What is compulsive eating?
Emotional eating occurs when people have feelings of emptiness or an emotional void they attempt to fill with food. Often food is consumed to self-soothe for deeper mental health conditions or emotionally charged situations.
The term “emotional eating” may also be a misnomer, and sometimes a distraction from a more psychologically meaningful understanding of a patient's entire patterns and beliefs about food weight and body. It is also connected to weight stigma, which are judgments or generalizations made based on a person's weight or size, that unfortunately may be present during diagnosis or treatment.
This eating pattern can lead to patients re-engaging in dieting and weight concerns and is also connected to weight cycling, which can lead to deep fears around eating, progressive weight gain over time, and extreme psychological turmoil, which is often hidden behind the normalization of these patterns with food.
People struggling with compulsive "overeating" may consume food throughout the day and have a difficult time managing their need to eat, both under eating at times and then feeling out of control with food at other times. Those with compulsive eating consume excess amounts of foods at time, having a difficult time tracking both hunger and fullness cues,
Emotional eating patterns will sometimes interfere with the daily functioning of the person with this condition. These behaviors associated with compulsive eating can also lead to weight cycling and potentially a lifelong challenging relationship with food and body. This may lead to the person not being at peace and not being able to fully enjoy the pleasures and joys of embracing food and body in a way that leads to maximum wellness.
Clinical approach to compulsive eating
Many confuse emotional eating or compulsive eating with binge eating disorders (BED). The terms compulsive eating/"overeating," emotional eating, and binge eating disorder are sometimes used loosely when speaking about issues around food and weight.
Anyone struggling with nourishing their body should have a thorough evaluation to better ascertain the presence of any treatable diagnostic conditions. In addition, someone who suspects they struggle with “overeating” may wish to work on their relationship with food, weight, and body from a “health at every size” perspective. This perspective means that no matter where a person is diagnostically, they will have a foundation to restore a peaceful relationship with food, body, and self, leading to greater self-compassion and self-care.
Although the condition of compulsive eating is not an officially recognized mental health disorder, according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the experiences of the person impacted by this condition involve considerable psychological (and sometimes medical) turmoil and consequences. The official classification for this eating condition falls under unspecified feeding or eating disorder (UFED).
Even with this classification, there are no criteria to diagnose someone with an emotional eating condition. Clinicians use the UFED diagnosis code when they choose not to specify, or there is no classification for the disorder. (4)
A clinician or treatment specialist will use the following criteria to evaluate a person's struggle with compulsive eating conditions: (5)
- Multiple daily episodes of uncontrolled eating
- Eating when not hungry
- Poor self-care evidenced in manifestations of insufficient nourishment with food, and also other aspects of poor self-care
- Continually picking at food throughout the day
- Feelings of guilt associated with eating too much
- Eating secretively
- Anxiety about weight, body image issues
- Frequent and unsuccessful diet attempts
- Weight cycling
- Eating in a way that does not allow oneself to become fully satiated, (such as eating small amounts in a mindless way throughout the day which can be tied to the guilt and shame around the act of eating)
- “Buy in” of diet culture
Compulsive eating disorder symptoms
People who struggle with compulsive eating may experience a wide range of signs and symptoms. To best identify the cause of the problems with those with this struggle , it is pivotal that patients first take time for self-reflection by examining how these behaviors affect them on an everyday basis.
Here are a few signs of compulsive eating:
- Eating uncontrollably without being hungry
- Eating much more rapidly than normal
- Secret eating or eating alone
- Feelings of guilt from "overeating"
- Obsessed with weight
- Depression or mood swings
- Awareness of abnormal eating patterns
- History of weight fluctuations and weight cycling
- Isolation due to embarrassment about weight and shape
- History of repeated attempts to diets
Many of those who struggle with compulsive eating believe that life will be better, and they will be a happier person if they are thinner. They may struggle to recognize that diet culture, or dieting in general, rarely leads to healthy outcomes of any sort and may blame themselves for “failed” dieting attempts. But, it is important to remember that people don’t fail diets, diets fail people.
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Effects of compulsive "overeating"
People experiencing issues related to compulsive eating often have similar physical manifestations like weight cycling and significant psycho-social stress. Other short and long-term effects include: (10)
- Digestive distress
- Acid reflux
- Energy crash
- Weight cycling
- Heart disease
- High blood pressure
- Sleep disruption
- Increased risk of certain cancers
- Risk of stroke
- Weakened immune system
- Depression and Anxiety
Related co-occurring conditions
Other medical conditions that are related to compulsive eating are those associated with weight cycling They include: (10)
- Heart attack
- Cancers of the digestion tract
- Heart disease
- Sleep apnea
- Social anxiety
Treatment of compulsive eating
There are many ways to treat emotional eating and compulsive eating. It is important to first evaluate each person individually using a bi-psycho-social model. It is especially important to gently inquire about underlying beliefs about food and explore the person's adherence to the diet culture mentality. Numerous studies show that behavioral therapy is an effective strategy for treating these issues, particularly when combined with medication or nutrition counseling. (9)
At Within Health we believe that no treatment founded solely on behavioral strategies is likely to lead to long term healing. We encourage a deep dive into underlying psychological experiences, paying close attention to attachment issues, weight shaming in a person's history, internalized shame around eating and engrained adherence to diet culture.
