reduced.

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Treating Binge Eating Disorder at Within Health

Here at Within Health, we understand the importance that each patient be treated as an individual. Our personalized treatment plans for clients are designed to help a person to explore their relationship with themselves, their bodies, and food.

Our treatment program for BED has three levels of care - partial hospitalization (PHP), intensive outpatient (IOP), and outpatient - and each client is carefully assessed to determine the appropriate treatment.

You’re much more than numbers on a scale, so we don’t use them. There will be no calorie counting, weight measurements, or any other numbers. Instead, we focus on an intuitive eating model to counteract the misguided beliefs that come from diet culture, as well as relearning to recognize internal cues of satiety and hunger.

We recognize that it’s hard asking for help for BED and hope you’re reassured that through every step of treatment with Within Health you’re met with compassion, respect, and empathy. We are proud to offer a safe space and support to any gender identity, ethnicity, sexuality, shape, and size.

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Frequently asked questions

Resources

  1. Pagán, C. N. (n.d.). Inpatient care for binge eating. WebMD
  2. Ekern, B., (2020, March 1) Determining the best level of care for eating disorder treatment. Eating Disorder Hope. 
  3. Seladi-Schulman, J. (2020, November 23). Therapy for eating disorders: Types, efficacy, and recovery. Healthline. 
  4. Brownley, K. A., Berkman, N. D., Peat, C. M., Lohr, K. N., Cullen, K. E., Bann, C. M., & Bulik, C. M. (2016). Binge-Eating Disorder in Adults: A Systematic Review and Meta-analysis. Annals of internal medicine, 165(6), 409–420. 
  5. Pagán, C. N. (n.d.). Outpatient care for binge eating: What to expect. WebMD. 
  6. Canter, T. (2019, June 24). Daily exposure therapy for Binge Eating Disorders: Faqs. Go Proud. 
  7. Iacovino, J. M., Gredysa, D. M., Altman, M., & Wilfley, D. E. (2012). Psychological treatments for binge eating disorder. Current psychiatry reports, 14(4), 432–446. 
  8. Lauren Muhlheim, P. D. (2021, September 7). How cognitive behavioral therapy can help treat binge eating disorder. Verywell Mind. 
  9. An introduction to nutritional therapy. National Eating Disorders Association. (2018, February 21).
  10. Kristeller J, Wolever R, Sheets V. Mindfulness-based eating awareness training (MB-EAT) for binge eating: A randomized clinical trial. Mindfulness (N Y). 2013;5(3):282-297
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