Compulsive Eating & Binge Eating Disorder

Experts and the general public differ in their understanding of compulsive overeating and binge eating disorder.

Binge Eating Disorder is the name of an eating disorder where a person is unable to prevent himself or herself from eating large amounts of food, often in a mindless state and in a short space of time; and the eating feels out of control. One difficulty knowing whether you have Binge Eating Disorder is that no-one knows exactly what kind of eating constitutes a “binge”. One man’s binge may be just another man’s hearty meal.

Compulsive Overeating is not quite the same as binge eating disorder; it describes a milder form of binge eating. But if you feel that you are a compulsive eater, does this really matter? Some people do not actually binge, they just go backwards and forwards to the fridge, looking for something that will satisfy their need to eat. Some people nibble a lot and can’t stop. Other people find that they cannot control themselves with specific foods like chocolate or cakes.

Emotional eaters eat a lot when they have bad emotions and even when they have good feelings. They feel that they have lost touch with hunger and can’t stop eating when they have had enough. They have  a love-hate relationship with food.

Food Addicts are people who think that they are addicted to food they claim that it is worse than drug or alcohol addiction because “you dont need to drink alcohol but you do need to eat; food is everywhere and we have to eat it every day”. They feel that they are powerless to control their urges.

At NCFED we do not believe that there is such a thing as food addiction even if your relationship with food feels like one. So you can see that binge, compulsive, emotional eating and so-called food addiction is much the same thing. What is common among binge eaters, emotional eaters and compulsive eaters is that they all have food cravings, they all  struggle to control their weight and they feel that they have a very conflicted relationship with food.

“Expert” Definitions of Binge Eating and / or Compulsive Overeating include some or all of the following features that occur with regularity, at least 3 times per week:

• Eating faster than usual
• Eating past the point of fullness
• Eating when not physically hungry – and you call yourself an emotional eater
• Eating alone or in secret
• Feeling upset or guilty after overeating
• Feeling that you are abnormal
• Feeling “taken over” or “driven” as if you have been possessed
• Trying to compensate for overeating by dieting, or restraining food. If you also purge to get rid of calories you are suffering from bulimia nervosa.

Sufferer descriptions might include comments like the following:

• I cannot control myself. I’ll open the fridge and eat. No matter what time of day, even if I’ve just finished breakfast or dinner. I’ll still search for food. I’m not necessarily hungry, I’m just addicted – it’s like a drug. The more I have the more I want. I eat it so quick, like there’s no tomorrow. And it’s always in secret. I even bring food to bed, and in the morning I put the wrappers in an outside dustbin so no-one knows what I’ve eaten.

• If I know that my family and husband are going out, I’ll make up an excuse to stay home, that way I can eat and eat and eat. I’m so disgusted and ashamed of myself. I hate myself for doing it. I know it’s wrong while I am doing it but I will carry on. That is what I can’t understand, while I’m bingeing. I know what I’m doing but I don’t stop. Food is ruling my life. I just wish I could take it or leave it. But it’s never enough.

• I eat properly in front of other people and eat masses when I get home and no-one can see me.

• I go backward and forwards to the fridge looking for something to satisfy me and nothing seems to.

• I start a diet on Mondays and by 11 o clock, I am in the biscuit tin, saying here I go again.

• I am fine for a while then I say just one bit of chocolate won’t hurt then it’s like I’ve blown it so who cares and I will start again tomorrow.

• I eat in the car before I get home stuffing my face and if people knew what I was doing I couldn’t bear it.

• I start thinking about pizza and I can’t relax until I have had it.

• I eat when I’m happy and I eat when I’m sad  but its not usually because I’m hungry

Two eating disorder experts, Fairburn and Beglin, have identified rates of binge eating in community studies as follows:

• About 1 in 2 individuals trying to control their weight say that they have binged in the last month (not stating what is in the binge). 1 in 4 adults of both sexes trying to control their weight have Binge Eating Disorder as defined below. 6% individuals in the adult community as a whole describe themselves as “Compulsive Eaters” with 2% meeting the criteria for full-blown Binge Eating Disorder.
• Another community sample cited by Fairburn 1992, in Oxfordshire identified 15% of young women aged 16-24 reporting at least one binge in the previous 3 months.

Compulsive forms of overeating affect men and women of all ages, unlike the other eating disorders that are heavily biased toward females. However, women are more likely to ask for help and this is probably because women are more concerned about the effects of overeating on their appearance. Compulsive forms of overeating are very common, we believe that almost 1 in 2 people who seek help for weight loss consider themselves to be compulsive eaters, this would add up to about 12 million people in the UK.

