Compulsive eating disorder (CED) can be a serious, potentially life-threatening illness. As with other eating disorders, it may occur in places ranging from primary school classrooms to homes for seniors. Everyone can benefit by learning how to recognize behaviors, symptoms, and possible causes, as well as knowing what you can do to help.
Julie Friedman, Ph.D., Executive Director of Binge Eating Treatment and Recovery at the Eating Recovery Center explains CED involves loss-of-control behaviors that can cause life-threatening obesity. These behaviors may include but are not limited to:
- Night eating
- Eating more after feeling full
- Impulsive eating
- Hiding food
- Hiding food wrappers and other evidence
- Rummaging for food out of the garbage
- Binge eating
What CED Is Not
Enjoying too much food at an annual Thanksgiving dinner or overdoing it by ordering a decadent dessert at a favorite restaurant is not an indication of CED. Someone who is, in fact, suffering from a clinical eating disorder will benefit from therapy, not dieting.
Misidentifying the Issue
CED is not its own diagnosis. Instead, it falls into a clinical category known as Other Specified Feeding and Eating Disorders (OSFED), which the Diagnostic and Statistic Manual of Mental Disorders (DSM-5) referred to as Eating Disorders Not Otherwise Specified (EDNOS) prior to May 2013. In its overview of OSFED, the Eating Recovery Center describes compulsive eaters as individuals suffering from "maladaptive thoughts and behaviors related to food, eating, and body image, but who do not meet all the diagnostic criteria for another specific diagnosis."
Friedman explains sometimes sufferers themselves misunderstand their own condition and seek treatment for the wrong problem. For example, some will, "Seek out weight loss versus an eating disorder treatment and then feel like a failure when their binge eating symptoms do not resolve."
Besides the possibility of incorrectly identifying a particular disorder, Friedman points out, "There are a number of slang terms that are used interchangeably with binge eating disorder, i.e. 'compulsive overeating,' which makes the search for effective, specialized treatment more difficult."
CED, Binge Eating, or Bulimia
Carolina House, an eating disorder treatment center, notes compulsive overeating is often confused with binge eating, which may be confused with bulimia nervosa, but all are different.
- With compulsive overeating, people tend to eat in response to a stressor, but they are unlikely to purge after they eat. However, instead of overeating in a single sitting, they may eat many times throughout the day, even when they aren't hungry. Overeating comes from ingestion of consistent small to medium portions.
- Compulsive overeating is re-classified as Binge Eating Disorder (BED) when overeating continues at least twice a week for six months. Importantly, this behavior is characterized by feelings of intense shame and distress.
- People with BED tend to overeat in response to a stressor, as well. However, they eat large amounts of food in a single sitting, regardless of whether they are hungry or full. People with BED are unlikely to purge.
- BED is recognized as a clinical diagnosis, giving it a significant distinction for the purposes of treatment and insurance. Friedman says, "Binge episodes typically involve eating much more rapidly than normal, eating until feeling uncomfortably full, eating large quantities of food when not hungry, eating alone due to embarrassment by how much one is eating, and feeling disgusted or guilty following these episodes."
- People with bulimia nervosa may also overeat compulsively, and/or they may binge. However after eating, someone with this disorder purges in an attempt to rid themselves of everything they've just eaten.
OSFED is believed to affect between 4 to 6 percent of the population, indicates Eating Recovery Center, and Carolina House notes about 2 percent of the population displays compulsive overeating symptoms, while about 8 percent of people with obesity do.
How to Recognize an Eating Disorder
Eating Recovery Center professionals provide several of the signposts as warning signs and symptoms of CED or another type of eating disorder:
- Change in attitudes or behaviors related to food, size, weight, and self-perception
- Extreme mood swings
- Withdrawal from usual social activities
- Avoiding eating with others, eating in secret, and/or disappearing after eating
- Hoarding and hiding food
- Unusual food rituals (perhaps associated with cutting, chewing, and eating very fast or slow)
- Obsessing over negative self image or appearance
For those who may be feeling anxious about themselves, the Eating Recovery Center suggests beginning with a short, confidential self-assessment quiz for BED, OSFED, or a general eating disorder to determine whether it's time to seek help.
How Others Can Help
Friends and family play an important role in recovery from an eating disorder. Specialists say early intervention is critical, so waiting to talk about it is unwise. Express your concerns about wanting a loved one to be healthy and happy in a caring, supportive way. Someone who is struggling with an eating disorder has deep fears, so be compassionate and gentle. If you're shut out on the first or second attempt at a private conversation, keep trying.
It's not a conversation about dieting, exercise, appearance, nor about being judgmental by placing shame or blame. Educate yourself about the subject and have resources to hand about where support groups and professional help are available.
What Can a Friend Do?
Help your friend by doing something enjoyable together; the suggestion will help them become less stressed. "Binging is often a stress-reliever," Friedman says, "So helping them incorporate a pleasurable activity is important." Friedman points out this kind of distraction needn't take up the entire day. She adds, "Just doing something they enjoy for even half an hour takes away some urgency and is helpful. Be there for them and willing to support them no matter what."
What Can Parents Do?
Friedman has advice for parents, too. "The first thing is to support your child. Many people experience stress from being overwhelmed from the demands of their life and not being able to deal with everything coming their way. Being able to lean on others helps your child manage things."
Even when a CED is not diagnosed as a full-blown clinical eating disorder, sufferers are at risk due to morbid obesity. Severe medical complications can arise, including:
- Bone disease
- Muscle loss
- Cardiac complications
- High blood pressure
- High cholesterol levels
- Gastrointestinal distress
- Organ failure
In addition to having effects on vital organs, the body's hormones, nervous system, and brain chemistry are impacted by poor nutrition.
CED May Be Difficult to Spot
Eating disorders can hide in plain sight. Many who suffer are highly secretive about the underlying issues, making it all the more difficult for loved ones and professionals to identify and address the disease.
The specialist healthcare organization Eating Recovery Center notes, "Over 70 percent of eating disorder sufferers will not seek treatment due to stigma, misperceptions, lack of education, diagnosis, and access to care."
Recovery Is Possible
Recovery from compulsive overeating and other eating disorders is definitely possible. Dr. Friedman talks about cognitive behavioral therapy combined with exposure and response prevention as the "gold standard" of change-based treatment. A multi-disciplinary approach covering dietary, medical, family issues, and mental health aspects helps patients accept and manage their disorder, adding to long-term success.