Use of naltrexone for treating binge eating and food obsession related to trauma: a case report and literature review

Impulse-control disorders, including those related to eating behaviors, are complex conditions with limited pharmacologic treatment options. While naltrexone is primarily used for opioid and alcohol dependence, emerging research suggests it may also be effective in managing a variety of impulse-driven conditions. As a pure opioid antagonist, naltrexone’s mechanism of action involves the inhibition of opioid receptors on dopaminergic neurons involved in the reward pathway of the brain, thereby reducing the reinforcing effects of substances such as alcohol and opioids. Research suggests that through this mechanism of action, naltrexone shows promise in treating impulsive behaviors also driven by the reward pathway, such as binge eating, purging, gambling, kleptomania, and self-injurious behavior, as well as autism spectrum disorder (ASD) and intellectual disability. This case presents a 28-year-old female with a history of intellectual disability, ASD, schizoaffective disorder, bipolar disorder, and posttraumatic stress disorder (PTSD) who displayed binge eating, hoarding, and aggression related to food following years of food restriction and trauma. After the failure of other medications, naltrexone was prescribed and showed a marked reduction in these behaviors. This case highlights naltrexone’s efficacy in treating trauma-associated binge eating and its broader potential in managing impulsivity-related disorders. Ultimately, further research is still needed to determine the proper dosages and duration of treatment and what conditions best indicate the use of naltrexone instead of alternative forms of treatment.