• Most, but not all begin to eat compulsively after a period of dieting
• Most put others first and attend to the needs of other people and not themselves
• Most, but not all have some difficulty knowing or expressing their needs
• Many, but not all, lack clarity about how they feel and cannot manage their feelings properly
• Most, but not all have low self-worth
• Most , but not all, need to be liked
• Psychologically, compulsive eaters are not different to people who eat normally
• Very overweight (morbidly obese) binge eaters tend to have a history of other mental health problems like depression, substance abuse and personality disorder.

Compulsive eating was first identified by a psychiatrist called Albert Stunkard in 1959. He did not understand it but he treated it with anti-epileptic medication, to no effect. We now understand compulsive eating better, although experts still differ in how they think about it. For example there are still many clinicians who think it is is an addiction and there are experts who think it is an attachment disorder, a way of self soothing in someone who had poor parenting in early childhood. There is a little bit of truth in every explanation. A brief overview of the different interpretations of compulsive eating is in the section underneath.

A dieting disorder? Binge eating disorder generally only occurs in someone who has been on a diet. Many writers have blamed dieting for provoking compulsive eating problems. They claim that dieting makes people deprived and depressed – and thus increases the desire for food that they are not supposed to eat. The solution would therefore be to forgo dieting, stop worrying about one’s weight, eat to excess all the foods on the forbidden list and eating would then settle down.  

Formal studies of dieting (see the Ancel Keys starvation studies) have shown that dieting provokes cravings, impulsive eating (you must eat something just because it is there), low mood, and the inability to stop eating when satiated. These symptoms persist well after someone has stopped dieting and even if they are eating normally. But not all people who diet become compulsive overeaters, so obviously something else is going on for people who develop a very unhappy relationship with food.

Not all people who ditch their diets and eat what they like regain control of their eating. Also, while the importance of prior and ongoing dieting cannot be ignored, other personal influences bear on whether one dieter will develop an eating problem and the other will not.

A food addiction Food can feel like an addiction, a desire to eat something that is forbidden; that will make you feel better in the short term even though it may harm your health and your weight in the long term. Both addicts and over-eaters refer to preoccupation with the “substance”, the sense of craving for particular foods, giving in, and not being able to have a reasonable amount. Both addicts and overeaters talk of repeated attempts to give up “tomorrow”. Like the traditional addictions to alcohol and drugs, compulsive eating is usually done in secret, and costs a great deal of money.

Food like ice cream, chocolate, biscuits and French fries that are rich in fats or sugars affect the same regions of the brain which are stimulated by drugs, cigarettes and alcohol via the production of dopamine.  Trying to stop eating these foods can lead to withdrawal symptoms and cravings for more. There is a popular theory that certain people are “addicted” to refined foods and sugar, so must abstain from them. But when such persons are given white flour and sugar in blind trials, they do not show increases in cravings or loss of control.

This suggests that the addictive effects of sugar and refined foods are partly psychological. So, addictions and compulsive overeating share some features but at the NCFED we believe that it isn’t  helpful to think of compulsive eating as the same as, for example, alcoholism. We do not like to define people as addicts and we can treat compulsive eating effectively without having to deprive people of a wide range of common foods.  

A habit? There is a large habit element in anything that we do over and over again. Habits become easily wired into the brain and what we do today tends to predict what we do tomorrow. Where food is concerned, some of our habits track right back to our childhood. Food habits are predictable, we all tend to eat what we like and we eat more at the weekend than we do at the start of a week. Even our indulgences are a habit. None of us change our habits very easily. Treating compulsive overeating must involve treating the habit aspect. Fixed habits cannot be ignored.

A stress disorder? Experts regard all the eating disorders as a response to “global stress”. Many people who eat compulsively have had a history of stress for a variety of reasons and during the process of assessment, we often find multiple occasions of stress in a client’s life story. In childhood, we tend to turn to food to manage stress because it is easily available and it does make us feel better in the moment.

Long term stress has an interesting effect on the body; it can make us hungrier and it does predispose to weight gain. On the other hand, not all people with a stressful past or present become compulsive eaters. An eating disorder is stressful; after all, overeating and blaming yourself for your behaviour is painful. People are very ashamed of their behaviour and try to hide it from others. And this may lead to more overeating.

