The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which is scheduled to be published in May, officially recognizes binge-eating disorder for the first time. It was included in the appendix of DSM-IV “for further study.”
Treatment is not likely to change much short-term, because the current approach to treatment is yielding positive results.
Long term, though, inclusion in DSM-5 legitimizes the disorder and makes it more likely that research of treatment methods will take place, yielding new, more effective forms of treatment.
A Combination of Therapies
So how is binge-eating disorder treated? As with other eating disorders, successful treatment typically includes a combination of therapies.
Treatment typically begins by educating patients about their condition, so they are more aware of their eating patterns and can identify triggers that influence how and what they eat.
Typically, cognitive-behavioral therapy (CBT) is the most effective treatment for binge-eating disorder. CBT integrates behavior therapy with cognitive psychology and is based on the idea that changing maladaptive thinking can change behavior.
The therapist provides information, guidance, support and encouragement. Goals include normalized eating, the reduction or elimination of binging and a reduction in eating behavior triggered by mood and events. Cognitive goals include improving the patient’s self-esteem and weight-related concerns.
CBT is typically combined with interpersonal therapy (IPT), which encourages patients to regain control of their mood and how they function. Using IPT, which is frequently used to treat depression, the therapist engages the patient and helps the patient feel understood. The therapist also presents a rational argument for the treatment, which the patient typically learns to accept.
DBT: Another Alternative
When patients fail to respond to CBT combined with IPT, dialectical behavioral therapy (DBT) is often used. DBT combines cognitive behavioral techniques for regulation of emotion, and reality testing with distress tolerance, acceptance and mindful awareness. DBT seeks to reduce binging by improving adaptive emotion-regulation skills.
Behavioral Weight-Loss Therapy
Behavioral weight-loss therapy (BWLT) is another option, but many believe that it is best for the patient to recover from binge-eating disorder before addressing weight loss. Those who have binge-eating disorder have no control over their eating, so they are unable to successfully lose weight and keep it off. Those who first address their eating disorder greatly enhance the probability that they will be able to lose weight and keep it off.
Exercise or other physical activity can also help those with binge-eating disorder develop a positive relationship with their body and learn to manage stress more effectively.
Start With a Plan
What works for one individual does not necessarily work for another, so treatment should be based on an in-depth diagnosis and a plan developed by a team, covering medical, behavioral and nutritional care, while also considering co-occurring disorders.
Depending on how far the disorder has advanced, in-patient care or residential care may be necessary to help the patient become medically stable and to begin intensive therapy. Insurers have often been resistant to that level of care, but they may be more flexible because of DSM-5.
When there are co-occurring disorders – and there are more often than not – it is critical to treat both or all of them concurrently. Otherwise, another disorder will likely become more advanced as the patient makes progress with binge-eating disorder. Many in the industry are hopeful that insurers will also be increasingly supportive of treating co-occurring disorders concurrently because of DSM-5.
While the recovery rate for binge-eating disorder is already higher than for other eating disorders, the inclusion of binge-eating disorder in DSM-5 increases the likelihood of more research and the development of more effective treatment.