Mindfulness-Based Eating Awareness Training (MB-EAT) is an intervention created primarily for Binge Eating Disorder (BED). It is a 10 session intervention that involves teaching patients a variety of mindfulness meditation techniques to address core issues of BED. The program structure focuses on 4 stages that cultivate a non judgmental awareness of the internal experience with eating and external patterns or triggers that continue the cycle of binging. 

Mindfulness-Based Eating Awareness Training

Dialectical behavior therapy (DBT) has shown positive outcomes in patients with binge eating disorder (BED), including a decrease in binge behaviors. In a study done in part by Dr. Marsha M. Linehan, a creator of DBT, 89% of the women receiving DBT had stopped binge eating by the end of treatment. Abstinence rates were reduced to 56% at the 6-month follow-up.  More research is needed with larger sample sizes to further support DBT as treatment for BED.

Dialectical Behavior Therapy for treating Binge Eating Disorder

- Dialectic Behavior Therapy
- Mindfulness-Based Eating Awareness Training

University of Texas at Austin

Syracuse University

This list includes different types of methods for treating and/or managing different feeding and eating disorders. These include, but are not limited to the following:
-	Mindfulness for Patients with Eating Disorders
-	Cognitive-Behavioral Therapy vs. Behavioral Weight Loss (BWL) as Treatment for Binge-Eating Disorder
-	Mindfulness-Based Interventions for Binge Eating Disorders
-	Dialectical Behavior Therapy for treating Bulimia Nervosa
-	Dialectical Behavior Therapy for treating Anorexia Nervosa
-	Subjective Experiences of Eating Disorder Treatments
-	Pharmacological Treatment for Binge Eating Disorders
-	Enhanced Cognitive Behavioral Therapy (CBT-E) for Eating Disorders
-	Family-Based Treatment of Eating Disorders in Adolescents

Treatment & Management Methods for Feeding and Eating Disorders

Binge eating disorder (BED), officially recognized by the American Psychiatric Association in the DSM-5 since 2013, is characterized by recurrent episodes of consuming large amounts of food. Unlike bulimia nervosa, these binges are not followed by compensatory behaviors such as purging. A key diagnostic feature is the significant psychological distress, including feelings of guilt and embarrassment, that occurs after a binge, which distinguishes the disorder from simple overeating.

Binge Eating Disorder (BED)

Kristeller, J. L., & Wolever, R. Q. (2010). Mindfulness-based eating awareness training for treating binge eating disorder: the conceptual foundation. Eating disorders, 19(1), 49-61.
https://www.tandfonline.com/doi/pdf/10.1080/10640266.2011.533605

Mindfulness-Based Eating Awareness Training for Treating Binge Eating Disorder

Telch, C. F., Agras, W. S., & Linehan, M. M. (2001). Dialectical behavior therapy for binge eating disorder. Journal of consulting and clinical psychology, 69(6), 1061–1065. https://doi.org/10.1037//0022-006x.69.6.1061

Dialectical behavior therapy for binge eating disorder

Mindfulness interventions have been shown to be beneficial for those suffering with eating disorders including anorexia nervosa, binge eating disorder, and bulimia nervosa.

Mindfulness for patients with eating disorders

Mindfulness-Based Interventions for Binge Eating Disorder

Though cognitive behavior therapy is generally considered the treatment of choice for bulimia nervosa, dialectical behavior therapy (DBT) may be particularly effective in treating bulimia nervosa due to its targeting of emotional dysregulation problems, which often underlie the eating disorder. One study has shown a significant decrease in binge/purging behaviors in patients with bulimia nervosa who underwent DBT with a focus on emotional regulation, though more research into this area is necessary.

Dialectical Behavior Therapy for treating Bulimia Nervosa

Dialectical behavior therapy (DBT) has been shown to be effective in treating anorexia nervosa (AN), as patients with the disorder who underwent DBT saw low dropout rates and increased BMIs which were sustained 6 months later. While standard DBT has been shown to be effective, a DBT program that was augmented to focus on overcontrolled emotions and behaviors which contribute to AN was more helpful in encouraging long term results.

Dialectical Behavior Therapy as Treatment for Anorexia Nervosa

One study examined the current literature on the experiences and perspectives of those across healthcare interfaces for eating disorders, to include individuals with eating disorders, people close to or caring for those with eating disorders such as family and friends, and health professionals.

Subjective Experiences of Eating Disorder Treatments 

One study explored the different pharmacological treatments for BED. The study found that antidepressants, appetite suppressants, and anticonvulsants, specifically, desipramine, fluvoxamine, fluoxetine, sertraline, citalopram, dexfenfluramine, sibutramine, and topiramate can aid in BED treatment. 

Pharmacologic Treatment for Binge Eating Disorder

Enhanced cognitive behavior therapy (CBT-E) is a transdiagnostic approach that is designed to treat multiple clinical conditions, including the complete list of eating disorders identified in DSM-V, such as anorexia nervosa, bulimia nervosa, binge eating disorder (BED), among others. It is different from typical CBT in that it aims to treat the underlying pathological factors contributing to several disorders, rather than any one condition. 

CBT-E is comprised of four stages, yet the details of each stage differ based on the individual patient and their clinical circumstances.

The overarching goal of CBT-E is to assist the patient in first acknowledging their harmful eating patterns and body-image concerns so that they can eventually begin actively participating in therapeutic sessions targeted at addressing the emotions, beliefs/thoughts, and behaviors (e.g., body-image concerns, low self-esteem stressful life events, interpersonal relationship conflicts, etc.)  sustaining their condition. 

