Psychological and medical treatments for binge-eating disorder: state-of-the-art.

Abstract

Purpose of review: Various psychological and medical treatments have demonstrated efficacy for binge-eating disorder (BED), but further improvement is warranted. This narrative research synthesis reviews randomized controlled trials (RCTs) published between November 16, 2022, and May 15, 2025, identified via systematic literature search.

Recent findings: Fourteen new RCTs were included. Cognitive-behavioral therapy (CBT) showed consistent efficacy for binge eating, abstinence, and eating disorder psychopathology; augmentation with lisdexamfetamine dimesylate (LDX) improved eating disorder psychopathology and weight loss, but not binge-eating outcome. Web-based self-help treatment reduced binge eating, eating disorder psychopathology, and impairment. Sequential designs suggested LDX and naltrexone/bupropion as maintenance options for responders, with CBT beneficial for nonresponders. Brain-based interventions showed initial evidence. Exploratory pharmacotherapy with nivasorexant was ineffective. No RCTs targeted youth.

Summary: Recent RCTs support digital CBT-based self-help treatment for improving psychological symptoms, and augmentation of CBT with LDX for improving psychopathology and weight loss in BED. Sequential designs suggest CBT's role for nonresponders to behavioral and/or pharmacological weight loss treatment, while for responders continued medication may be helpful. Brain-directed treatments need further validation. Future research should elucidate mechanisms and short-term and/or long-term efficacy, and overcome the lack of evidence in younger populations.