A comprehensive assessment to address whether or not a diagnosable eating disorder is present is of the utmost importance. Additionally, an examination for any underlying medical conditions and/or psychiatric diagnosis is vital to healing.
Clinical approaches may use a combination of therapies grounded in an understanding of psychological experiences and processes. Meaningful psychotherapy, (which may utilize aspects of CBT DBT, ACT, Internal Family Systems, Interpersonal Psychotherapy, and others), along with nutritional counseling grounded on principles of health at every size with will help build a foundation of mindful and intuitive eating. It is critical that the destructive impact of diet culture be addressed head on.
Doctors will often prescribe the same medications used in the treatment of BED and are effective in addressing some of the biological aspects of the underlying factors that can disrupt a person’s relationship with food and eating. (11) They include:
- Lisdexamfetamine dimesylate (Vyvanse): The first FDA-approved medication to treat binge eating disorders in adults.
- Antidepressants: These medications target mood-regulating brain chemicals and address underlying depression and anxiety that may be impacting a person’s relationship with food
- Anti-seizure drugs: There are some medications in this category that may be used in treatment of binge eating, but this should be seriously vetted by a psychiatrist familiar with eating disorders. Providing any medications that interrupt appetite as a solution for the struggles associated with this condition can further reinforce in the patient the very idea that there is something negative of to be gotten rid of, with regard to hunger understanding compulsive "overeating"
Understanding compulsive eating
The simplistic idea that emotional eating, or compulsive eating, are about people consuming food as an unhealthy coping mechanism for combatting stress, or negative feelings, often leads the sufferer to feel even worse about their struggle. Although these aspects of the condition may be present, these ideas overlook the impact of diet culture, weight shaming and internalized weight shame that often are a significant part of the person's painful struggle.
Living with the disorder
These painful behaviors associated with compulsive eating occur even though sufferers feel horrible both physically and mentally after an indication of the grip they have on the person's psyche and the need for this struggle to be taken seriously and with great compassion and also an understanding of the dynamics at play.
However what is most important to understand is that emotional eating is as much about not eating enough as it is about emotional eating episodes. Addressing compulsive eating constitutes a greater opportunity to help individuals with self-care in the many ways focus on self-care can help a person heal and find peace and wellness.
The following emotions often trigger these emotional eating episodes: (6)
- Poor self-esteem
Living with this condition is challenging because it is often difficult to understand, unless the practitioner has a grasp of the bio-psycho-social origins of disordered eating and the destructive impact of diet culture. Compulsive eating behaviors may appear to resemble drug addiction cravings and obsessive thinking in compulsive eating conditions mimic those of those with a substance use disorder. (5)
However, treatment for struggles around this condition are vastly different from treatment for substance use disorders, and involve the journey of embracing the process of engaging in self-care, understanding health at every size principles, getting onto the pathway of mindful and intuitive eating, and combating diet culture.
Often those struggling with this condition will seek out weight loss treatment or diets. This is a sad reality and speaks to the importance of greater psycho-education about the destructive impact of dieting and diet culture and the opportunity to help sufferers embrace a new approach with food that can lead to long term peace and joy in their relationship with food/body and self.
The impact of the restrictive mindset and the painful experience of weight cycling can also impact a person's mental state, worsened by:
- Feelings of anxiety
- Poor body image
These lead people to avoid social engagements where food will be present or other social expectations cause them to feel alienated from others. So not only does this impact overall well being, but also the quality of relationships can be profoundly impacted too, because individuals don't feel comfortable telling others about their condition nor do they feel able to engage socially due to their internal struggle.
Historically in some communities of providers , Compulsive eating is seen as a subgroup of being “overweight” and food addiction and does not have a DSM classification of its own. (5)
Compulsive eating has been around for a long time, yet, there is tremendous misunderstanding within the eating disorder field about what this term really means and how to approach a person who may be struggling.
It is often interchanged with BED even though it is a separate experience and does not have its own DSM 5 diagnostic category. BED was recognized in 1959 as a mental health condition associated with disordered eating habits. (7)
However, it was not until 2013 that BED finally made its way into the DSM 5. There are many reasons why this is the case, but suffice to say that the field of eating disorders is still learning and growing and there is much room for greater understanding of this complex behavior leading to significant psycho-social pain, and medical consequences as well.
How to help someone with compulsive eating disorder
Compassion and empathy are crucial to helping someone recover from emotional eating. If someone close to you is struggling with an eating condition like compulsive "overeating", try to avoid stigmatizing comments, passing judgment, or attaching labels whenever possible.
Support the person struggling with this condition and help them seek the treatment they need to recover through providers that thoroughly understand the depth of the struggle, who do not oversimplify the condition and who understand principles of health at every size and mindful/intuitive eating. It is also vital to remember that there could be medical and psychiatric aspects to this experience that require attention and thoughtful care.
Within Health works with each patient to understand their personal treatment needs, hopes, and goals. Call our admissions team to learn how Within Health’s treatment milieu heals people with disordered eating conditions.