Binge-Eating Disorder: Clinical Foundations and Treatment

By James E. Mitchell, MD, Michael J. Devlin, MD, Martina de Zwaan, MD, Scott J. Crow, MD and Carol B. Peterson, PhD

Course Outline

This innovative scientific reference and clinical tool is virtually two books in one. Part I thoroughly yet succinctly reviews the literature on binge-eating disorder, covering diagnosis and epidemiology, clinical features and course, links to obesity, medical risks, and current treatment data. Part II provides an evidence-based cognitive-behavioral treatment manual. Session-by-session guidelines address how to help individuals or groups change their eating behavior, cope with emotional triggers, restructure problematic thoughts, deal with body image concerns and associated problems, maintain improvement, and prevent relapse. Featured are more than 40 clearly explained homework assignments and handouts, all in a large-size format with permission to photocopy.

About the Authors

James E. Mitchell, MD, is NRI/ Lee A. Christofferson MD Professor and Chair of the Department of Clinical Neuroscience at the University of North Dakota School of Medicine and Health Sciences and President of the Neuropsychiatry Research Institute. Dr. Mitchell focuses primarily on research in the areas of eating disorders and obesity. He is past president of the Academy for Eating Disorders and the Eating Disorders Research Society and is on the editorial board of the International Journal of Eating Disorders. Dr. Mitchell has published more than 300 scientific articles and has either authored or edited 12 books.

Michael J. Devlin, MD, is Associate Professor of Clinical Psychiatry at Columbia University College of Physicians and Surgeons and Associate Director of the Eating Disorder Research Unit at the New York State Psychiatric Institute. His major academic interest is in the diagnosis and treatment of patients with eating disorders. Dr. Devlin is an active member of the Academy for Eating Disorders and is past president of that organization. He serves on the editorial boards of two journals, the International Journal of Eating Disorders and Eating Behaviors. In addition to research in eating disorders, Dr. Devlin is active in medical student education and in the training and supervision of psychiatry residents, particularly in cognitive-behavioral therapy.

Martina de Zwaan, MD, is Professor and Head of the Department of Psychosomatic Medicine and Psychotherapy at the University Hospital of Erlangen, German. She is the author of numerous scientific and clinical papers on the subject of eating disorders, mainly bulimia nervosa, binge-eating disorder, and obesity.

Scott J. Crow, MD, is Professor of Psychiatry at the University of Minnesota. His research examines the course, outcome, and treatment of eating disorders and obesity. Dr. Crow is the recipient of an Independent Scientist Award (from the National Institute of Mental Health) focusing on the course, outcome, and treatment of eating disorders. He is past president of the Academy for Eating Disorders and director of the Eating Disorder/Assessment Core of the Minnesota Obesity Center.

Carol B. Peterson, PhD, is Research Associate/Assistant Professor in the Eating Disorders Research Program at the University of Minnesota, where her investigations have focused on the assessment, diagnosis, and treatment of bulimia nervosa, anorexia nervosa, binge-eating disorder, and obesity. She has authored over 50 articles and book chapters and has served as an investigator on several federally funded grants. Dr. Peterson is also Adjunct Assistant Professor in the Department of Psychology at the University of Minnesota and has a part-time private practice in which she specializes in the treatment of eating disorders.

Learning Objectives

After completing this course you’ll be able to:

