Binge Eating Disorder Treatment: Therapy, Lisdexamfetamine and Newer Options

The first-line treatment for binge eating disorder (BED) is psychotherapy: eating disorder-focused cognitive behavioral therapy (CBT) or interpersonal therapy, in individual or group format. For adults who prefer medication or do not respond enough to therapy, the American Psychiatric Association suggests an antidepressant or lisdexamfetamine (Vyvanse), which is FDA-approved for moderate to severe BED in adults. Topiramate and GLP-1 medications such as semaglutide are used off-label, and the GLP-1 evidence is still early.

A central point runs through all of it: BED treatment targets the binge eating, not weight. The APA's patient guidance states that weight loss is not a primary goal of treatment and that calorie-restricting diets may make bingeing worse.

What binge eating disorder is, and what it is not

BED involves recurrent episodes of eating an unusually large amount of food with a sense of loss of control. Under the criteria the APA summarizes, binges occur at least once a week for three months and include at least three features such as eating more rapidly than normal, eating until uncomfortably full, eating large amounts when not hungry, eating alone out of embarrassment, and feeling disgusted, depressed or very guilty afterward. Unlike bulimia nervosa, there are no regular compensatory behaviors such as vomiting, fasting, excessive exercise or laxative misuse.

BED is not the same as occasional overeating, and it is not defined by body size. People with BED live in every kind of body. Many have spent years in cycles of strict dieting and bingeing, and many feel deep shame. That shame, and the weight stigma people meet in health care, are reasons people delay getting help; the site's article on weight stigma explains how bias can worsen both mood and eating.

BED often travels with other conditions, including depression, anxiety and ADHD. The APA guideline notes high rates of psychiatric co-occurrence across eating disorders and recommends that the initial evaluation identify them. A good assessment also asks about mood, suicidal thoughts, substance use, trauma and medical conditions such as diabetes. If you are thinking about suicide or are in crisis, call or text 988 (the 988 Suicide & Crisis Lifeline) or go to the nearest emergency room.

Treatment options at a glance

Psychotherapy first: CBT and interpersonal therapy

The APA recommends that patients with BED be treated with eating disorder-focused CBT or interpersonal therapy in individual or group formats, describing therapeutic benefit with small potential for harm. The APA's patient information calls CBT, individual or group-based, the most effective treatment for BED and notes that interpersonal therapy has also been shown to be effective.

Eating disorder-focused CBT usually starts with regular eating: three meals and planned snacks at predictable times, because long gaps and rigid restriction are common binge triggers. It then works on the thoughts and situations that set off binges, including stress, boredom, loneliness and rules about "forbidden" foods, and on body image and relapse prevention. Self-monitoring of eating, without calorie counting, is a core tool. The site's post on CBT for eating disorders describes the approach.

Interpersonal therapy takes a different route: it focuses on relationship problems, role changes, grief or isolation that keep the binge cycle going. The sibling article on interpersonal therapy explains the method in the context of depression. Group formats can work well for BED; see group vs individual therapy.

When specialist therapy is hard to find, the APA training materials note that web-based CBT and CBT-based guided self-help have modest effects on binge eating but can be used as an initial approach.

Lisdexamfetamine (Vyvanse): the FDA-approved medication

Vyvanse is indicated for moderate to severe BED in adults, as well as ADHD. Its label states that it is not indicated or recommended for weight loss and that its safety and effectiveness for treating obesity have not been established. Safety and effectiveness have not been established in patients with BED younger than 18.

What the trials showed

Two pivotal 12-week trials enrolled 383 and 390 adults with BED and found that lisdexamfetamine at 50 or 70 mg a day reduced binge eating days per week more than placebo. The most common side effects, reported by at least 10% of participants on the drug, were dry mouth, insomnia and headache, and pulse and blood pressure rose on average. A later relapse-prevention study gave lisdexamfetamine to adults for 12 weeks and then randomized those who responded to continue it or switch to placebo for 26 weeks; 3.7% of those who continued met relapse criteria compared with 32.1% of those switched to placebo.

The APA training materials describe a typical schedule of starting at 30 mg in the morning and increasing to a therapeutic dose of 50 to 70 mg, with lower maximum doses for significant kidney impairment and extra caution in people with high blood pressure or heart disease. Those decisions belong to the prescriber, not the patient.

Risks to weigh

Vyvanse carries a boxed warning that it has a high potential for abuse and misuse, which can lead to a substance use disorder, and that misuse can cause overdose and death. It is a Schedule II controlled substance. Prescribers assess the risk of misuse before and during treatment, and check heart rate and blood pressure; the sibling guide on stimulant heart and blood pressure monitoring describes what that looks like. If you already take a stimulant for ADHD, the comparison of Adderall vs Vyvanse explains how the two differ.

