Clinical characteristics and treatment of eating disorder patients with binge eating

We have long done cognitive-behavioral therapy (CBT) for eating disorder patients, especially anorexia nervosa (AN), and have found it to be effective. Patients with binge eating have recently increased. However, the evidence for the effectiveness of the CBT in reducing binge eating is not strong. An appropriate therapeutic goal, not only for reducing binge eating but also for reducing a variety of psychopathology including anxiety, dysthymia and self-esteem, is important. Although it is reasonable to use CBT as the first line of approach, a more effective treatment or combination of treatments is needed. To resolve the problem, we studied 43 binge eating patients, from the 130 eating disorder patients admitting to our outpatient clinic during the year after March 1997; 7 AN, 33 bulimia nervosa (BN), and 3 eating disorder not otherwise specified, according to DSM-IV. Their clinical characteristics were as followed: age (22.0 ±5.7 yr, 14~48 yr), body mass index (BMI) (19.5±3.1 kg/m², 12.2~33.1 kg/m²), body weight changes (13.9±7.6 kg, 0~32 kg), difference from ideal body weight (4.5±6.2 kg, - 6.5~22.4 kg), duration (41.3±53.8 months, 2~300 months), and inappropriate compensatory behaviors (vomiting, n = 32; misuse of laxatives, n = 4; both, n= 1; fasting, n=6). Treatment outcomes showed that only one third of the patients improved after at least 3 months of therapy. In comparing those who improved (n = 15) and those who did not or who were drop-outs (n= 28), no significant differences were found in characteristics between the 2 groups, except that the longer the duration from onset to the first admission to the clinic, the higher the drop-out rate (p= 0.07). By factorial analysis, using the results of the Eating Disorder Inventory questionnaire, the body weight changes highly correlated with the following psychological problems: 'ineffectiveness', 'maturity fears', 'interpersonal distrust', and 'lack of interoceptive awareness', or 'alexithymia'. Based on these findings, it is necessary to prevent patients from attempting to force themselves to quit binge eating immediately, and consequently to learn to feel, both physically and psychologically, contentment from their main meals. The clinical implications for the future treatment are that we should clearly focus on helping patients recover interoceptive awareness and improve lowered self- esteem.