Assessment and treatment of binge-eating disorder.

The patient presenting with binge-eating disorder requires a detailed clinical assessment that takes into account behavioral, somatic, and psychological aspects of the disorder. Treatment selection depends on the patient's particular goals. Antidepressant medications and CBT are effective, at least in the short term, in suppressing binge eating and reducing depressive symptoms. Fluoxetine may, in addition, promote short-term weight loss, which is more likely to be maintained if medication is administered in the context of behavior therapy. Preliminary study suggests that behavior therapy may be designed to promote weight loss, even in the absence of medication treatment, without undermining binge cessation. Appetite suppressant medications clearly promote weight loss, but their use in suppressing binge eating has yet to be studied specifically. Further study is needed in several areas including the feasibility and efficacy of treatment approaches that combine medication and psychotherapy, the efficacy of individual versus group psychotherapy, the long-term outcome of various forms of treatment, and the clinical features that predict favorable response to different treatment modalities.