Psych-Talk with Dr. Mike: Compulsive Overeating Dr. Mike Gropper
Somewhere in their lives, compulsive overeaters have learned to turn to food to comfort painful emotional states or alleviate tension, anxiety, boredom, and for some, being alone.
By DR. MIKE GROPPERdr mike 88(photo credit: )How nice it would be to have a simple addiction like booze... you give it up and you are recovering. But you have to eat. Well I eat... when I'm hungry... when I'm full... when I'm anxious... when I'm happy... when I'm sad... well you get the idea. Food, the friend that never fails.
- Yossie, age 27
When I was a kid I was trained that food made it all better. When we were totally broke my mom would cook the most. She was a compulsive feeder, so I became a compulsive eater.
- Motti, age 40
I cry because food makes me overweight and no one sees the real me inside. I try to show the real me and I think that people don't like me because I am overweight. Another catch 22 or chicken and egg thing. I see my son gaining weight and I grieve. I want out... but then I realize that there is no out. Miri, age 52 Every diet has failed. I am a lifer on Weight Watchers; I have been through Nutra System. But it's not about the weight... it's about the inability to deal with feelings and emotions... about using a bowl of pasta or a pound of m&m's as a narcotic to stem the pain. That's what compulsive overeating is.
- Anat, age 33
Compulsive overeating 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. 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. Compulsive overeaters are often caught in the vicious cycle of binge eating and a multitude of stressors. Somewhere in their lives, compulsive overeaters have learned to turn to food as a way of comforting painful emotional states or just to alleviate tension, anxiety, boredom, and for some, being alone.
Is Compulsive Eating an Addiction?
Compulsive overeating meets all the criteria of an addiction with loss of control, compulsive use of food, and the inability to cut back on this behavior even when the individual is risking potential health problems such as heart disease, diabetes, stroke, hypertension, and impotency. Like other addictions such as drugs and alcohol, smoking, and gambling, once a person learns to use food in such a compulsive and over indulgent manner, compulsive overeating becomes conditioned or associated with all types of situations, people, and places where the behavior takes place. These subtle and not so subtle cues trigger the impulsive eating bouts that characterize compulsive overeating. One can see that regardless of the origins of the use of food to deal with emotions, the behavioral pattern has a life of its own. For example, many compulsive overeaters cannot refrain from binge eating when they are in the kitchen. The kitchen triggers an all or nothing perception of food that doesn't allow the individual to set limits and control his/her eating. For someone else, a negative emotional state such as having a marital fight, can trigger a full scale overeating episode with no limits. It is not uncommon for Compulsive Overeaters to eat normally or even restrictively in front of others and then make up for eating less by compulsively overeating in private at a later time. Compulsive overeating late at night when others are asleep such as raiding the refrigerator is very common. Many Compulsive overeaters even have a secret stash of junk food hidden for their personal use. One of my clients told me about her secret stash of chocolate bars that she kept hidden in her desk at her office.
Why Do Diets Work at First and Then Fail?
Compulsive overeaters are constantly struggling and unhappy with their weight. With compulsive overeating, the number read on the scale often determines how the person feels about him/herself. Constant dieting and restricting food becomes a way of life for the compulsive overeater. Diets, while they work initially in helping overeaters shed off pounds, they rarely succeed in the long run because the individual has not learned how to deal with his/her addiction to food, and how to prevent the full blown relapse to excessive eating. Each new diet is tried in hope that it will be the one that works to combat the compulsive overeating. At first, there may even be some weight loss success with the diet, but unfortunately in most cases the diet ends in failure and all the lost weight is regained. Only one in every 100 people who goes on a diet succeeds in losing weight permanently. The rest gain it back again, and sometimes gain back more than they lost in the first place. The average dieter begins-and breaks-four diets a year. Ninety-five percent of all dieters, in fact, will regain their loss weight in 1-5 years. The question is, why? Why do diets fail? In my work with struggling dieters, I have found It has to do with the hidden emotions that drive this individual back to the table time and time again, even when they're full. Diets provide good nutritional info, but they never explain why the person was overeating in the first place!
