Case-Based Review

Binge-Eating Disorder: Prevalence, Predictors, and Management in the Primary Care Setting

Journal of Clinical Outcomes Management. 2015 November;22(11)

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170. Pearlstein T, Spurell E, Hohlstein LA, et al. A double-blind, placebo-controlled trial of fluvoxamine in binge eating disorder: a high placebo response. Arch Women’s Ment Health 2003;6:147–51.

171. Hudson J, McElroy S. Raymond NC, et al. Fluvoxamine in the treatment of binge-eating disorder: a multicenter placebo-controlled, double-blind trial. Am J Psychiatry 1998;155:1756–62.

172. Miller W, Rollnick S. Motivational Interviewing: helping people change. 3rd ed. New York: Guilford Press; 2013.

173. Rollnick S, Miller W, Butler C. Motivational interviewing in health care: helping patients change behavior. New York: Guilford Press; 2008.

Treatment

Prior to her next medical follow-up, the patient meets with a psychologist. The patient discloses that she has been binge eating several times per week for over a year; she also discloses a history of prolonged sexual abuse perpetrated by a step-parent during her childhood. When the patient returns to her follow-up medical appointment, she reports that her psychologist has diagnosed her with BED and PTSD. She states that they are using cognitive behavioral techniques to regulate her mood and eating behavior, with a specific aim of avoiding excessive dietary restraint. In addition, they are working together to discuss her unfulfilling romantic history and processing her experiences of trauma. Since her last appointment with the primary care physician, she reports an increased awareness of her eating habits, improvement in mood, and a 10-lb decrease in her weight.

The patient reports that she has continued to meet weekly with her psychologist and has slowly begun reintroducing low-impact exercise to her routine. She continues to lose weight gradually, but with a priority of stabilizing eating behavior and avoiding binge episodes versus aiming for weight loss. She reports that her mood has stabilized. Her cholesterol and triglycerides remain high, but her blood pressure is controlled effectively with medication. Her physician recommends continued psychological treatment, periodic meetings with a nutritionist, and prescribes medication for her cholesterol. A follow-up appointment with her physician is scheduled in 6 months.

Summary

BED is the most common eating disorder, but one for which many do not seek treatment directly, instead presenting to primary care for a host of comorbid psychiatric and medical conditions. Proper screening and referral in the primary care setting can optimize the likelihood of patients’ obtaining empirically supported treatments with coordinated care between primary care and behavioral health providers. Some sources for information for patients and providers are listed in Table 3 . As the literature does not yet overwhelmingly support a particular treatment modality over another, the primary care physician should support patient preferences amongst the options reviewed above. Given that a large body of literature supports the use of motivational interviewing strategies [172,173] to optimize the likelihood of engaging in a wide range of health behaviors in the primary care setting, reliance on such strategies to promote engagement in BED treatment is highly recommended.

Corresponding author: Karen K. Saules, PhD, Eastern Michigan University, Psychology Clinic, 611 W. Cross St., Ypsilanti, MI 48197, ksaules@emich.edu

Financial disclosures: None.