Treating Binge Eating: Antidepressants or Cognitive Behavioral Therapy?

Binge eating can have many negative outcomes. People who engage in binge eating (BED) tend to have a higher body mass index (BMI) than those who do not, and are at increased risk for obesity, which can lead to a range of health problems. Treating BED has been shown to be very difficult, as a number of factors influence behavior in BED and ultimate treatment outcome. Two of the most common methods for treating BED are cognitive behavioral therapy (CBT) and the use of antidepressant medication, with or without CBT. Carlos M. Grilo of the Department of Psychiatry at Yale University’s School of Medicine in Connecticut wanted to compare treatment forms. In a recent study, Grilo assessed 108 clients prior to, during, and after treatment for BED using CBT alone, fluoxetine, or placebo.

Grilo found that several variables determined outcome in the sample of participants. First, the youngest participants saw the biggest improvements when they received fluoxetine only. But for those with low self-esteem, overvaluation of body context and negative affect, CBT proved more effective. In fact, overvaluation emerged as the most significant predictor of BED remission. Not only did the participants with high levels of body awareness and sensitivity toward their weight in relation to their image see bigger improvements in BED frequency, they also saw decreases in psychopathology related to BED and decreases in depression. Overvaluation also appeared to improve remission rates in individuals who received medication only.

“These findings suggest that, among patients with BED, overvaluation accounts prospectively for unique and meaningful variation in binge eating, eating disorder psychopathology, and depression treatment outcomes,” Grilo said. He added that the largest weight losses occurred in participants with negative affect, low self-esteem, and high levels of depression. These same individuals also had fewer episodes of binge-eating post-treatment when compared to those with more positive psychological states, especially those in the medication-only group. In sum, the findings from this study, although gathered from over a short period of time from a primarily white sample, give clues as to the varying factors that contribute to treatment outcome success in individuals with BED.

Grilo, Carlos M., Robin M. Masheb, and Ross D. Crosby. Predictors and moderators of response to cognitive behavioral therapy and medication for the treatment of binge eating disorder. Journal of Consulting and Clinical Psychology 80.5 (2012): 897-906. Print.

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  • Sydney

    November 7th, 2012 at 3:53 AM

    Just like anything else, what works for one may not work for another. But the thing is finding the right combination of treatment options that will then work for each individual patient. As long as the treating provider is willing to tweak these for each person then I think there can be success for any patient.

  • David

    November 7th, 2012 at 6:53 AM

    It would make sense that if you cure the depression, you will will cure the BED. I would think that BED is really an attempt at self-medicating for depression anyway. Only one question after I read this article: What is overvaluation? That is a term I am not familiar with. Oh, and to say that people with BED are at risk for being obese is a bit obvious, no?

  • Lizzie

    November 7th, 2012 at 6:55 AM

    BED is definitely a hard issue to treat. I should know. I have struggled with it since my late teen years. I was in college when it started. It was a result of not properly managing stress, but I didn’t know it at the time. I just knew I suddenly wanted to eat all the time, even when not hungry. The only thing I wanted to do was to eat. It has gotten better over time, but it is still there. My first inclination when upset or board is to eat. Right now, I have an emergency Snicker’s bar in my underwear drawer. It’s been there for ten weeks though!

  • j mills

    November 7th, 2012 at 1:33 PM

    while no one method may work the best for everybody,it is good to see that choices can be made based on various factors and this could in turn lead to faster treatment in future patients.

    also this method gives us a second option if one form of treatment does not work well for someone.

  • James Finley, Phd--retired psychologist

    February 21st, 2013 at 3:51 PM

    How was self-esteem measured? What is an operational definition of overvaluation? What is body
    context and how was negative affect measured?

    If I am reading this correctly, “high levels of body awareness and sensitivity toward their weight in
    relation to their image…” showed decreases in BED frequency and decreases in depression level,
    however measured. Such a self-evident finding adds little to a scientific knowledge base.

    To Dr. Grilo I say, “birds tend to fly and fish tend to swim”. I hope this helps you as much as your
    study has helped me!

    Dr. Finley

  • kathi

    June 30th, 2013 at 8:04 PM

    Are you the Dr. Finley that facilitated cbt groups at del amo in 2001- 2004?

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