Cognitive behavior therapy of binge eating disorder.

Binge eating disorder (BED) is characterized by recurrent episodes of uncontrollable eating, even when not hungry, until uncomfortably full, occurring at least twice a week for a 6-month period. This is differentiated from bulimia nervosa (BN) by the lack of compensatory mechanisms such as purging/laxative abuse. There are significantly higher levels of psychiatric symptoms in patients with BED as compared to those without BED. Furthermore, depressive symptomatology may increase the patient's vulnerability to binge eating as well as to relapse after treatment. Grazing is defined as eating small amounts of food continuously. BED in the pre-bariatric patient can manifest as 'grazing' about 2 years post-bariatric surgery. Treatment should be directed at eating behavior, associated psychopathology, weight and psychiatric symptoms. Cognitive behavior therapy is based on changing the patient's erroneous ways of thinking about themselves, the world and how others perceive them. This includes a focus on normalizing food intake as well as challenging dysfunctional thinking, identifying feelings, and developing non-food coping skills. It increases a sense of control and therefore helps the patient adhere to behavior change strategy, as well as improving mood and reducing associated psychopathology. Interpersonal therapy is based on the relationship between negative mood low self-esteem traumatic life events, interpersonal functioning and the patient's eating behavior. The rationale being that eating represents maladaptive coping with underlying difficulties. While psychotherapy either CBT or IPT leads to decrease in disordered eating behaviors and improved psychiatric symptoms, it has little effect on weight hence; its benefit is optimal when used in conjunction with bariatric surgery.