success stories

Posted July 9, 2003

A Habit That is Easy To Develop When Living Alone

Understanding Compulsive Eating

Amy L. Glaser, Ph.D.
Vol. V No. 2, March/April 2001
Taken from St. Luke’s Institute

Compulsive eating is characterized by eating large amounts of food while experiencing a loss of control over the amount of food consumed. This perceived loss of control is an essential feature of compulsive eating. Compulsive eaters often begin eating when they are not hungry, and then continue to eat past the point of physical fullness. They typically eat very rapidly, and may eat alone due to embarrassment about the quantity of food they are consuming. Compulsive eating also has a strong emotional component. Eating episodes tend to be triggered by "difficult" emotions such as sadness, loneliness, rage, or anxiety. During the eating episode, some individuals describe feeling distracted, numb, or in a trance-like state. Afterwards, most compulsive eaters experience self-loathing, shame, and guilt.

Most compulsive eaters have made numerous attempts to diet, and they often believe their problems are rooted in a lack of willpower or self-discipline. It is important to recognize that dieting is not the answer. In fact, rigid dieting is likely to contribute to a cycle of compulsive eating. The individual begins a diet plan which leaves him/her feeling hungry and controlled. Emotional triggers and physical hunger then lead to eating foods that are not on the diet plan. Having "cheated," the individual believes he/she has failed, and then eats compulsively. Following the eating episode, the individual renews his or her commitment to a rigid diet, and the cycle begins again.

Effective treatment for compulsive eating must first include a thorough psychological and physical assessment. If other psychological disorders are present, such as major depression, they should be treated. Often antidepressants are helpful for both the depression and for the eating issues. In addition, many people who eat compulsively are obese. Therefore, they may have medical conditions that need to be monitored by a physician.

Cognitive-behavioral therapy, which emphasizes changing thinking and behavior that lead to overeating episodes, has been shown to be effective in treating compulsive eating. In this highly structured therapy, the duration of the treatment and content of the sessions are defined at the beginning of treatment. The therapist is directive during sessions, and may give the client assignments to work on between sessions. Although many clients are seeking weight loss, the primary goal of therapy should be to reduce compulsive eating episodes. For maximum effectiveness, weight loss should be a secondary goal in the initial phase of treatment.

The cognitive component of therapy emphasizes changing thoughts. One of the most common patterns of thinking that must be restructured in treatment is dichotomous or "all or nothing" thinking. Compulsive eaters often categorize specific foods as "permitted" or "forbidden" and typically think about their behavior as alternating between the extremes of "good" (following a strict diet) or "bad" (eating compulsively). Eating even a small amount of a forbidden food leads to the thought that "the diet is ruined" and often triggers a binge.

The behavioral component emphasizes changing how compulsive eaters eat rather than what they eat. They are encouraged to avoid severe caloric restriction. Instead of eliminating certain foods entirely, they are taught to introduce gradually previously forbidden foods in reasonable quantities. They are also educated in how to recognize and respond to internal regulatory cues (such as hunger and satiety) rather than external cues (such as the amount of food on the plate). They learn to monitor both food intake and their feelings before, during, and after eating, in order to draw connections between their emotional state and the desire to overeat.

In addition, compulsive eaters are taught to expand their range of pleasurable activities. For many, eating has become a primary source of nurturance and relaxation. For those who ignore their own emotional and social needs, eating may be the only time they focus on themselves. They need to find other satisfying and enjoyable activities, and recognize the importance of allowing themselves time for daily relaxation and self-nurturance. They are encouraged to develop a reasonable exercise plan, both as a way of reducing symptoms of anxiety and depression, and for health benefits.

Many people find Overeaters Anonymous (OA) to be an effective complement to cognitive-behavioral therapy. The groups are an opportunity for support and encouragement, and can be particularly useful for individuals who feel alone in their struggles with food. However, it is important to recognize that OA groups vary widely, and that there is little, if any, research on the efficacy of OA in treating compulsive eating. Some OA groups encourage rigid, all-or-nothing thinking by categorizing certain foods are forbidden and defining any consumption of these foods as a relapse. Further, OA characterizes compulsive eating as a physiological addiction. Research suggests these ideas are counterproductive to successful treatment.

Compulsive eaters often believe the solution to their struggle can be found through rigid self-control. However, they are far more likely to find an answer in compassionate self-exploration. Understanding the thoughts and feelings that trigger eating episodes, changing eating behavior by learning to eat in response to physiological cues, and practicing new ways of self-nurturance are the essential elements for recovery.

Amy L Glaser, Ph.D. is a psychologist in the Talitha Life Program at SLI.