Out of control binge eaters who get help from a therapist do better in the short-term than people who use self-help techniques, new research shows.

But in the long-term, self-help and therapist-led or therapist-assisted approaches seem to have about the same effectiveness, Dr. Carol B. Peterson of the University of Minnesota in Minneapolis and her colleagues found.

Binge eaters often eat large amounts of food while feeling a loss of control over their eating. It is different from the binge-purge syndrome of bulimia because binge eaters do not purge afterward by vomiting or taking laxatives. Binge eating disorder is contributing to the rise in obesity.

While medications can help reduce bingeing episodes among people with the disorder, psychotherapy is the most effective approach to treatment, Peterson and colleagues note in a report in the latest issue of the American Journal of Psychiatry. Self-help interventions have also shown promise.

Peterson's team compared the effectiveness of various group therapy approaches by randomly assigning 259 adults with binge eating disorder to 20 weeks of therapist-led, therapist-assisted, or self-help group therapy, or to a waiting list.

After treatment, just over half of people who had therapist-led group treatment were abstaining from bingeing, compared to a third of those in the therapist-assisted groups, 18 percent in the self-help groups, and 10 percent in the waiting list group. The frequency of binge eating was also lower in the therapist-led or assisted groups compared to the self-help group or the waiting list group.

When the researchers followed up 6 and 12 months after treatment ended, they found no difference in bingeing abstinence rates or binge eating frequency among the groups.

However, the study participants who got help from therapists were more likely to stick with the treatment for 20 weeks; 88 percent of people in the therapist-led groups and 81 percent of those in the therapist-assisted groups completed 20 weeks of treatment, compared to 68 percent of people in the self-help groups.

The presence of a therapist may enhance short-term abstinence and reduce the likelihood of dropout, Peterson and her team say. But self-help groups may be helpful when therapists aren't available, they add.

These findings suggest that self-help group treatment may be a viable alternative to therapist-led interventions in some settings, Dr. Walter Kaye of the University of California San Diego writes in an editorial accompanying the study.

It should be noted, however, that the power of such treatments may be limited since many patients continued to have substantial degrees of binge behaviors at 12-month follow-up, Kaye notes.

SOURCE: American Journal of Psychiatry, December 2009.

Medicine