Psychological Treatments of Binge Eating Disorder

Context: Interpersonal psychotherapy (IPT) is an effective specialty treatment for binge eating disorder (BED). Behavioral weight loss treatment (BWL) and guided self-help based on cognitive behavior therapy (CBTgsh) have both resulted in short-term reductions in binge eating in obese patients with BED. Objective: To test whether patients with BED require specialty therapy beyond BWL and whether IPT is more effective than either BWL or CBTgsh in patients with a high negative affect during a 2-year follow-up. Design: Randomized, active control efficacy trial. Setting: University outpatient clinics. Participants: Two hundred five women and men with a body mass index between 27 and 45 who met DSM-IV criteria for BED. Intervention: Twenty sessions of IPT or BWL or 10 sessions of CBTgsh during 6 months. Main Outcome Measures: Binge eating assessed by the Eating Disorder Examination. Results: At 2-year follow-up, both IPT and CBTgsh resulted in greater remission from binge eating than BWL (P<.05; odds ratios: BWL vs CBTgsh, 2.3; BWL vs IPT, 2.6; and CBTgsh vs IPT, 1.2). Self-esteem (P<.05) and global Eating Disorder Examination (P<.05) scores were moderators of treatment outcome. The odds ratios for low and high global Eating Disorder Examination scores were 2.8 for BWL, 2.9 for CBTgsh, and 0.73 for IPT; for self-esteem, they were 2.4 for BWL, 1.9 for CBTgsh, and 0.9 for IPT. Conclusions: Interpersonal psychotherapy and CBTgsh are significantly more effective than BWL in eliminating binge eating after 2 years. Guided self-help based on cognitive behavior therapy is a first-line treatment option for most patients with BED, with IPT (or full cognitive behavior therapy) used for patients with low self-esteem and high eating disorder psychopathology.