What the evidence does not show: much about long-term outcomes beyond the trial periods, or how lisdexamfetamine compares with CBT in large head-to-head trials.

Off-label options: antidepressants and topiramate

The APA suggests either an antidepressant or lisdexamfetamine for adults with BED who prefer medication or have not responded to psychotherapy alone, and its training materials note that antidepressants can increase the likelihood of clinical improvement and remission. The guideline advises choosing among antidepressants by tolerability, side effect profile and drug interactions, and notes that older tricyclics and MAOIs are less likely to be used. No antidepressant carries an FDA indication for BED, so this use is off-label.

Topiramate, an anticonvulsant approved for epilepsy and migraine prevention, is also used off-label. In a multicenter trial of 394 adults with BED and obesity, topiramate produced binge eating remission in 58% of participants compared with 29% on placebo, along with weight reduction. About 16% of the topiramate group stopped because of side effects, compared with 8% on placebo, and tingling (paresthesia), drowsiness and nausea were among the most common. Like any off-label choice, it is a decision to make carefully with a prescriber who can review your other conditions and medications.

GLP-1 medications and binge eating: what is known so far

Semaglutide, liraglutide and related medications reduce appetite and are widely used for weight management and type 2 diabetes. The Wegovy label covers weight reduction and cardiovascular risk reduction in specific groups, not BED, so using a GLP-1 medication to treat binge eating is off-label. Wegovy also carries a boxed warning about thyroid C-cell tumors seen in rodents, and it is not used in people with a personal or family history of medullary thyroid carcinoma or MEN 2.

Two 2026 reviews summarize the evidence. A systematic review of incretin therapies for binge eating found 12 studies, mostly with fewer than 75 participants, showing consistent reductions in binge eating but limited by small samples, varied methods and short follow-up. A meta-analysis of 25 randomized trials in people with obesity found moderate reductions in binge eating and emotional eating, with larger effects in trials enrolling people with diagnosed BED. The same analysis found higher dietary restraint on GLP-1 medications, rated every included study as having some concerns or high risk of bias, and called for adequately powered trials in people with diagnosed BED.

That increase in restraint matters because rigid restriction is one of the engines of the binge cycle, and eating disorder specialists worry about appetite suppression masking, rather than resolving, disordered eating. A GLP-1 medication may be a reasonable conversation when BED coexists with obesity or diabetes, but it is not a substitute for therapy and is not yet an evidence-based BED treatment. The site's review of GLP-1 medications for binge eating disorder discusses the clinical considerations in more depth.

Putting a plan together

A sensible sequence for many adults looks like this:

1. A full evaluation, including mood, ADHD, substance use and a medical review with basic labs.
2. Eating disorder-focused CBT or IPT, individual or group, or guided self-help if specialist care is not available yet.
3. Regular eating and a move away from restrictive dieting.
4. If binges continue after a fair trial, or the person prefers medication, a discussion of lisdexamfetamine or an antidepressant with a prescriber.
5. Treating co-occurring depression, anxiety or ADHD, which can also shape the medication choice.

Worked example: an adult with weekly binges, low mood and untreated ADHD symptoms may benefit from a plan where a prescriber evaluates both conditions, because a single medication choice could affect both. Someone with high blood pressure or a past stimulant misuse problem, by contrast, might reasonably start with therapy and, if medication is needed, an antidepressant. These are illustrations of how factors interact, not recommendations for any individual. The sibling guide on medication, therapy or both explains how combined care is weighed more generally.

Most people with BED are treated as outpatients; the APA's patient information states that outpatient treatment is often most appropriate. When binge eating is accompanied by purging, severe medical complications or uncontrollable symptoms, see the guide on eating disorder levels of care.

Setbacks and staying well

Binges rarely stop in a straight line. A stressful week, a return to dieting, poor sleep or a change in medication can bring them back, and a single binge does not mean treatment has failed. Good CBT plans for this directly: it identifies early warning signs, such as skipping meals or rising self-criticism, and sets out what to do in the first day or two after a lapse, usually returning to regular eating rather than compensating with restriction.

If medication is part of the plan, any decision to stop it should be made with the prescriber, who can plan the timing and watch for a return of symptoms. Ongoing therapy check-ins, a support group, or periodic booster sessions can help keep progress steady after the main course of treatment ends.

