Compulsive Overeating and Binge Eating are the most common eating disorders.  These are food addictions that are similar yet distinct in character.  Compulsive overeating is characterised by persistent fantasies about food.

Food has an irresistible allure to the compulsive overeater because it is associated with a happy or psychologically satisfying experience, either in the past or the present.  He/she thinks about or gorges on food even when not particularly hungry in order to fill his/her psychological need.  Compulsive overeaters normally engage in binge eating.

Binge eating is characterised by the uncontrollable urge to rapidly consume large quantities of food within a short period of time regardless of feelings of hunger or fullness.  Unlike compulsive overeaters, people with binge eating disorder (BED) do not have a compulsion to overeat and do not spend a great deal of time fantasising about food; they simply prefer to gobble up food at a rapid-fire pace.

A number of them may have very negative feelings about food in contrast to those with compulsive overeating disorder who love the very thought of food.  Although binge eating behaviours are present in bulimia as well as compulsive overeating, BED sufferers do not purge, fast, or engage in strenuous exercise after binge eating; thus, people with BED are more likely to be overweight and obese than those with bulimia.

Within the general Australian population, the incidence of binge eating disorder is estimated at 4%, affecting males and females almost equally.  In a study of 15,000 Australian women aged 18-22, 20% were found to have symptoms of binge eating disorder.

The food consumed during compulsive eating and binge eating episodes is often sweet, fatty, or salty – and usually high in calories – with textures that make them easy to eat fast.  Doughnuts, cookies, potato chips, French fries, and burgers, are perfect examples.

Compulsive overeating and binge eating are typically done in secrecy since these actions are accompanied by acute feelings of embarrassment due to the inability to control one’s impulses.  The compulsive overeater or binge eater may desperately promise himself/herself to stop and is momentarily convinced that this is possible, but he/she ultimately surrenders to the urge.  The failure to exert self-control or willpower further intensifies his/her existing feelings of powerlessness and low self-esteem.

Compulsive overeaters and binge eaters

Compulsive overeaters and binge eaters may try to defy their compulsions by going on strict diets, fasting programs, or community weight loss programs.  These attempts are often dominated by “all or nothing” thinking with no middle ground, meaning the efforts are expected to result either in a total success or hopeless failure rather than gradual progress. Of course, such expectations are unrealistic. 

Without constant adequate medical and psychological supervision, however, many succeed temporarily but fall back into a pattern of secretive overeating or binge eating after a prolonged period of food denial.  They may attempt to hide the relapse due to embarrassment, but eventually, the extra poundage will give their secret away. A destructive pattern of yo-yo dieting may emerge.  Out of desperation, they may turn to diet pills, prescription weight loss medications, laxatives, or diuretics.

Compulsive overeaters and binge eaters come in all shapes and sizes.  Those who do not purge what they eat often become overweight or obese.  They usually loathe themselves for failing to be figure-perfect in the eyes of family members, peers, and society in general.  The misunderstanding and public humiliation to which overweight people are frequently subjected adds to their burden of despair.

The triggers for binge eating

Compulsive overeating and binge eating are frequently triggered by feelings of emptiness and stress followed by the desperate desire to fill the void or replace the distress with feelings of well-being.  They may also be used as a defence or shield behind which one hides from disturbing or unwelcome emotions such as anger, grief, sadness, boredom, and even happiness. Compulsive overeating and binge eating are sometimes referred to as emotional eating or stress eating.

However, the physical and psychological consequences defeat the purpose of feeling good. The physical consequences include obesity and health risks such as heart disease, heart attack, stroke, high blood pressure, high cholesterol, diabetes, arthritis, bone deterioration, liver disease, gallbladder disease, kidney disease, or kidney failure.

The psychological consequences include self-disgust, loneliness, shame, guilt, anxiety, despair, and depression.  These physical and psychological conditions need to be treated in combination with the eating disorder itself.

Compulsive overeating and binge eating are both treatable with counselling and therapy. Approximately 80% of compulsive overeaters who seek help from professional counsellors and therapists recover completely or experience a significant reduction in symptoms.  Cognitive-behavioural therapy (CBT) and interpersonal therapy are equally helpful in treating binge eating disorder.

CBT teaches people how to keep track of their eating, change their unhealthy eating habits, and change the way they act in tough situations.  Interpersonal psychotherapy helps people examine their relationships with friends and family and make changes in the problem area.

For compulsive overeaters and binge eaters who are overweight, the best treatment might be a combination of a weight-loss program to improve health and self-esteem along with counselling to pinpoint the roots of psychological problems and the psychological triggers of compulsive overeating or binge eating episodes.

