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3 Types of Eating Dysregulation Underlying Patients’ Higher Weights




A major reason for the failure of current medical treatment for “overweight” is that “weight” problems often are actually eating problems. Higher weight may be due to genetic loading, metabolic or hormonal conditions, neurotransmitter imbalances, chronic dieting and weight cycling, or other causes, but it often occurs because people are eating in ways that are out of sync with appetite cues for hunger, pleasure and satiation. To resolve this problem, eating disorders’ therapists have been successfully using psychology of eating approaches for more than three decades and it’s time for other health care professionals to follow their lead.

Dysregulated eating comes in several varieties, including emotional eating, mindless eating, and binge-eating. Usually patients have more than one form of eating dysfunction and often engage in all three types. Underlying them all is anticipated or actual distress (generally felt as anxiety or bodily tension) lessened by the act of eating, which prevents or reduces it. Discomfort might come from obsessing all evening about the leftover lasagna in the refrigerator and keeping busy to refrain from eating it, then finally scarfing it down in one fell swoop before falling exhausted into bed. Or, distress might arise in a flash, driving someone to mindlessly polish off three cookies in a four-pack, in spite of having reached satiation after having consumed only one. In broader clinical terms, this dysregulated dynamic could be called obsession (intrusive thoughts about eating or distress about refraining from eating) followed by compulsion (the act of eating), which reduces the anxiety caused by the intense food craving. Thus, is habit formed, for who wants to experience ongoing internal angst when it could be made to disappear in a delicious twinkling. This dysfunctional dynamic overrides “normal” eating appetite cues: to eat when hungry, choose foods that are enjoyable, eat with awareness and an eye toward pleasure, and stop eating when full (quantity) or satisfied (quality).

Here is how dysregulated eating plays out in emotional, mindless or binge-eating:

1. Emotional eating is done to avoid, prevent or reduce emotional distress which may be caused by internal or external stress, memories, or simply experiencing mildly unpleasant or uncomfortable feelings. Emotional eating is meant to cheer you up or calm you down. Eating a pint of Ben and Jerry’s ice cream might act as a pick-me-up and be the highlight of a boring Saturday night alone or, alternately, help soothe rattled nerves after your boss chews you out in front of your entire department or you finally mail in your taxes minutes before the federal tax deadline. Such eating has a distinct, specific purpose: to re-regulate emotional dysregulation by tuning it up or toning it down. It also can serve as a prophylactic to unwanted feelings such loneliness, anger or disappointment. Why feel bad when you can, instead, eat something that tastes good? 

2. Mindless eating is just that—snacking or grazing through what’s in your food cabinets or refrigerator on auto-pilot. Or it could play out as overeating because you’re not paying attention to fullness or satisfaction cues. Mindless eating is done as if you’re in a trance and is usually not driven by any one specific discomfiting emotion, unless it’s boredom or the desire to avoid tasks. It’s done because there is food somewhere to be had. You think of it or see it and you eat it. It’s that simple, no thinking required. Unconscious eating is also born of habit: before you flop down on the sofa to watch TV, you automatically gran a bag of chips or you keep eating simply because the food is in front of you. Overeating is another form of mindless eating. When it’s all gone, you’re done, and not before.

3. Binge-eating is classified as a Feeding and Eating Disorder in the Diagnostic and Statistical Manual of Mental Disorders. It involves eating an excessively large amount of food in a short period of time—often rapidly, with little awareness, to well beyond full—“on average, at least once a week for 3 months” without the ability to control intake, followed by feelings of guilt, shame, or disgust (1). Bingeing is a self-driven activity that takes on a life of its own, an act accompanied by feelings of frenzy, madness and desperation. In its aftermath, the stomach feels distended and aches and you are wracked with guilt, shame and remorse.

To understand patients’ specific eating problems, health care professionals need to ask questions about their state of mind before, during and after eating. Moreover, patients need to hear that they are not bad, permanently defective or societal outcasts because of their dysfunctional eating patterns, and that they can resolve them by obtaining emotional and psychological support via therapy and intuitive-eating or health coaching, as well as through groups, workshops, books, blogs, podcasts and videos tailored to healing dysregulated eating.

Endnote
(1) American Psychiatric Association, ed. Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (Washington, DC: American Psychiatric Association, 2013), 350.


Disclaimer: Please note that this article is intended for informational and educational purposes only. It is not intended as a substitute for the medical or psychological assessment, advice and individualized care from your personal health care provider or mental health professional. Please consult with your personal health care professional regarding your individual situation and concerns. For health care providers, the information contained herein may not be applicable or appropriate for every patient. Paige O’Mahoney, M.D. and Deliberate Life Wellness LLC specifically disclaim any and all liability arising directly or indirectly from the use of any information or products contained in these materials. Mention of products, techniques, methods, resources, approaches, or other entities in our materials is for informational purposes only and does not indicate endorsement.






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