Questions to ask your clinician

• Is this binge eating disorder, or could it be bulimia nervosa, night eating or another pattern?
• Have you trained in eating disorder-focused CBT or IPT, and what does a typical course involve?
• How will we measure progress, for example binge days per week?
• If you suggest medication, is it FDA-approved for BED or off-label, and why this one for me?
• How will treatment address weight stigma and avoid a dieting focus?
• What happens if I have a setback?

How the practice approaches binge eating

The practice's eating disorders page describes its integrative view of binge eating. Its ongoing care includes psychiatric evaluation and medication management, psychotherapy including CBT and DBT, coaching, lab testing, and nutrition and lifestyle psychiatry. The practice is out of network with all insurance plans, and payment is due at the time of service. A free discovery call is the first step, and the team can answer questions about care options there, including whether its clinicians treat binge eating disorder and whether eating disorder-focused CBT is available. For other topics in this series, return to the Choosing Psychiatric Care guide.

Frequently asked questions

Is binge eating disorder the same as food addiction?

No. Binge eating disorder is a defined psychiatric diagnosis with specific criteria. Food addiction is a research concept without an agreed diagnosis. The overlap is debated, and BED treatment does not depend on resolving it.

Will treatment for binge eating disorder make me lose weight?

It might or might not. Weight loss is not the primary goal; the goal is stopping binges and normalizing eating. Some medications used off-label, such as topiramate and GLP-1 agonists, are associated with weight loss in trials, while lisdexamfetamine is not indicated for weight loss.

Can I take Vyvanse for binge eating if I also have ADHD?

Vyvanse is FDA-approved for both ADHD and moderate to severe BED in adults, so one medication can sometimes address both. Whether it is right for you depends on your heart health, blood pressure, any history of substance misuse, and other medications, which a prescriber reviews.

Should I diet while in treatment for binge eating?

Most eating disorder treatments ask people to stop restrictive dieting, because rigid restriction often triggers binges. The APA notes that calorie-restricting diets may make bingeing worse. Any nutrition plan should be built with your treatment team.

How long does CBT for binge eating disorder take?

Courses of eating disorder-focused CBT are typically structured over several months. The exact length depends on severity, other conditions and how quickly regular eating is established.

Can teenagers be treated for binge eating disorder?

Yes, with psychotherapy as the mainstay. Vyvanse's safety and effectiveness for BED have not been established in people under 18, so medication decisions for teens need particular care with a child and adolescent prescriber.

Sources

1. APA Practice Guideline for the Treatment of Patients With Eating Disorders: training slides. American Psychiatric Association, 2023. psychiatry.org
2. What Are Eating Disorders?. American Psychiatric Association, 2023. psychiatry.org
3. Vyvanse (lisdexamfetamine dimesylate) prescribing information. Takeda / DailyMed, U.S. National Library of Medicine, 2026. dailymed.nlm.nih.gov
4. Lisdexamfetamine Dimesylate for Adults with Moderate to Severe Binge Eating Disorder: Results of Two Pivotal Phase 3 Randomized Controlled Trials. Neuropsychopharmacology 41(5):1251-60 (McElroy SL et al.), 2016. pubmed.ncbi.nlm.nih.gov
5. Efficacy of Lisdexamfetamine in Adults With Moderate to Severe Binge-Eating Disorder: A Randomized Clinical Trial. JAMA Psychiatry 74(9):903-910 (Hudson JI et al.), 2017. pubmed.ncbi.nlm.nih.gov
6. Topiramate for the treatment of binge eating disorder associated with obesity: a placebo-controlled study. Biological Psychiatry 61(9):1039-48 (McElroy SL et al.), 2007. pubmed.ncbi.nlm.nih.gov
7. Topiramate tablets prescribing information. DailyMed, U.S. National Library of Medicine, 2026. dailymed.nlm.nih.gov
8. Incretin-Based Therapies for the Treatment of Binge Eating: A Systematic Review. Pharmacotherapy 46(5):e70135 (White RT et al.), 2026. pubmed.ncbi.nlm.nih.gov
9. The effectiveness of glucagon-like peptide-1 receptor agonists (GLP-1RAs) on binge eating in patients with obesity: a systematic review and meta-analysis. eClinicalMedicine 98:104007 (Emptage I et al.), 2026. pubmed.ncbi.nlm.nih.gov
10. Wegovy (semaglutide) injection prescribing information. DailyMed, U.S. National Library of Medicine, 2024. dailymed.nlm.nih.gov

Educational information, not medical, tax or legal advice. Decisions about diagnosis, medication and treatment belong with a clinician who knows your history.