The sequential binge: a new therapeutic approach for binge eating

Introduction

A significant proportion of eating disorder patients experiencing binge eating do not respond to cognitive behavioral therapies (CBT). Here, we present a new behavioral technique, the sequential binge (SB) that aims at reducing both food intake during binges and daily binge numbers. Specifically, SB replaces the usual pattern of food ingestion during a binge by a repeated monotonous food ingestion sequence interspersed with short incremental pauses. This pattern of ingestion is hypothesised to facilitate boredom towards the ingested foods and promote a sense of control over binge foods.

Methods

15 eating disorder in-patients with refractory binge eating who were non-responsive to intensive CBT were given SB as an adjunct to their treatment. Patients were followed up for 16 weeks after SB implementation.

Results

Compared to regular binges, SB was associated with a 44% relative reduction in the planned food intake during binges (p<0.001), a longer refractory period after the binge (median: 48hrs vs. 4hrs, p=0.002), and an average relative reduction of binges by 26% the day after SB (p=0.004).

Conclusion

This case series shows promising evidence for the use of SB in patients with refractory binge eating. Further evaluation of the use of SB for refractory binge eating in a prospective double-blind clinical study seems justified.