Binge-Eating Disorder

Conduct a DSM-5-TR–based clinical interview to determine whether episodes involve consumption of a large amount of food in a discrete period with loss of control, then characterize episode frequency, compensatory behaviors, restriction, purging, substance use, mood symptoms, trauma symptoms, and functional impairment. DSM-5-TR clinical assessment remains the preferred diagnostic method for eating disorders; EDE-Q and BEDA-Q are adjunctive self-report measures for structured symptom capture.BMJ+1BMJMethodology for studying Relative Energy Deficiency in Sport (REDs): a narrative review by a subgroup of the International Olympic Committee (IOC) consensus on REDsNatureMechanism-based subtyping in binge eating: understanding neurobehavioral heterogeneity across negative emotionality, approach behavior, and executive function | Translational Psychiatry

When recurrent binge eating is accompanied by extreme compensatory behaviors, evaluate for bulimia nervosa rather than BED. BED is characterized by binge eating without extreme compensatory behaviors, whereas binge eating can also occur in bulimia nervosa and anorexia nervosa binge/purge type.Nature+1NatureMechanism-based subtyping in binge eating: understanding neurobehavioral heterogeneity across negative emotionality, approach behavior, and executive function | Translational PsychiatryScienceDirectEating disorders A lower binge frequency can support an other specified feeding or eating disorder formulation when full bulimia nervosa criteria are not met.WileyWiley5 Other Specified Feeding or Eating Disorder‐Bulimia ...

Do not use body size to rule in or rule out BED. Binge-type eating disorders carry psychiatric and physical comorbidity, medication and health-care utilization, and elevated mortality and suicidality risk irrespective of comorbid obesity; the treatment target is loss-of-control eating and associated psychopathology, not weight alone.NatureNatureMechanism-based subtyping in binge eating: understanding neurobehavioral heterogeneity across negative emotionality, approach behavior, and executive function | Translational Psychiatry

Offer therapist-led cognitive behavioral therapy as a primary treatment for BED. Meta-analytic evidence found greater post-treatment abstinence from binge eating with therapist-led CBT than with waiting-list control, and CBT is associated with remission of binge eating and purging in 30% to 50% of patients, with significant improvement in most others.BMJ+1BMJMeta-analysis of the effectiveness of psychological and ...acpjournalsEating Disorders | Annals of Internal Medicine

Set outcomes around binge abstinence or reduction, eating-disorder psychopathology, and functional recovery. CBT and structured self-help approaches, largely CBT-based, have demonstrated benefit for binge-eating outcomes; structured self-help can be considered when therapist-led CBT is inaccessible, but the comparative evidence cited specifically supports therapist-led CBT against waiting list.BMJBMJMeta-analysis of the effectiveness of psychological and ...

Address co-occurring depression, anxiety, and PTSD in the treatment plan rather than assuming that binge remission will resolve all psychiatric symptoms. In BED, PTSD occurs in a substantial minority of patients, and a DSM-5-TR–based psychiatric assessment identifies whether integrated or sequential treatment is required.BMJ+1BMJMethodology for studying Relative Energy Deficiency in Sport (REDs): a narrative review by a subgroup of the International Olympic Committee (IOC) consensus on REDsPubMedThe integrated treatment of eating disorders, posttraumatic stress disorder, and psychiatric comorbidity: a commentary on the evolution of principles and guidelines

For an adult with moderate to severe BED in whom a stimulant is appropriate, start lisdexamfetamine 30 mg orally once daily in the morning. Increase by 20 mg at approximately weekly intervals to the recommended target range of 50 to 70 mg once daily; do not exceed 70 mg daily. Discontinue treatment if binge eating does not improve.dailymed nlm nih+1dailymed nlm nihThese highlights do not include all the information needed to use VYVANSE safely and effectively. See full prescribing information for VYVANSE. VYVANSE® (lisdexamfetamine dimesylate) capsules, for oral use, CII VYVANSE® (lisdexamfetamine dimesylate) chewable tablets, for oral use, CII Initial U.S. Approval: 2007dailymed nlm nihVYVANSE- lisdexamfetamine dimesylate capsule

