Diagnosis and management of binge eating disorder |
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Authors: | CYNTHIA M BULIK KIMBERLY A BROWNLEY JENNIFER R SHAPIRO |
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Institution: | 1.Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7160, USA;2.Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7160, USA |
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Abstract: | This paper addresses current issues regarding the diagnosis and management
of binge eating disorder (BED). Controversies in diagnosis include the lack
of empirically validated criteria, the lack of a universally recognized operational
definition of a "binge episode", and the lack of age-appropriate assessment
instruments in light of growing reports of BED among children and adolescents.
For adults with BED, several pharmacological and behavioral treatments have
shown promise in reducing binge frequency and related psychological symptoms
of disordered eating (i.e., disinhibition, hunger, depressed mood). Second-generation
antidepressants and cognitive behavioral therapy are among the most widely
studied treatments. However, no behavioral interventions have demonstrated
efficacy with respect to weight loss (which is a critical concern for many
BED sufferers who are overweight). Furthermore, randomized controlled trials
for BED have been plagued by high drop out and placebo response rates, as
well as by insufficient follow-up after active treatment ends to determine
long-term outcomes. Therefore, the long-term utility of the various intervention
strategies studied thus far remains unclear. More research is needed on innovative
medications and behavioral treatments that explore novel modalities to reduce
the subjectively reinforcing properties of binge eating. In addition, expanded
use of information technologies may be particularly instrumental in the treatment
of patients who experience marked shame, denial, and interpersonal deficits,
or who face limited access to specialty care. Ultimately, examining BED within
the broader context of the current obesity epidemic will be an important area
of study. |
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Keywords: | Binge eating disorder diagnostic criteria antidepressants behavioral therapy information technologies |
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