Sometimes life is very stressful and the sufferer has learned that overeating provides a short term remedy for feeling overwhelmed, and offers a way of coping with the ups and downs of life.

Sometimes the stress comes from within. If you suffer from perfectionism, and are always trying to perform to your own high standards, if you never feel quite good enough;  overeating can be both a way of consoling yourself for the pressure or  beating yourself up for not living up to your own high standards

Learning how to manage stress is an important part of treatment, but the therapist must first discover where the stress comes from and how to address its roots. So this is something that we have to take into account when we are developing a treatment plan.

Lack Of Willpower?

People who try to control their weight but fail to do so often say that they lack willpower. They may try many different kinds of diets, or resort to slimming pills or other more dangerous practices to control their weight but nothing works in the end. Some people say that they have just given up trying to lose weight but this does not change their damaging relationship with food.

Willpower is just another word for self-regulation and compulsive eaters may have very good willpower capacities for stopping smoking or  giving up alcohol. But food appears to be something else entirely. Some people are born with heightened willpower; this may be something to do with how the brain organises information (search “central coherence“). A series of experiments called the Marshmallow studies shows how willpower differences can already be evident from a very early age.

We have no reason to suppose that all compulsive eaters have weak willpower. What is true, is that they have more cravings and urges,  probably due in part to their dieting history. Nutritional rehabilitation will take care of some cravings and we have interesting new skills to teach people how to strengthen their willpower toward food. No one will ever need to say that they have no willpower. This is a skill we can teach, and people are not condemned to a lifetime of struggling with food.

Deeper emotional problems?

attachment theory” is one explanation for  compulsive eating and overuse of substances with early problems in having needs met in childhood. In such cases we believe that children have lost the capacity to self-soothe, or trust other people, and turn to something else (like food) to calm themselves.

Is this a solution? We know that compulsive eating does not respond well to traditional psychotherapy which gives a lot of attention to the past.Overeating responds better to coaching that improves emotional resilience and does not give a great deal of attention to the past. People who learn to communicate their feelings, who know exactly what they feel and can manage their feelings a little better than before, stop overeating.

Compulsive forms of eating is not a sign of trauma although some experts think it is.  There is no  higher risk of trauma in people who eat compulsively than among people who eat normally (unless you also happen to be a person of significantly larger size, or someone with bulimia nervosa).  If trauma is present, it causes hyper-vigilance and very sensitive emotions. If this is true for you, food does help to calm you or distract you from horrible memories.  Trauma focused therapy will then become a part of your treatment.

These therapies work best which they are ALL built into a suitable treatment plan.

CBT adapted for eating disorders is the therapy of choice but it is not enough on its own. This gives attention to unhelpful behaviour and the thinking which helps to propel it. This will include work on body image and self esteem which are invariably poor among binge eating patients. Nowadays we use an expanded form of CBT which includes some marvellous tools that are designed to improve your control over stressful emotional events.

Cognitive Defusion – a tool based on expanded CBT which has shown reduction in binge eating events by up to 50% – not to be used on its own.

Nutritional Rehabilitation: dietary chaos affects neural appetite systems, metabolic function and mood. This treatment model includes a number of tools to restore appetite and satiation, help a person distinguish hunger from emotional cravings and tweak eating experiences which contribute to overeating. Nutritional rehab is also designed to stabilise blood sugar which is disrupted by binge eating and is not a diet.

Stress Management: basic stress management reduces the number and quantity of overeating events

DBT / Trauma work: For extreme emotional instability and for those who have suffered trauma these approaches will be helpful and remove elements of emotional issues that could interfere with treatment.

Relapse Prevention: A psychological approach which teaches people how to avoid lapses and how to recover without damage and having to atone.

Drugs/ Medication: Many people turn to weight loss drugs to deal with compulsive eating. They do not work and they make things worse. At the NCFED we also do not favour antidepressant drugs even though the were recommended for the treatment of binge eating in the NICE guidance for eating disorders. We have found them ineffective and you can recover without them in most cases. Good therapy will give control back to you where it is most needed – from within.

: The 12-step Fellowships use a model of treatment that regards compulsive eating as an addiction with contributing sensitivity toward white flour, stimulants and sugar. Groups such as Over Eaters Anonymous are available for people who subscribe to group therapy. At the NCFED, we do identify people with addictions during assessment. But we rarely consider binge eating to be an addiction. We aim to help people eat all foods, with none forbidden or dangerous, without fear of loss of control and to use therapy to help people transform their relationship with food and with themselves.