Exploring Womens Experiences of Treatment for Binge Eating Disorder: Methylphenidate Vs. Cognitive Behavioural Therapy

A previous randomized controlled trial (RCT) investigated methylphenidate (MP) and cognitive behavioural therapy (CBT) treatments in women with BED and a BMI 25. The following qualitative study enrolled 15 treatment completers (8 MP, 7 CBT) and four clinicians (3 CBT psychologists and 1 MP psychiatrist). The primary objectives were to explore the patients' and clinicians lived experiences of BED treatment. Informed by a phenomenological methodology, semi-structured interviews captured their narrative accounts. Key themes were then identified from transcribed audio recordings, using thematic analysis methods. The patients in both groups described the importance of mindfulness and self-awareness in helping them regain control over their food intake. In addition, a positive patient-clinician relationship was reported to be integral to treatment success as it acknowledged the need for safety and comfort in this group. Patients in the MP group described the drug's primary benefit to be appetite reduction, which decreased food preoccupation and binge frequency. Although the beneficial effects were not immediate in the CBT group, the patients appreciated obtaining a "toolbox of skills" to manage their binges. The clinicians corroborated the patients' general experiences of the treatments. They also described the importance of a collaborative clinician-patient relationship and the social determinants of health that affected treatment accessibility. Both clinicians and patients saw stress as a reason to binge or relapse. Therefore, it is proposed that treatments have a stronger focus on adaptive stress-coping skills. Taken together, these qualitative findings add a much-needed perspective on clinical treatments for compulsive overeating. The study is especially important considering that a psychomotor stimulant similar to MP is the only approved pharmacotherapy for BED and to date, little is known about the patient's subjective experiences.