Multivariate therapeutic approach to binge-eating disorder: combined nutritional, psychological and pharmacological treatment

Abstract

Treatment for binge-eating disorder (BED) is directed towards either the physical or psychopathological impairments, and often does not cover all the alterations characterizing the disease. In 30 BED patients, we monitored the effects of three types of 6-month treatment, randomly assigned to one of the three treatment groups, each consisting of 10 patients. Group 1 received a 1700-kcal diet (21% proteins, 27% lipids, 52% carbohydrate), cognitive-behavioural therapy (CBT), sertraline (50-150 mg/day) and topiramate (25-150 mg/day); group 2 received the same diet, CBT, sertraline; and group 3 received nutritional counselling and CBT. Binge frequency and weight were assessed every month. The Eating Disorder Inventory-2, the Symptoms Check List-90-Revised (SCL-90-R) and the Personality Diagnostic Questionnaire-4-Revised (PDQ-4-R) were administered before and after treatment. Binge frequency and excessive weight decreased significantly only in group 1 patients, in whom improvement was noted in total Eating Disorder Inventory-2 scores and the subitems 'bulimia', 'drive for thinness', 'maturity fear', 'ascetism', in total SCL-90-R scores and in the subitem 'somatization', in PDQ-4-R subitems 'schizotypic personality' and 'dependent personality'. Group 2 patients improved on the SCL-90-R subitems 'depression' and 'interpersonal relationship' and in the PDQ-4-R 'schizoid personality'. Combination therapy seems to be the only fully effective treatment in BED patients.

Behavioral Peculiarities in Patients With Surplus Body Mass and Obesity

“…Эти стили могут сочетаться с психопа-тологической симптоматикой, но такое сочетание далеко не обязательно [16,17]. В рамках каждого из стилей поведения нарушения контроля проис-ходят по разным психофизиологическим механиз-мам.…”

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“…Fruits and vegetables were included three to four times a day. Meals were recommended to be consumed five or six moments a day to prevent excessive hunger, and a food replacement list was offered [12,23].…”

“…On this purpose, the education to healthier eating and life styles, and the modification of dysfunctional thoughts and habits are essentials. The most evaluated and developed intervention for BED includes behavioral (BT) and Cognitive-Behavioral Therapies (CBT) [11,12]. Behavioral treatments, focused on diet and lifestyle modification, and caloric restrictions should be moderate, and a normal or hypo caloric diet seems to be the best strategy to prevent bingeing.…”

An Overview of Treatments for Obesity in a Population with Mental Illness

“…19,21,22 Between 30% and 50% of people with BED are also obese 17,23 and obesity research has demonstrated that when CBT is compared with behavioural weight loss interventions (calorie restriction and exercise) for BED, CBT results in greater treatment effects than other interventions after both short-and long-term follow-up. 18,19,24 Patient selection and the way in which CBT is provided may play a role in terms of treatment efficacy for both BED and non-BED obese populations.…”