Treat lisdexamfetamine as a controlled-substance decision, not merely a BED medication trial. Before prescribing, assess each patient's risk of abuse, misuse, and addiction; educate the patient and family on secure storage and disposal; then reassess risk and monitor frequently for abuse, misuse, and addiction throughout therapy.dailymed nlm nih+1dailymed nlm nihVYVANSE- lisdexamfetamine dimesylate capsulefdaFDA approves multiple generics of ADHD and BED treatment

Dose-limit lisdexamfetamine in renal impairment: maximum 50 mg once daily with severe renal impairment, defined as GFR 15 to less than 30 mL/min/1.73 m², and maximum 30 mg once daily with end-stage renal disease, defined as GFR below 15 mL/min/1.73 m².dailymed nlm nihdailymed nlm nihVYVANSE- lisdexamfetamine dimesylate capsule

At each follow-up, record binge-eating days or objective binge episodes, loss-of-control eating, compensatory behaviors, and functional impairment. If using the EDE-Q or BEDA-Q at baseline, repeat the same instrument to track symptom direction; these instruments supplement rather than replace ongoing clinical assessment.BMJ+1BMJMethodology for studying Relative Energy Deficiency in Sport (REDs): a narrative review by a subgroup of the International Olympic Committee (IOC) consensus on REDsNatureMechanism-based subtyping in binge eating: understanding neurobehavioral heterogeneity across negative emotionality, approach behavior, and executive function | Translational Psychiatry

For patients receiving lisdexamfetamine, track the labeled common BED adverse effects—dry mouth, insomnia, decreased appetite, increased heart rate, constipation, jitteriness, and anxiety—and reassess stimulant misuse, abuse, and addiction risk throughout treatment.dailymed nlm nih+2dailymed nlm nihVYVANSE- lisdexamfetamine dimesylate capsulefdaFDA approves multiple generics of ADHD and BED treatmentdailymed nlm nihLISDEXAMFETAMINE DIMESYLATE CAPSULES These highlights do not include all the information needed to use LISDEXAMFETAMINE DIMESYLATE CAPSULES safely and effectively. See full prescribing information for LISDEXAMFETAMINE DIMESYLATE CAPSULES. LISDEXAMFETAMINE DIMESYLATE capsules, for oral use, CII Initial U.S. Approval: 2007 Stop treatment when binge eating does not improve rather than escalating indefinitely.dailymed nlm nih+1dailymed nlm nihThese highlights do not include all the information needed to use VYVANSE safely and effectively. See full prescribing information for VYVANSE. VYVANSE® (lisdexamfetamine dimesylate) capsules, for oral use, CII VYVANSE® (lisdexamfetamine dimesylate) chewable tablets, for oral use, CII Initial U.S. Approval: 2007dailymed nlm nihVYVANSE- lisdexamfetamine dimesylate capsule

Escalate diagnostic reassessment when binge eating persists despite adequate treatment exposure, when compensatory behavior appears, or when depression, anxiety, trauma symptoms, or suicidality dominate the presentation. BED has meaningful psychiatric comorbidity and elevated mortality and suicidality risk among binge-type eating disorders, making persistence of high-risk symptoms a reason to broaden treatment rather than simply change the anti-binge medication.BMJ+2BMJMethodology for studying Relative Energy Deficiency in Sport (REDs): a narrative review by a subgroup of the International Olympic Committee (IOC) consensus on REDsNatureMechanism-based subtyping in binge eating: understanding neurobehavioral heterogeneity across negative emotionality, approach behavior, and executive function | Translational PsychiatryPubMedThe integrated treatment of eating disorders, posttraumatic stress disorder, and psychiatric comorbidity: a commentary on the evolution of principles and guidelines