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Abstract

Binge-eating disorder (BED), described as recurring binge-eating without inappropriate compensatory weight control behaviors, was included as an own diagnostic entity in the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition in 2013, established from its clinical utility. While this clinical utility of BED entails its prognosis in the natural time course and treated time course, the longitudinal evidence for the natural time course is still limited, indicating the urgent need to generate additional scientific evidence on the trajectories of BED in the natural time course. Based on mostly adolescent community samples, the restricted available evidence suggests a chronic natural time course of BED with alternating periods of relapse and remission and a prospective risk for physical and mental comorbidities, like excess weight gain and associated sequelae. In contrast, a variety of specific psychological and pharmacological treatments for BED, including psychotherapy, structured self-help treatment, pharmacotherapy, and weight loss treatments, were largely evaluated, demonstrating short- and long-term efficacy for binge-eating reduction and improvements in associated eating disorder and general psychopathology in BED. Psychotherapy, in particular cognitive-behavioral therapy, was the most-extensively studied and most well-established of these evidence-based treatment approaches, but does not specifically address weight loss, albeit future weight gain may be prevented through the elimination of binge-eating episodes. Implications for future research include the optimization of these evidence-based treatments, especially against a significant proportion of patients with BED without full recovery or with relapse from BED after treatment. In addition, the long-term efficacy of the evidence-based treatments warrants further investigation, in particular for pharmacotherapy studies with an elevated risk for adverse events.