Bulimia Nervosa

Bulimia Nervosa is an eating disorder characterised by a destructive pattern of binge-eating and subsequent inappropriate behaviour to control one’s weight to compensate for the intake of calories or to limit caloric absorption.  Inappropriate weight control measures include purging and non-purging behaviour.  For a bulimic person obsessed with the idea of keeping weight off, even a salad or half an apple may be perceived as a binge that needs to be purged.

Purging involves self-induced vomiting and the abuse of laxatives, diuretics, or enemas.  Vomiting may be achieved through chemical, mechanical, or manual means. Ingesting large quantities of fizzy drinks or emetics such as syrup of ipecac are typical examples of chemical methods.

Mechanical means include the use of cutlery, wands, toothbrushes, or tongue depressors to stimulate the throat and the zone behind the tongue, especially the overhanging uvula.  Manual techniques include using one’s finger for the same purpose.  Abdominal compression using manual or other means is also intended to induce vomiting.  Enemas, laxatives, and diuretics are used to stimulate bowel movement and urination.  Non-purging activity includes excessive exercise and extreme fasting.

People with bulimia nervosa often gobble down their food rapidly with little chewing during the binge phase.  The binge phase, which takes place secretly, generally ends when abdominal discomfort is felt.  This is followed by acute pangs of guilt and the irresistible compulsion to purge the excess calories.

An individual is diagnosed with bulimia when he/she has had an average of two binge-eating/purging episodes a week for at least three months.  Common symptoms of bulimia include tooth cavities and irreversible erosion of dental enamel (due to the acid in vomit), scarring on the backs of hands or small cuts and calluses across the tops of finger joints (due to repeatedly thrusting fingers down the throat to induce vomiting), broken blood vessels in the eyes (from the strain of vomiting), and a pouch-like appearance at mouth corners (due to swollen salivary glands).

Suspicious behaviour includes buying large quantities of food that disappear right away and regularly going to the bathroom right after meals.  Discarded packaging for laxatives, diet pills, emetics (vomit-inducing drugs), and/or diuretics (fluid-reducing medication) may also point to bulimic tendencies.

In the last 20 years, there has been a dramatic increase in bulimia around the Australian continent.  Official statistics show that 5 out of 100 people in Australia suffer from bulimia nervosa.  However, at least two studies have indicated that only one-tenth of bulimic cases have been reported.  It is estimated that the true incidence could be as high as 1 in 5 in the student population.  Bulimia is more common than anorexia nervosa, and it usually begins early in adolescence.  In some cases, the condition progresses to anorexia, although most people with bulimia have a normal to high-normal body weight.

The consequences of bulimia

Bulimic individuals often experience fluctuations in weight by more than 10 pounds due to the binge-purge cycle.  There are more severe physical consequences, however.  The recurrent binge-and-purge cycles can lead to electrolyte and chemical imbalances that can impair the functions of the heart and other major organs.

Purging behaviours cause dehydration and a loss of potassium and sodium that result in electrolyte imbalances.  These imbalances can lead to an irregular heartbeat or heart failure and possible death.  Laxative abuse can result in chronic irregular bowel movements and constipation, peptic ulcers, and pancreatitis.

Frequent vomiting can cause inflammation and possible rupture of the oesophagus.  At the other end, periods of bingeing increase the potential for gastric rupture.

Treatment for bulimia may involve medication with antidepressants to help lower the rate of binge-purge cycles and treat related mental conditions such as anxiety or depression.  However, psychological counselling and nutritional counselling constitute the major forms of treatment.

Nutritional counselling refers to the development of a healthy diet plan to fit the individual’s needs.  The main type of psychotherapy used to treat bulimia is cognitive-behavioural therapy, which aims to change deeply-ingrained unhealthy eating patterns and the negative thoughts that fuel them.  The first phase of psychological counselling focuses on stopping the binge/purge cycle and restoring normal eating patterns.

The second phase focuses on identifying and changing dysfunctional beliefs about weight, body shape, and dieting.  The final phase targets the emotional issues that are at the heart of the eating disorder such as low self-esteem, relationship issues, feelings of loneliness and isolation, underlying anxiety or depression.

Related articles:

Anorexia Nervosa: The Silent Killer

Eating Disorders: Loving and Loathing Food

Anorexia Nervosa: The Risks of Being Too Thin

If you’re concerned you or someone you know may suffer from compulsive overeating or bulimia, they could require professional help. Australia Counselling has therapists, counsellors and psychologists in Sydney, Melbourne, Perth, Adelaide, Brisbane, Canberra and regional areas of Australia. Visit our eating disorders page to search for a counsellor, therapist or psychologist in your local area who works with eating issues.