Diets don't work when life's challenges make you crave comfort snacks. Diets don't work when your spouse or best friend, or family member hurts your feelings and a bowl of ice cream promises you more comfort than a conversation with any of these people. What about your hunger when your boss vetoes your vacation plans? A chocolate bar sure tastes good then, doesn't it? What happens when you've just come back from lunch and your bank manager calls you to tell you how your overdraft has exceeded the maximum allowed by the bank. You're probably munching on the chips sitting on your desk.
When it comes right down to it, compulsive overeaters can't control their overeating because they use food to force back all the other things they feel. You may do this by overeating at every meal, or constantly snacking, or by choosing the wrong types of foods despite your best intentions. The bottom line is that somehow eating has been chosen as the preferred way to handle negative emotions. This psychological pattern makes you fall off the diet wagon time and time again.
Help for Compulsive Over Eaters
While diets offer limited help and only for the short-run, long-term treatment solutions are available. First, motivation to get the help is the crucial first step. I would strongly recommend that a compulsive overeater go to a psychotherapist who has solid training in cognitive behavioral therapy, relapse prevention, and in the treatment of addictive disorders. Knowing how you feel, while a crucial part of treatment, in itself is not enough. The therapist must be aware of how to help the compulsive overeater change their thinking about food and actions when exposed to food.
Coping skills such as identifying the emotional and external triggers related to excessive food binging should be a core part of therapy. Assertiveness training should be taught to teach the compulsive overeater how to say no to temptations to binge, whether from situations when food is available or offered by friends and loved ones.
Self-esteem issues need to be explored and self-confidence built up.
Other goals of therapy should include using the skills of a dietitian-nutritionist to learn to keep a balanced diet, shop for food wisely, and prepare healthier foods. Regular aerobic exercise is strongly recommended after this person has been given the go ahead by a physician. Another goal of therapy is to help the individual develop a healthier body image and learn to feel good about daily achievements. Building support is also crucial. Besides getting this support from family members, friends, and co-workers, many compulsive overeaters are helped by attending compulsive overeaters anonymous groups, something that I strongly recommend as an adjunct to therapy.
Case study: Susan, 48-year-old accountant, has been married to Bob for 20 years. They have two children. Bob is a workaholic and the only thing that matters to him is how well he does in his high tech career. In his marriage with Susan, he has continually criticized her and implied that she is incompetent. Furthermore, Bob always tells Susan that she is unattractive. In fact, Susan was a very attractive woman, but after years and years of verbal abuse by Bob, she turned to compulsive eating as a way of dealing with a lack of intimacy and verbal abuse in their marriage. When Susan began therapy, she was very depressed and frustrated about her marriage and particularly how much she hated her self-image. She acknowledged that she was addicted to food, and started attending Overeaters Anonymous group meetings. This was for sure a very positive step since once an addiction begins, even if there are psychological underpinnings for its inception, the addiction has a life of its own, and needs to be treated with therapy designed for addiction. In therapy, Susan's motivation to change was strengthened. She was also helped to learn to identify the personal triggers that made her think about food and binge, and was taught coping skills to reverse this vulnerability. Psychotherapy helped Susan to begin to discover that she had abandoned her 'true' self-feelings because being herself and letting her emotional feelings out was not possible with her husband. Some of this learning also anteceded her marriage and went back to her childhood. To cope with the pain, she used food to cover up and distance herself from her real needs. While compulsive eating gave Susan some momentary relief, she hated how obese and unsexual she had become. Therapy helped Susan to get her addiction under control, supported her attendance to Overeaters Anonymous meetings, and helped support her through a divorce. Today, Susan is trying to rebuild her life. She is scared and at times very lonely, but at the same time very hopeful about her future.
Groups to help compulsive overeaters are currently being formed at the Jerusalem Medical Center Dyskin 9A in Jerusalem and in Ra'anana at the Golan Center. To learn more, call 1-700-700-487
Dr. Mike Gropper is an American trained psychotherapist and marital therapist, and the director of SmokeQuitters [www.smokequitters.co.il.]
Contact him at Golan Center, Ahuza 198, Ra'anana, (09) 774 1913, or Shalom Mayer Center, Diskin Street 9A, Kiryat Wolfson, Jerusalem, (02) 563 6265, mikeruth@zahav.net.il
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