Author of the following article on couples counseling and real love, NYC psychotherapist Colette Dowling, LCSW, has also written The Cinderella Complex: Women's Hidden Fear of Independence, a best seller in twenty-three languages, and other books on relationhip issues.
The following article on compulsive binge eating was written by Colette Dowling, LCSW, a NYC psychotherapist. She is the author of eight books, including "You Mean I Don't Have to Feel This Way?": New Hope for Depression, Anxiety and Addiction, and The Cinderella Complex.
Compulsive binge eating is a problems affecting large numbers of women who are obsessively involved with food and dieting. Many become hooked on diet pills. Others, locked in cycles of losing and gaining and losing, never seem to be able to get off the dieting pendulum. The struggle with weight becomes a constant in their lives. For a saddeningly large number of women, eating is not a natural and pleasurable experience. It is fraught with anxiety and a kind of drivenness.
For the woman who has a problem with compulsive binge eating, almost no aspect of life goes unaffected. If she's binging frequently she feels herself to be in the grip of a frightening addiction. Friends and lovers go by the wayside as her involvement with food and dieting increases. Once-pleasurable activities are forgotten. Her waking hours become dominated by compulsive eating or binge eating, the prepartion for binging, and its aftermath. In the early stages it may be hard to recognize the obsessional nature of compulsive binge eating because preoccupation with size and weight is so prevalent in our society it's considered normal. But in time the woman with an eating problem begins to feel that things are out of control. Thoughts about food and weight can become so all-consuming that they interfere with functioning. "We have seen patients who weigh themselve forty times a day," Hudson and pope, of Harvard Medical School, have reported. "Between weighings they obsess about whether there might be some slight error in the scale, or perhaps some anomaly of the humidity, which might cause it to register a shade lower than the true weight, or some angle of the light that causes them to slightly misread the dial."
Social pressures to be thin and beautiful have long been thought to be contributors to eating problems in women, but biology has added a new view. Eating affects--and is affected by--the same chemicals in the brain that regulate mood. Understanding the relationship between compulsive eating, binge eating and mood disorders is important for anyone who feels her eating is bordering on out-of-control, not just the woman with a full-fledged eating disorder.
In the early 1980s, Dr. Katherine Halmi of Cornell University Medical College reported the startling findings of a study she conducted at the State University of New York. Of 355 students surveyed, 13 percent met the official DSM (Diagnostic and Statistical Manual) criteria for bulimia. Dr. Halmi's was one of the first studies to show how widepsread eating disorders had become. Fascinated, James Hudson and Harrison Pope, two psychiatrists doing research on bulimia at McLean Hospital, ouside of Boston, applied Katherine Halmi's figures to the general population and estimated that 5 million people in the United States would suffer from bulimia at some time in their lives.
Hudson and Pope decided to sample seniors from two schools in the Boston area. At College A, "a prestigious rural college for women," 14.7 percent turned out to have full-fledged eating disorders and another 10 percent binged at least once a week. "Even more striking findings emerged from College B, an urban coeducational university," they wrote. "Of 102 women respondents, bulimia, anorexia, and once-a-week binging brought the grand total of those with compulsive eating disorders to an alarming 32.5 percent."
Although their findings correlated with those of other researchers, the figures were so high Hudson and Pope felt another study was needed. After working up a new questionnaire and testing its validity, Hudson and Pope went off to suburbia. "We stood in the middle of a mall and offered every woman a dollar to fill out the same confidential questionnaire and deposit it in a sealed box."
This was research grass-roots style. In all, 300 women participated. "When we opened the box and scored the results, we were stunned."
Many of Hudson and Pope's shoppers, it turned out, suffered from more than mild compulsive eating. Over 10 percent met the diagnostic criteria for full-fledged bulimia. And among the younger women the illness was rampant: 17.7 percent were, or had been, bulimic.
Many women are caught up in unhealthy eating rituals that may be less severe than anorexia and bulimia but which still wreak havoc on them physically and emotionally. By studying the more extreme forms of eating disorder, scientists have gained insight into how ALL eating compulsions work.
Compulsive binge eating, for example, may be related to a category of behaviors known as "obsessive compulsive". People with full-blown obsessive-compulsive disorder (OCD) may wash their hands dozens of times a day or count obsessively. In all obsessive illnesses the behaviors and thought patterns seem to have a life of their own. In bulimia, the compulsive component is uncontrollable binging. The binge itself has a strikingly unthinking, automatic quality. It's as if "the normal shutoff mechanisms fail, almost as if some piece of circuitry had been miswired in the brain," Hudson and Pope reported, in their classic book, New Hope for Binge Eating, which was published in the eighties. Those who suffer from compulsive beinge eating may be vulnerable to other psychiatric disorders, scintists have found. Major depression occcurs far more frequently in bulimics than in the general population. Major depression shares other features with eating disorders, notably, disturbances in sleep, energy, and mood. Interestingly, in both depression and eating disorders there's often a drastic decrease in sexual desire.
The most intriguing link between eating disorders and depression is antidepressant medication, to which both illnesses respond. When bulimic women are treated with antidepressants, any depression they have is relieved as well.
But fascinatingly, bulimic women who aren't depressed also respond to antidepressants. In other words, it isn't only the depressive symptoms of bulimia that are being treated with the medication. The bulimia, in toto, is treated--the binging and purging, the obsessive thoughts about weight, food and size, and any mood disturbances that many accompany these symptoms.
An important neurochemical link between depression and eating disorders is serotonin disturbance. Bulimics have lower than normal levels of serotonin and low serotonin is also associated with depression and anxiety. They also reduce the sensation of having eaten enough--which may in part explain why bulimics feel compelled to binge.
Medication plays an important role in treating an eating disorder, but psychotherapy is also important. Compulsive eating wreaks havoc with self esteem and produces tremendous shame. Psychotherapy helps to repair self esteem and address psychological problems that may have preceded the development of the eating disorder.
For a discussion of the different type of eating disorders click here.
Colette Dowling, LCSW, who wrote this article on compulsive binge eating, has an MSW degree from Smith College's graduate school of social work and is a licensed clinical social worker. She is also a psychoanalyst, having received her training at The Institute for Contemporary Psychotherapy, in New York, and is trained in the use of EMDR for the treatment of trauma.
Colette Dowling has a private therapy practice in New York. Her
office in Chelsea is convenient to Hoboken, Jersey City, Brooklyn and
Queens. She can be reached at email@example.com, or at
Information on Colette's therapy practice can be found at Psychology Today.
To hear Colette speaking about the anxiety of beginning therapy, click the audio button.
Copyright Colette Dowling, 2006-2010