Principles of managing binge eating disorder

The primary goals of treatment in the management of patients with binge eating disorder are to first reduce the frequency of binge-eating episodes, reduce other associated symptoms and manage associated comorbidities; and then to help the patient have a positive relationship with food and eating, by focusing on good psychosocial function and mental wellbeing. Patients are primarily managed in an outpatient setting with psychological therapies as a first-line treatment. Patients are often started on pharmacological treatment when psychological therapies are ineffective or difficult to access.

Assess patients for medical complications, in particular those associated with obesity such as diabetes and hypertension.

The Eating Disorders Examination Questionnaire (EDE-Q) (available via the Centre for Research on Eating Disorders at Oxford (CREDO) website) assesses severity of symptoms, which is relevant to accessing care through the Medicare Benefits Schedule, see here for current information.

Admit patients to hospital1 who:

  • are at risk of suicide
  • are medically unwell
  • have refractory symptoms to outpatient care.

If a comorbid psychiatric disorder is identified, refer to recommendations for the disorder; and manage it concurrently. Substance abuse and deliberate self-harm need to be addressed first to enable a person with binge eating disorder to engage in therapy.

Better outcomes are seen in patients with an early response to treatment (within the first weeks of treatment), no history of drug abuse or obesity, and those with good interpersonal function. Approximately 50% of patients make a full recovery, 30% a partial recovery and 20% continue to be symptomatic after treatment.

Discuss contraception, preconception planning and psychotropic use with females with binge eating disorder, see here for information.

The treatment of binge eating disorder during the perinatal period follows the same principles as above; however, use pharmacological treatment with caution in pregnancy and breastfeeding. Depending on the patient’s baseline symptoms, weight and medical status, the parent and fetus or infant may require more frequent monitoring than usual.

For advice on psychotropic use during pregnancy, see here and use while breastfeeding, see here.

Useful resources are available from:

1 If involuntary treatment is required, it must be undertaken in accordance with relevant mental health legislation—see the Royal Australian and New Zealand College of Psychiatrists website.Return