There are so many myths and misunderstandings about binge eating disorder (BED) that it can be isolating to anyone living through it. What’s more, those misconceptions can lead to misguided—or even harmful—treatment approaches for those who seek help. “Much of my early binge eating disorder treatment was focused on being more controlled around food while also reducing physical restriction, a combination that led to further confusion and tension around food,” says Stacy Jones, a peer mentor at Equip.
Indeed, several competing factors can contribute to binge eating disorder treatment that’s ineffective at best and harmful at worst: diet culture, misunderstandings about the illness, and a lack of research into evidence-based treatment strategies. The good news is that more attention is being paid to this incredibly common eating disorder, and we’re learning more about what works (and doesn’t work) in binge eating disorder treatment.
Read on to learn about the challenges those seeking binge eating disorder treatment might face, as well as the distinct therapeutic approaches that are most effective for treating BED.
Who needs binge eating disorder treatment?
While binge eating disorder is the most commonly diagnosed eating disorder, many people still don’t recognize it as a true mental illness. People struggling mistakenly believe it’s a matter of willpower, that they have an issue with “food addiction” or “overeating”, or that their behaviors are a personal failing rather than a serious mental health problem. All of this can lead them not to seek out help.
While there are some signature clinical signs of binge eating disorder that health providers might use to make a diagnosis (including regularly eating past the point of fullness, hiding food from others, etc.), there are also many misconceptions about the illness that prevent individuals from getting help. One important myth to bust: weight gain is not a requirement for a diagnosis.
“Weight gain is not included as a criterion in the DSM-V for diagnosis of BED,” says Equip therapist Jenna Robinow, LMSW. "People with BED may gain weight, lose weight, or the number on the scale may not change much at all, even when symptoms are severe.”
Equip dietitian Gabriella Cohen agrees, adding that—much like other eating disorders—binge eating disorder is not an illness that can be diagnosed based on physical appearance alone. “BED can happen in all body types,” she emphasizes.
How is binge eating disorder treatment different from treatment for other eating disorders?
There are certainly some overlaps between binge eating disorder treatment and treatment strategies for other eating disorders, like anorexia and bulimia. A solid nutrition plan from a registered dietitian is one of the most important starting points and—perhaps contrary to many misconceptions about BED—experts say the treatment for binge eating should be rooted in addressing the urge to binge, not by suppressing or ignoring hunger.
“A big component of treatment is identifying the binge triggers—besides restriction—such as specific places, situations, or people that may need to be put on hold until regular eating patterns are established,” says Cohen. “It’s important to take a collaborative approach with team members, the patient, and their support network to learn skills to cope with urges, determine how much support is needed when, and to prevent compensatory behaviors.”
Robinow says that from a therapists' perspective, binge eating disorder is not treated as radically different from other eating disorders. “The core tenets are the same: safety in all forms is always paramount, then establishing more regular eating habits; coping differently with key judgements and fears around food, body image, or other drivers of the eating disorder symptoms; and of course building toward a life worth living, free from the eating disorder,” she says.
But there are some specific issues that providers focus on more intentionally in binge eating disorder treatment. “Targeting feelings of shame is often at the core of binge eating disorder treatment,” Robinow says. “Folks with BED, or those around them, may associate binging with stigmatizing and exaggerated themes like gluttony, laziness, or poor self control. Those associations are harmful and unfounded, as BED is a neurological disorder and its symptoms should not be mistaken for the content of someone's character.”
Jones seconds this sentiment, explaining that “there are so many layers to binge eating disorder, and physical restriction is only one. Mental restriction and emotional regulation can contribute to what is driving the eating disorder. There is also the myth that lack of willpower is the problem, especially for those who are fat. People with BED are often met with invalidation, being told they just need more self control or to lose weight. This couldn't be further from the truth. BED is complex and requires an individualized approach that fights anti-fat bias and considers the purpose the eating disorder is serving.”
In terms of specific modalities, binge eating disorder treatment employs many of the same therapeutic approaches as other eating disorders, such as cognitive behavioral therapy for eating disorders (CBT-E), exposure and response prevention (ERP), and dialectical behavior therapy (DBT).
For children, adolescents, and young adults with binge eating disorder, FBT is widely considered the gold standard of evidence-based treatment. “A support system can be essential in supporting the structure necessary to regulate eating patterns and reduce urges. FBT can also be important for accountability and emotional support,” Cohen says. Equip’s research has found that our FBT+ approach is effective for treating binge eating disorder in young people.
Jones says her recovery incorporated a fair amount of acceptance and commitment therapy (ACT), an action-oriented approach that focuses on accepting thoughts and feelings without judgment. “Acceptance and commitment therapy uses acceptance and mindfulness, as well as self-compassion, to increase flexibility in thinking and improve emotional regulation,” Jones explains. “ACT provides space for the full range of human experiences, which allows for a more regulated nervous system and the ability to navigate experiences in ways that align with one's values. It also offers an incredible antidote to the shame and guilt that often coincides with binge eating.”
Why restriction has no place in binge eating disorder treatment
One of the most harmful myths about binge eating disorder treatment is that the way to stop binges is by restricting food. This could not be further from the truth; in fact, doing so will almost inevitably make eating disorder behaviors worse.
“As with any other diagnosis, one of the main focuses of treatment would be structured regular eating patterns,” Cohen says. “For BED, it’s extremely important to reduce the physiological binge urges. A lot of the time, the binge urges are coming as a result of prolonged restriction or hunger not being honored earlier on in the day, which can lead to loss of control over eating and a binge.”
Cohen goes on to add, “the danger of combining binge eating disorder treatment with intentional weight loss is that it would require patients to eat less of what they currently need, which can continue to trigger binges and loss of control around eating.”
Robinow also points out that focusing on caloric intake is misguided in binge eating disorder treatment. “Like weight gain, calories are also not mentioned within the diagnostic criterion for BED,” she says. “Eating past the point of satiation, and continuing despite feeling ill and eating with a sense of feeling out of control are better markers of binging than calorie counting. While folks in eating disorder treatment are offered a meal plan, treatment does not include withholding food or restricting calories. Eating adequate and full meals at regular intervals is actually key to preventing binge behaviors. Planning for a calorie deficit is likely to backfire and is not part of binge eating disorder treatment.”
At Equip, we take an individualized approach to binge eating disorder treatment, tailoring care to the needs of each patient and their support network. Every patient is matched with a multidisciplinary care team—which includes a dietitian, therapist, and medical provider, as well as peer and family mentors—to treat the whole person, rather than just targeting individual symptoms. As with our treatment for other eating disorders, we always begin with normalizing eating habits, and pull from a variety of evidence-based modalities to create a personalized and adaptable treatment plan. Schedule a consultation to learn more about how we approach binge eating disorder treatment.
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