Disordered Eating of Another Kind
By Kimberly Dennis, M.D.
Medical Director of Timberline Knolls Residential Treatment Center
January 1, 2010
I am sure most of us at one time or another has felt guilty for going back for a second or third serving of food, whether or not we are still hungry. During a holiday party or special occasion, it's common to "overindulge." It is probably the most socially-sanctioned way to escape or medicate the tensions that arise during hectic holiday times at family gatherings. It also happens to be one of the least acknowledged ways to stuff intense emotions that might otherwise surface in such settings. This speaks to the depth of denial that we have on a societal level about how people "use" food—the same denial that exists as a major symptom in other addictions to a lesser extent.
Millions of Americans engage in overeating on a daily basis and have a relationship with food that is shrouded in secrecy and shame. While most people identify anorexia or bulimia as eating disorders, the most common eating disorder is the least talked about--binge eating or compulsive overeating. Officially referred to by the medical community as Eating Disorder Not Otherwise Specified (ED-NOS, which includes binge eating disorder), it is the most common eating disorder in the United States, affecting more than 20 million Americans.
Millions of individuals use food as a substance in the same way that others with the disease of addiction use alcohol or drugs. When some people repeatedly consume large amounts of food, their brains receive a relaxed or calming feeling similar to the feeling alcoholics or substance abusers receive when they use. This is related to a similar reaction in the brain's reward circuitry. For some people it's brought on by using food and for others it's alcohol, work, sex, self-injury, gambling, drugs, and/or combinations of any of the above.
One of the biggest problems in treatment once compulsive overeating is identified as an illness is helping sufferers (and their treatment providers!) understand the illness has relatively little to do with food. Food just happens to be the "substance" of choice and food related behaviors/body/weight obsession the most obvious symptoms. These symptoms arise when a person uses substances in attempts to manage deeper, underlying developmental, emotional, and spiritual issues that set the scene for the addiction to develop. Further, because binge eating disorder is rarely recognized as a primary, progressive, potentially fatal illness, and often because only the medical symptoms are treated (high blood pressure, diabetes, high cholesterol, weight loss), the root of the illness is never addressed. In fact, most physicians and mental health professionals fail to include compulsive overeating and binge eating as an eating disorder. This happens frequently when patients go to treatment for a traditional substance use disorder. They are often told by their physician to go on a diet and lose weight. It's critical that physicians, family members and individuals themselves understand and recognize the behavioral and emotional signs and symptoms of compulsive overeating, which may include:
- Cannot consistently maintain healthy boundaries around consumption of food.
- Eats an unusually large amount of food at one time -- more than a most people would eat in the same amount of time.
- Eats much more quickly during binge episodes than during regular eating episodes.
- Eats until physically uncomfortable and physically feels like they're on the verge of vomiting due to the amount of food consumed.
- Eats when depressed, sad, angry, afraid, lonely, or bored.
- Eats large amounts of food even when not really hungry.
- Eats in secret (closet eaters).
- Often eats alone during periods of normal eating, owing to feelings of embarrassment about food or weight.
- Feels disgusted, depressed, ashamed or guilty after binge eating.
- Hides food or food wrappers/remnants.
- Steals food.
- Obsessively thinks about food or meals.
- Repeatedly attempts to cut down on intake (chronic dieting).
It's important for individuals who think they may suffer from compulsive overeating to be honest with themselves, their family and their physician about the depths of their struggles with food. Acknowledging there is a problem is the first step on the road to recovery. The next step involves tapping into the Help that is available to arrest the illness one day at a time!
Kimberly Dennis, MD, is the medical director at Timberline Knolls Residential Treatment Center. Located in Lemont, Ill., TK is designed exclusively for women and adolescent girls with emotional disorders, including eating disorders, addiction, mood disorders and other co-occurring disorders. Dr. Dennis is a member of the Academy of Eating Disorders, the American Academy of Addiction Psychiatry, and the American Society of Addiction Medicine.
