Cognitive Behavioral Therapy in Binge Eating Disorder and Bulimia Nervosa

Stein D, M.D.,
The Pediatric Psychosomatic Department, Safra Children’s Hospital, The Chaim Sheba Medical Center, Tel Hashomer, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

Address: Pediatric Psychosomatic Department, Sheba Medical Center, 52621 Tel Hashomer. Phone: 03-5302690; fax: 03-5305129; e-mail:


We start with a brief description of the role of dysfunctional cognitions on the development and maintenance of binge eating disorder (BED) and bulimia nervosa (BN). Thereafter we describe the “classical” cognitive behavioral therapy (CBT) model in BED and BN. The treatment of these two disorders includes three basic stages: 1.Psycho-educational and behavioral stage. In this stage, the patients receive information on the cognitive perspectives of BED and BN and on the principles of CBT in these disorders. They are instructed how to carry out their daily food monitoring and the relevance of this procedure, the reasons for dieting being contraindicated in this treatment, as well as the provision of alternative behaviors to avoid bingeing/purging and of stimulus control techniques for maladaptive eating-related behaviors. 2. Cognitive stage. This stage takes place only in the case of significant reduction in bingeing/purging behaviors. It uses the classical dysfunctional thought record (DTR) technique, focusing mainly on cognitive distortions related to eating, weight, body image, and self-esteem. 3. Consolidation of the achievements of treatment and relapse prevention. This stage emphasizes the continuation of improvement after the end of the treatment and the importance of setting realistic goals (e.g., not nercessarily total abstinence of bingeing/purging behaviors), of differentiating between lapse and relapse, and the conditions calling for reinstitution of past effective CBT techniques.

Thereafter we present up-to-date data with respect to the efficacy of CBT in BED and BN, including clinical recommendations, contraindications, advantages and limitations. Specifically we relate to the novel “transdiagnostic” CBT model that has been recently imitated because of the lack of efficacy of the “classical” CBT in a significant minority of BED and BN patients. This relates in particular to influential illness-maintaining processes such as perfectionism, core low self-esteem, mood intolerance, and interpersonal difficulties.