Binge eating disorder: Updated overview for primary care practitioners

Abstract

Objective: To provide an updated overview of binge eating disorder (BED) that includes recommendations relevant for primary care practitioners.

Quality of evidence: PubMed, Google Scholar, and PsycInfo were searched with no time restriction using the subject headings binge eating disorder, treatment, review, guidelines, psychotherapy, primary care, and pharmacotherapy. Levels of evidence for all treatment recommendations ranged from I to III.

Main message: Binge eating disorder is associated with considerable patient distress and impairment, as well as medical and psychiatric comorbidities, and was added to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, in 2013. Primary care practitioners are well suited to screen, diagnose, and initiate treatment for BED. A stepped-care approach to treatment starts with guided self-help, adding or moving to pharmacotherapy or individual psychotherapy as needed. The psychotherapies with the most research support include cognitive behaviour therapy, interpersonal therapy, and dialectical behaviour therapy. In terms of pharmacotherapy, evidence supports the use of lisdexamfetamine, antidepressant medications, and anticonvulsant medications.

Conclusion: This overview provides guidance on screening, diagnosis, and treatment approaches based on the currently available evidence, as well as expert opinions of a diverse group of experts to help guide clinicians where evidence is limited.

Figure 1.

Treatment algorithm