Binge Eating Disorder Treatment
Bingeing is triggered by both physiological factors (hunger) and emotional factors such as stress, depression or anxiety. Effective treatment for binge eating disorder needs to target both the physiological and the emotional triggers as well as the underlying causes. Cognitive Behavioural Therapy (CBT) is known to be the most effective treatment for binge eating disorder so is most commonly recommended by our clinicians. However, for those who do not find CBT the right approach, there is growing evidence for other treatments that can help.
Cognitive Behavioural Therapy
CBT is the current leading treatment for binge-eating disorder (NICE Guidelines, 2004). CBT focusses on both physiological and emotional triggers to binge eating, establishing a healthy eating plan in order to reduce physiological urges, and providing insight into and skills for coping with emotional triggers.
A healthy eating plan entails eating regularly (typically three meals and three snacks a day) and including all food groups in your diet (including treat foods). Advice is given on how to develop a weight maintenance diet - and this often significantly reduces or even stops binge eating. Your therapist will support you in putting this into place and using food diaries to help you notice any patterns or triggers for residual bingeing. Further CBT techniques can then be developed to help you address these. This might include CBT techniques to help you challenge unhelpful thinking (such as thought challenges), techniques to help you manage difficult emotions (such as self-soothing) or techniques to manage any behaviours which feed into your bingeing (such as behavioural experiments). CBT techniques can also be used to look at any other issues, including body image concerns, low self-esteem, or perfectionism.
Many people will find that this is sufficient, and that body image is much improved following treatment. For those who are overweight who wish to lose weight, further dietetic support can be given to make small, healthy weight changes without triggering the binge eating disorder.
CBT is a structured skills based therapy that is most suitable for people who want to be guided by their therapist to find new ways of coping.
Dialectical Behavioural Therapy (DBT)
For people who binge eat in combination with other impulsive behaviours such as binge drinking or self harming, DBT may be recommended as an alternative to CBT. DBT is an emotional skills based treatment that combines eastern approaches (Buddhist theory, Eastern psychological and spiritual philosophies) and western therapies, including CBT. DBT sees bingeing as having developed as a way of coping with or surviving difficult emotions, and focuses on developing healthy ways of responding to emotions in the here and now.
Dialectical behaviour therapy encourages change but also promotes acceptance - both of the individual and of where they are along the road to recovery. A dialectical approach encourages people to let go of black and white thinking (“I’m either recovered or stuck with this eating disorder forever”) and to develop a more balanced perspective (“I am working towards recovery and there may be bumps along the way”). This can also be helpful in challenging other black or white thinking typically seen in those with eating disorders.
DBT offers a skill-based approach to developing healthier ways of coping, and comprises of 4 sets of skills:
mindfulness (learning how to be in the moment and make decisions using your “wise” mind)
distress tolerance (learning how to tolerate and manage difficult emotions in a crisis)
emotional regulation (learning how to identify emotions and help reduce the likelihood of extreme changes in emotion)
interpersonal effectiveness (becoming more assertive, asking for help when needed, and saying no)