treatment for binge eating disorders

treatment for binge eating disorders Cognitive-behavioral and interpersonal approaches used with bulimia have
been adapted for BED. Dialectical behavior therapy, originally designed for
borderline personality disorder, has also been utilized. All three approaches
have been shown to be reasonably successful at reducing short-term bingeing
but are relatively ineff ective at producing long-term weight loss (Wonderlich,
de Zwaan, Mitchell, Peterson, & Crow, 2003).
Interpersonal therapy (Fairburn, 1997) for BED aims to modify the underlying
relational diffi culties, assessing the interpersonal context out of which the
eating pathology emerged, along with clients’ current relationships. Triggers to
binges are also identifi ed. Aft er this assessment phase, little focus is given to
eating disorder symptoms per se.
Interpersonal diffi culties usually fall into one of four categories: unresolved
grief, role disputes, relational transitions, or interpersonal defi cits. Aft er the
most pressing problem area is targeted, clients are asked to take the lead in
sessions by generating ways to improve their relational diffi culties. Clinicians’
role is to off er feedback and encouragement. Treatment concludes with a
review of progress and relational areas requiring further work. For example,
interpersonal therapy with one student revealed that her eating problem took
hold aft er the sudden death of her father. Instead of grieving her own loss, she felt obliged to comfort and counsel her mother, who had slipped into a debilitating
and isolating depression. Treatment focused on helping the student go
through the mourning process and on changing her long-standing tendency
to negate her own needs in the service of caring for others.
Dialectical behavior therapy, which was created by Marsha Linehan
(1993), targets impulsive behaviors by enhancing emotion-regulation skills.
According to this theory, individuals who regularly engage in impulsive and
destructive behaviors are unable to mediate the physiological arousal that
accompanies aff ect. When faced with strong emotion, they are prone to feeling
overwhelmed and inept and to engage in maladaptive behaviors such as
bingeing. However, these behaviors further diminish self-esteem and reinforce
fear of emotion, thereby increasing the likelihood of the behaviors. Treatment
begins with an explanation of the model and an introduction to behavioral
chain analysis, i.e., thoroughly examining the thoughts, feelings, body sensations,
and events that lead to impulsive behaviors. Clients are asked to keep
a diary detailing maladaptive behaviors, their emotional precipitants, and
attempts to cope using skills acquired in treatment. Th ese skills include core
mindfulness (being aware of and abiding one’s internal experiences without
judging them), emotion regulation (labeling emotions, using them as sources
of information, and, when possible, changing circumstances that give rise to
intense emotions), and distress tolerance (managing unavoidable distress with
strategies such as distraction, self-soothing, and weighing the pros and cons
of tolerating the distress versus bingeing). Treatment concludes by planning
ways to prevent relapses.
BED is more amenable to self-help and group approaches than is either
anorexia or bulimia (Wonderlich et al., 2003), making it the most conducive
to treatment in college counseling centers.