Overeating as an addiction
The current media and political focus on the ‘obesity epidemic’ is creating a demand for answers into how overeating behaviour is treated and, ideally, minimised. The healthcare professionals, who are at the forefront of dealing with this issue, are trying to uncover how long-term health can be achieved for those with overeating behaviours, and often as a result, obesity.
Treatment for overeating has predominantly been medical, focusing on physical and dietary interventions, ignoring the individual’s mental state.
Overeating to the point of obesity continues to remain outside of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), reinforcing the focus on overeating as a medical problem only.
Comparisons between overeating and substance addiction
Ultimately, what we need to understand are the causes behind overeating and how we sustainably treat those with this behaviour. If we delve deeper into overeating, we uncover parallels to addiction, and by using the existing information we have regarding addiction treatment, it can help us to uncover the drivers in people who overeat.
Parallels drawn between overeating and substance addition include:
- Hypersensitivity to the behaviour of others
- Dissociation to relational issues, where the individual is emotionally detached from those around them
These factors are suggested to impact the level of tolerance to negative emotional states, resulting in compulsive quick fixes, such as addictive behaviours or overeating.
In contrast to substance addiction, the aetiology, or simply put, the causes of eating disorders, are relatively unknown. Currently there are three diagnostic categories for eating disorders:
- Anorexia nervosa
- Bulimia nervosa
- Other specified feeding or eating disorders (OSFED), formally known as eating disorders not otherwise specified (ENDOS), which includes binge eating disorder (the closest to overeating)
Why do people overeat?
Overeating undoubtedly leads to obesity, but why a person overeats is not clearly comprehended. Despite growing support that obesity should be considered a behavioural problem, a person’s attachment orientation and underlying emotional regulation capacity has only recently started to be incorporated into research on eating disorders.
Research into eating disorders has found that emotions, particularly negative ones, can increase food consumption. Those negative emotions, particularly related to attachment, such as emptiness and loneliness, need to be further explored for us to better understand overeating.
Given the nurturing properties of food in the caregiver relationship, one interpretation is that obese individuals turn to food as a representation of maternal soothing, with the sufferer having a sense of anxiety, loneliness and depression and an inability to self-soothe when experiencing these states.
The role of shame
Currently there are high profile debates on sugar labelling and tax. Reactive public health interventions have proven to be effective in reducing the impact of substance abuse and it has been proposed that these be replicated with food. Such debates that provide a potential barrier to overeating, are not addressing the psychological background and emotional health of the individual, and could even exacerbate a sense of alienation.
It is widely publicised that overeating is increasing costs to the NHS and creating a strain on benefit payments, with early, weight-related deaths currently estimated at £3.6 billion per annum. Such statistics can incite resentment towards a vulnerable group, evoking shame. Shame can be a contributing factor to the psychological vulnerability to overeat, which draws on further parallels with addiction and substance abuse. The resulting shame from engaging in behaviour such as overeating or substance abuse creates a cycle of low self-esteem and continual abuse, a blend of emotions of anxiety, anger and disgust until the cycle can be stopped through interventions, namely therapy.
Shifting perceptions – minimising blame, shame and stigma
If we view overeating as a personal choice, we may be in danger of stigmatising those who overeat –providing another interesting similarity to addiction in relation to judgment. In the addictions field this is called the ‘abstinence violation effect’. This has been proven to have a profound impact on relapse, by creating strict all-or-nothing rules about abstinence, which evokes feelings of failure. With food this can be applied to sugar being made a ‘forbidden food’ or certain foods being classified as bad, causing any slip into these being considered a dietary failure. This in turn, could contribute to shame, and exacerbate the deeper psychological issues. A shift in perception is needed to alleviate blame and the subsequent shame of overeating.
Our approach to treatment
As therapists, our team look at overeating beyond just the medical symptoms, and address the psyche of those who overeat, in a bid to focus on the root cause. I have done in-depth research into this area and the key factors that we, as healthcare professionals, should focus on in the treatment of overeating include:
- Exploring developmental factors and subsequent emotion regulation strategies during treatment, to help facilitate sustained weight loss
- Formulating treatment around attachment functioning and interpersonal relationships
- Multiple factors that contribute to emotional overeating, suggesting that associated interventions may need to be individually designed
- Developing new coping strategies – if overeating is necessary for emotional functioning, it will not be given up until it is replaced with other strategies
- Public awareness of the relationship between obesity and mental health, which tends to focus on the rhetoric of the simple formula of poor will power. Wider re-education is needed to help shift public perception and knowledge
- Acknowledging the connection between overeating and addiction, and addressing it through reparative relational therapy – if this is not done, the overeater is kept in a cycle of poor inter-relations, where they soothe with food
- Looking out for parallels between overeating and addiction, particularly a low tolerance to extreme emotions such as:
- Alexithymia (the inability to process and articulate emotions)
The overriding message from the addiction model is if a person’s underlying mental health is not addressed, the individual will continue to turn to food as relief, preventing any hope of long-term sustained weight maintenance.
What can be learned from the success of addiction treatment programmes is the need for a combined approach for psychology and medicine, incorporating attachment theory and reparative therapy, to address this gap in current overeating treatment approaches.
Charlotte Parkin and the teams at Priory Wellbeing Centre Fenchurch Street, Priory Wellbeing Centre Harley Street and Priory Hospital Roehampton, specialise in individualised treatment for addiction which includes eating disorders (based on assessment).
Overeating, an alternative form of affect regulation? Charlotte Parkin, PGDip, MSc.