What is compulsion?
A compulsion is a type of behavior or a mental act that a person engages in to reduce anxiety or distress. Typically, a person feels compelled or driven to perform an act of compulsion to ease the distress associated with an obsession to prevent a dreaded situation, for example, excessively exercising to prevent weight gain.
Compulsions typically don’t provide pleasure or gratification, although an individual may experience some temporary relief from engaging in them.1 They usually engage in what may seem like trivial or repetitive actions and have obsessive thoughts about certain things.
What is compulsive eating?
When looking to define compulsion in terms of eating, contrary to how it appears, compulsive eating is not about hunger. It’s typically a way a person copes with difficult feelings, thoughts, and emotions. Compulsive eating is not an official diagnosis in the DSM-5, rather, it’s a complicated disordered behavior that can present as a sign or symptom of different eating disorders.2
Compulsive eating, also called binging, is considered when an individual eats large amounts of food in a single sitting or by ‘grazing’ when someone continually snacks throughout the day.2 They may experience an irresistible impulse or have an irrational motive to eat compulsively.
Bulimia and binge eating disorder
There are two eating disorders where one of the primary characteristics is compulsive eating: bulimia nervosa (BN) and binge eating disorder (BED).
In both BN and BED, a person engages in recurring episodes of binge eating which is defined by:
- Eating an amount of food in a short period of time that is significantly more than what most people would eat in the same amount of time.
- Feeling out of control when eating.
Signs and symptoms of compulsive eating
There are some signs and symptoms that could indicate you or your loved one is compulsively eating. However, it’s important to be aware that displaying just one or two of these signs doesn’t necessarily point to compulsive eating.2,3
Behavioral and environmental
The behavioral and environmental signs and symptoms of compulsive eating include but aren’t limited to:
- Feeling out of control when eating
- Feelings of guilt and shame after an episode of compulsive eating
- Stealing or hoarding food
- Fear of eating in social situations or with others
- Evidence of binge eating, such as discovering missing food or lots of empty wrappers
- Creating schedules or rituals for compulsive eating
- Repetitive behaviors when it comes to eating
- Feeling compelled to eat even when not hungry
Some of the physical signs and symptoms of compulsive eating include:
- Noticeable fluctuations in body size and shape. Weight may go up or down
- Gastrointestinal issues, such as acid reflux, nausea, or diarrhea
- Difficulty concentrating
Complications of compulsive eating
Those who have an inner drive to compulsively eat without engaging in purging behaviors, like self-induced vomiting, over-exercise, laxative/diuretic use, or fasting, typically are above the normal weight range. This is associated with an increased risk of developing a number of health conditions, including:4
- Metabolic syndrome
- Heart disease
- Type 2 diabetes
- Certain types of cancer
- Joint and muscle pain
- Sleep disturbances
There are also emotional and psychological health risks associated with compulsive eating such as anxiety, depression, self-harm, and suicidal ideation.4
Compulsive eating vs. binge eating disorder
There remains some confusion as to whether there is a difference between compulsive eating and binge eating disorder. This is primarily because compulsive eating and binge eating disorder are extremely similar in the symptoms described by those who struggle with food in this way.
What it typically comes down to is the frequency of binges. If compulsive eating is something you do on occasion, then you probably don’t meet the diagnostic criteria for binge eating disorder, where compulsive eating behaviors occur with regularity at least three times a week.
Even if you only engage in compulsive eating every now and then due to emotional distress that doesn’t mean that it’s something that should be ignored. There is no telling if your emotional and compulsive eating behavior may develop into a full-blown eating disorder if left unchecked.
Therefore, if you do experience episodes of compulsive eating, no matter how infrequently, reach out for help and support. With professional help, you can address the root causes behind the reasons behind your urge to compulsive eat and find better coping mechanisms for your emotions.
Other examples of compulsive disordered eating behaviors
Binging isn’t the only compulsive behavior associated with eating disorders.
