Binge-Eating Disorder: Prevalence, Predictors, and Management in the Primary Care Setting

Alternatively, positive treatment outcomes have been associated with low levels of emotional eating at baseline, older age of onset, weight loss history that is negative for amphetamine use, and decreases in depressive symptoms during treatment [124,134,136,137]. In addition, early response to treatment (defined as a 65%–70% reduction in binge eating within 4 weeks of starting treatment) tends to be associated with greater long-term (ie, 1–2 year) remission from BED and lower eating disorder psychopathology, across a variety of psychological treatment approaches [138–144].

Interpersonal Psychotherapy

IPT for BED was adapted by Wilfley and colleagues [145] from IPT for depression, and the rationale for its use with BED is based on successful outcomes for individuals with bulimia and multiple studies documenting interpersonal deficits in individuals with BED [146]. IPT seeks to address interpersonal problems in 4 areas: interpersonal conflict, grief, role transitions, and interpersonal deficits [135]. While adapting IPT for BED, it was noted that the course of BED tends to be more chronic than the course of depression, thus the focus of IPT for BED was shifted from addressing the interpersonal precipitants of the disorder to the interpersonal factors that maintain the disorder [145]. Fewer studies examining the effectiveness of IPT in treating BED have been published than those examining CBT for BED, but it appears that IPT is as efficacious as CBT immediately post-treatment [130], and at 1- [130] and 4-year follow-up [147]. In addition, at least 2 studies have been published that compare IPT, cognitive behavioral therapy–guided self-help (CBTgsh), and behavioral weight loss [133,141]. Overall, results support the use of both IPT and CBTgsh (discussed in more detail below), with important moderators of treatment effects observed. For example, Wilson et al [133] found that clients with higher levels of psychopathology were better suited for IPT. The authors conclude that these results could inform a model of evidence-based stepped care, where CBTgsh, a low-cost, low-intensity treatment, should be considered as the first line of treatment. Secondarily, IPT, which represents a more specialized and expensive form of treatment, could be considered the next level of care, particularly for clients who are not demonstrating rapid improvement in response to CBTgsh.

Dialectic Behavior Therapy

A small number of studies have investigated the treatment of BED with dialectical behavior therapy (DBT). Originally developed to treat borderline personality disorder [148], DBT is of particular interest given its explicit targeting of emotion regulation. According to the DBT model of BED [149], emotional dysregulation is the core psychopathology in this disorder, and binge eating is viewed as attempts to influence, change, or control painful emotions. Initially, promising results were published showing positive treatment effects in an uncontrolled study [150] as well as wait-list controlled trials [151]. Notably, relative to wait-list controls, participants in a DBT guided self-help program (who received an orientation, DBT manual, and six 20-minute support calls across 13 weeks) reported reduced past-month binge eating, higher binge eating abstinence rates, and over the longer term improved quality of life and reductions in ED psychopathology. However, a comparison of DBT-BED with an active comparison control group (ie, nonspecific supportive therapy) failed to find significant differences between the 2 treatments (defined as effect size greater than 0.5) at 12-month follow-up in binge eating abstinence, binge eating frequency, most ED-related psychopathology, positive affect, depression, and self-esteem [152]. Therefore, DBT may have potential and, at a minimum, is equally efficacious as supportive therapy.