After the patient has begun to heal, CBT-E treatment provides them with coping mechanisms to manage challenges to their recovery so that they can maintain their progress.

Enhanced Cognitive Behavioral Therapy (CBT-E) for Eating Disorders 

The family-based treatment (FBT) method for eating disorders entails a clinician working with the adolescent patient and their family to establish a comprehensive care plan that extensively engages the patient's home/family life.

Comprised of three phases, FBT is characterized by granting the patient's family responsibility to monitor and oversee their child's eating behaviors in order to support the patient's sustainable adoption of healthy eating habits. As the patient progresses in their recovery, they are incrementally granted more autonomy over their dietary decisions and eating preferences.

Family-based Treatment of Eating Disorders in Adolescents

Research unfortunately indicates that anorexia nervosa treatment outcomes are not always ideal. Although oftentimes significant weight is restored by the end of treatment, psychological symptoms frequently go largely unaddressed, indicating a gap in current treatment procedures that may leave patients more vulnerable to relapse.

Anorexia Nervosa Treatment Outcomes

Depending on the severity of the case of bulimia nervosa, treatment methods may vary, but often include the following: 

- Purging cessation
- Nutritional support
- Monitoring 
- Medical treatment for complications
- Psychotherapy
- Psychiatric medication

Bulimia Nervosa Treatment

CBT is known as an effective treatment for binge-eating disorder (BED) in that it helps people to stop binge-eating, but it does not actually help people to lose weight (which is important because BED puts people at high risk for obesity and the health problems associated with that).  Because of this shortcoming, perhaps another treatment option is necessary to help people with BED to lose weight.

Cognitive-Behavioral Therapy vs. Behavioral Weight Loss (BWL) as Treatment for Binge-Eating Disorder

Multiple forms of treatment exist for binge eating disorder, each with different levels of efficacy in terms of prompting remission of binge-eating episodes, lessening psychological symptoms, and reducing body weight:

- Psychotherapy
- Structured self-help treatment
- Combined treatment
- Pharmacotherapy
- Behavioral weight loss treatment
- Self-help weight loss treatment
- Inpatient treatment 

Binge Eating Disorder Treatment Outcomes

In general, treatments for ARFID can be divided into two major groups: 

- Psychological treatment
- Adjunctive pharmacological treatment

Avoidant/Restrictive Food Intake Disorder (ARFID) Treatment

Several models exist to include family members in anorexia nervosa treatment. These models strive to put theory-based strategies into action, either by addressing intra- and inter-personal factors that maintain the disorder, by addressing behaviors of the illness, or by focusing on improving the well-being of the family as a whole: 

- CBT-oriented family module
- Systemic family therapy
- Maudsley model of family-based therapy (FBT)
- New Maudsley Model for Collaborative Care (NMCC)

Family Inclusion in Anorexia Nervosa Treatment

Neuromodulatory techniques are also being studied to directly affect the brain to regulate food intake and reduce AN’s psychological symptoms. Multiple forms on neuromodulation have been studied or are being studied currently, including the following:
- Transcranial direct-current stimulation (tDCS) 
- High-frequency repetitive transcranial magnetic stimulation (rTMS) 
- Deep brain stimulation (DBS)

Neuromodulation for Anorexia Nervosa Treatment

- Hunger
- Fullness
- Pleasure in small quantities of food
- Quality preference over quantity
- Non-nutrition eating triggers
- Mindful food choices

Aspects of Binge Eating Addressed when Cultivating Mindful Eating

- control of responses to varying emotional states
- ability to make conscious food choices
- awareness of hunger and satiety cues
- difficulty with self-acceptance


Core Issues of Binge Eating Disorder Addressed by Mindfulness-Based Eating Awareness Training

Complications resulting from binge eating disorder can be divided into two main types, based on acuteness:

- Chronic binge eating disorder complications
- Acute binge eating disorder complications

Binge Eating Disorder Complications

An estimated 94% of BED patients also have at least one other comorbid psychiatric condition, and nearly 23% of BED patients have attempted suicide. Some mental illnesses seem to be most common among patients:

- Mood disorders
- Substance use disorders
- Anxiety disorders
- Personality/conduct disorders

Binge Eating Disorder Comorbid Psychiatric Conditions

Several risk factors have been found to be associated with an increased likelihood of developing binge eating disorder:

- Minority status(es)
- Low socioeconomic status
- Trauma/violence
- Body dissatisfaction
- Comorbid psychiatric conditions

Binge Eating Disorder Risk Factors

The primary factor that differentiates binge eating disorder from simple overeating is the significant psychological distress experienced after a binge. Individuals with the disorder often feel guilt and embarrassment following their eating episodes, which is not a defining characteristic of overeating.

Distinguishing Binge Eating Disorder from Overeating

Analyze the following clinical scenario. Based on the information provided, what is the most likely diagnosis? Justify your reasoning by referencing specific details from the case and explaining why other potential diagnoses are less probable.

Clinical Scenario: Eating Patterns

A client reports that at least twice a week, they secretly and rapidly consume an unusually large amount of food until they are uncomfortably full. They do not engage in any behaviors like vomiting or excessive exercise afterward. The client expresses profound feelings of guilt, shame, and disgust with themselves following these episodes. Based on this information, which statement best analyzes the client's condition?

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