  1. List the two characteristics of binge eating according to Table 1.1.
  2. Define “picking” and “nibbling” according to the Eating Disorder Exam.
  3. Define a snack according to the Eating Disorder Exam, Table 1.2.
  4. Discuss the findings of Fairburn and colleagues (1998).
  5. State the major criticism of BED as a clinically significant disorder.
  6. Compare BED with bulimia nervosa and anorexia nervosa, according to epidemiological studies.
  7. State the comparison of Hispanic women to white women regarding binge eating.
  8. State the first objective binge eating episode in children according to studies done by Decaluwe and Breat (2003).
  9. Discuss the findings of Agras and colleagues (1995) regarding treatment for binge eating.
  10. Describe the findings of Masheb and Grilo (2006) regarding emotion and overeating.
  11. State the mean age at which participants seek treatment according to Mussell and colleagues (1995).
  12. Discuss the findings of Mitchell and colleagues (1999) comparing treatment seeking women with BED or BN.
  13. Discuss the results of community studies according to Telch and Stice (1998).
  14. State the two criteria needed for obesity to fit the definition of an eating disorder.
  15. List the three difficulties the obese binge eater suffers from.
  16. Discuss a few of the longitudinal studies that suggest binge eating may promote weight gain and obesity.
  17. State the findings of Polivy and Herman, 1999, regarding overeating.
  18. Discus the findings of Marcus et al., 1995b, comparing cognitive treatment and behavioral weight loss programs.
  19. State the findings of Goldfein and colleagues (1993) with regard to the rate at which BED subjects ate.
  20. Define EMA and briefly describe one study.
  21. Describe the study of Bulik and colleagues (2002) regarding male and female twins with BED.
  22. List the two types of comorbidity frequently seen with BED.
  23. Describe the role of tricyclic antidepressants and a decrease in binge eating.
  24. Discuss the first study of a weight loss agent (Stunkard et al., 1996a).
  25. Describe the first bariatric surgery, the jejunoileal bypass.
  26. Describe the most commonly performed bariatric surgery in the United States.
  27. Describe the bariatric surgery for the “super-obese.”
  28. State the role of BED as a substantial problem for patients who undergo bariatric surgery.
  29. State the consensus that bariatric surgery can “cure” binge eating and why this is true.
  30. List the three direct factors leading to BED according to figure 6.1.
  31. Describe the cognitive portion of cognitive behavioral therapy.
  32. State the core component of CBT for most disorders.
  33. Describe stimulus control techniques.
  34. Describe experiential learning.
  35. Describe dialectical behavior therapy.
  36. Compare the results of severely binge-eating women and moderately binge-eating women.
  37. Describe how the length of CBT sessions affects outcome.
  38. Discuss the findings of Grilo and colleagues (2005a) regarding the use of Orlistat.
  39. Compare the eating behavior between BED and BN.
  40. Describe genetic factors with BED.

Course Contents

Part I – What We Know About Binge-Eating Disorder and Its Treatment

  1. Diagnosis and Epidemiology of Binge-Eating Disorder
  2. Clinical Features, Longitudinal Course, and Psychopathology of Binge-Eating Disorder
  3. Binge-Eating Disorder and Obesity
  4. Eating Behavior, Psychobiology, Medical Risks, and Pharmacotherapy of Binge-Eating Disorder
  5. Binge-Eating Disorder and Bariatric Surgery
  6. Psychotherapy for Binge-Eating Disorder
  7. Binge-Eating Disorder and the Future

Part II – A Cognitive-Behavioral Treatment Program for Binge-Eating Disorder

  • Introduction to This Treatment Program
  • Session-by-Session Therapist Guidelines
  • Patient Materials: Session-by-Session Handouts and Worksheets



“A splendid contribution by a seasoned, expert team of authors. The volume combines first-class scholarship with clinical wisdom and practical experience, and succeeds admirably in providing a comprehensive yet succinct summary of the state of the art and science in this field. Essential reading for clinicians, who will especially appreciate the user-friendly, evidence-based cognitive-behavioral treatment program.”  G. Terence Wilson, PhD., Oscare K. Buros, Professor of Psychology, Rutgers University; Director, Rutgers Eating Disorders Clinic

“This book combines a thoughtful consideration of the status of binge-eating disorder (BED) together with a manual for a multimodal treatment program that has been in use for a decade and has been tested in controlled trials. It will be useful for both psychologists and psychiatrists in training, as well as practitioners.” – W. Steward Agras, MD, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine.

“In the years since the formulation of provisional diagnostic criteria for BED, research on this problem has proliferated. Now a group of the foremost experts in the field have compiled a comprehensive volume that provides state-of-the-art information on all aspects of BED. This book is an invaluable resource for researchers, clinicians, and educators, and a ‘must’ for all serious students of eating disorders.” – Marsha D. Marcus, PhD, Department of Psychiatry, University of Pittsburgh School of Medicine; Chief, Eating Disorders Program, Western Psychiatric Institute and Clinic

“The research evidence has been extracted and analyzed in a readily accessible format, and ambiguities and uncertainties in the field are clearly presented. The cognitive-behavioral intervention model in the second part of the book is an excellent example of how science can be translated into treatment.” – Janet Treasure, PhD, FRCP, FRCPsych, EatingDisorders Research Unit, Department of Academic Psychiatry, Guy’s Hospital, London, UK