Those with bulimia nervosa and anorexia nervosa often engage in purging behaviors to compensate for unwanted calories. One of these purging behaviors is exercise compulsion, which is exactly what it sounds like, a drive to excessively exercise to influence body size and weight.
Exercise compulsion, also sometimes referred to as exercise addiction or exercise bulimia, is often used in place of self-induced vomiting.
Key signs that you may have exercise compulsion are that you schedule your life around exercise, and feel intense anxiety and distress when unable to exercise. Other signs and symptoms include:5,6
- Exercising despite injury illness, or other medical complications
- Frequent exercise at inappropriate times with no attempt to suppress the behavior
- Exercising for hours each day and intense fear in states of rest
- Refusing to eat if unable to exercise afterward
- Not taking rest or recovery days
- Exercising when fatigued
- Prioritizing exercise over other commitments
- Self-esteem dependent on perceived physical fitness, body weight, and body size
- Being defensive if someone questions how much you’re working out
Exercise compulsion can offer temporary positive reinforcement. Physical activity increases endorphin levels (the feel-good chemicals) which provides you with a sense of well-being. To chase the ‘high’ you continue to exercise excessively, despite the fact that you’re compromising your health.
The most significant dangers of extreme exercise are overuse syndromes, such as stress fractures, menstruation irregularities, low heart rate, and osteoporosis.7
Other physical health consequences of exercise compulsion include:
- Tendonitis—a painful inflammation of the tendons
- Electrolyte imbalances
- Arthritis or chronic joint pain
- Heart issues, including arrhythmia
- Weakened immune system
- Infertility and other reproductive issues
Exercise compulsion can also have a significant effect on a person’s mental health. Psychological complications of excessive exercise include anxiety, depression, perfectionism, low self-esteem, withdrawal from relationships, and more.
The act of purging itself can become compulsive in a condition known as purging disorder. This other specified feeding and eating disorder (OSFED) is characterized by engaging in compensatory behaviors after eating, as well as deep-seated feelings of shame and self-loathing.8
Purging disorder becomes compulsive when engaging in compensatory behaviors becomes addictive. For example, self-induced vomiting can actually change a person’s brain chemistry, boosting serotonin levels and releasing endorphins.8 This can result in a ‘high’ that those with purging disorder are driven to recreate following a meal.
Purging is typically implemented to relieve feelings of anxiety and being out of control but can exacerbate both in the long run. Other psychological consequences of purging disorder include mood swings, irritability, and depression. The different forms of purging often have similar physical side effects, which include:8
- Electrolyte imbalances
- Dental issues
- Swelling of the throat
- Rectal bleeding
- Chronic diarrhea
- Vital organ damage
Laxative misuse or abuse
Overuse of laxatives is another form of purging that can become compulsive. It can be difficult for someone to stop using laxatives because their body has become reliant on them to produce bowel movements.8
Getting help for compulsions and eating disorders
It can be quite hard to tackle compulsions associated with eating disorders on your own. You might swear that you’re never going to binge eat or exercise until exhaustion again, but then the urge hits again and you feel powerless to resist. However, unless you break the cycle, you’re putting your physical and mental health at risk.
The sooner you reach out for professional help for your compulsive eating disorder behaviors, the better your long-term outcomes will be. The most common form of treatment for compulsive eating disorder behaviors and their associated disorders is therapy.
Various forms of therapy, such as cognitive behavioral therapy (CBT) and group therapy, are utilized to help a person work towards understanding the underlying causes and triggers of their compulsive behaviors and the impact they have on their lives.
Additionally, professional eating disorder treatment will also address any co-occurring conditions, such as obsessive-compulsive disorder and depression, and health complications to help improve overall recovery outcomes.
We understand that seeking help for your compulsive behaviors is difficult and may involve a period of withdrawal symptoms. Therefore, we believe that anyone in treatment should be met with compassion, empathy, and support, where they are given a safe space to talk about their concerns without judgment.