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Compulsive eating disorder. Signs, causes and treatment of compulsive overeating. How to tell if you have a food addiction

Every person at least once in his life got up from the table with a full stomach. If this happens rarely and he can control his appetite at such moments (he just allowed himself to relax and enjoy delicious dishes), then there is nothing terrible or pathological about it. An evening walk, an extra hour in the gym, a fasting day will not allow extra calories to be deposited on the body in unnecessary places.

It’s a completely different matter if this happens unconsciously and every time - after another stress experience. This is already compulsive overeating - an eating disorder, the main cause of which is negative emotions. Leads to excess weight, and in the absence of proper measures - to obesity.

What it is?

According to the Diagnostic and Statistical Manual of Mental Disorders, binge eating disorder is a disorder and is designated as a diagnosis with a separate code - 307.51 (F50.8). If a person in a state of stress simply awakens a brutal appetite, which he is unable to fight, we are talking about an eating disorder. This is not the norm. Moreover, an attack can be triggered by both serious situations (the death of a loved one, dismissal from work) and minor unpleasant moments that cause negative emotions (the boss raised his voice, a quarrel with a loved one).

The second name of the disease, common in medical circles, psychogenic overeating, most fully reflects its essence. This is an uncontrollable appetite, which is caused not by physiological, but by mental reasons.

Unfortunately, the habit of eating up any problem with large amounts of tasty and high-calorie food is one of the most common causes.

Diagnoses. This same diagnosis can sometimes sound like a hyperphagic reaction to stress.

Causes

To overcome compulsive overeating, you need to understand its causes. In fact, there are only 2 of them: stressful situations and experiences. But it’s one thing when a person is in prolonged depression and eats away the grief of losing a loved one. And it’s completely different when suspicious and vulnerable girls begin to consume huge quantities of pastries and cakes just because the zipper on their favorite dress broke today or their husband didn’t congratulate them on their wedding anniversary. In the first case, serious psychotherapeutic help will be required, and in the second, a change in one’s own worldview.

Sometimes women begin to suffer from it after a diet, thereby nullifying all efforts. The reason for this behavior: dissatisfaction with the results (I expected to lose 10 kg, but in the end I only lost 3 kg).

Despite the fact that overeating is called psychogenic, scientists are actively studying the question of how genetic predisposition influences it. To date, they have already identified 3 genes, the presence of which leads to obesity as a result of a tendency to overeat. These genes received the following codes: GAD2 (stimulates appetite), FTO, Taq1A1 (reduces dopamine levels).

Etymology. The term “compulsive” comes from the Latin word “compello,” which means “to compel.”

Clinical picture

The main symptoms of compulsive overeating can be noticed both by the person suffering from it and by his loved ones. They usually lie on the surface and are difficult to hide:

  • food like the only way cope with sadness, melancholy, loneliness;
  • reluctance to show the problem to other people leads to its absorption in solitude;
  • the need to eat to satiety;
  • loss of control over appetite and food absorption;
  • eating even in the absence of hunger;
  • eating an abnormally large amount of food in a short period of time;
  • feelings of self-loathing and guilt after attacks;
  • pronounced gluttony during times of stress.

The main thing in the clinical picture is the inability to control one’s own appetite. Every time a person begins to get nervous, worry, suffer, he drowns out his mental torment with a huge portion of something tasty, and sometimes he himself does not notice that he eats much more than his norm.

Since it most often affects mentally unbalanced people who take everything that happens very close to their hearts, they become prisoners of this disorder for a long time. Young girls and teenagers are most often at risk. Although men who are embarrassed to openly express their emotions can also eat up their problems with salted fish in the evenings and wash them down with unlimited amounts of beer.

Another feature of the disorder is that in a state of stress the patient rarely eats soups, cereals, fruits or vegetables, the benefits of which for his health would be obvious. Usually they use fast food, something fried, fatty and salty, soda (especially energy drinks) and alcoholic drinks. Accordingly, the result is rapid weight gain. In the absence of the necessary measures to block appetite, everything ends in obesity and related diseases.

Diagnostics

With the problem of compulsive overeating, you can contact a therapist (he will give a referral to the right specialist) or directly to a psychotherapist, since he is the one who treats this disease. Since no tests or instrumental research methods can confirm or refute this diagnosis, a regular interview is used and a special test is performed.

According to the Diagnostic and Statistical Manual of Mental Disorders, a diagnosis is confirmed if 3 of 5 criteria are met:

  1. The feeling of fullness in the stomach after eating food causes discomfort.
  2. Even a large portion is eaten very quickly, almost imperceptibly.
  3. Self-loathing, depressed mood, guilt after overeating.
  4. Eating in the absence of hunger.
  5. Eating alone.

Treatment

If a person has wondered how to deal with his abnormal eating behavior, this is already a good sign. This means that he is aware of the existence of a problem and the need to solve it as quickly as possible. Getting rid of compulsive overeating on your own is very difficult - almost impossible. Therefore, you need to start by visiting a specialist - and best of all, a psychotherapist. It is he who will prescribe the correct course of treatment in accordance with the individual characteristics of the patient.

Therapy will be carried out in two directions at once, since the disease is complex. It combines psychological and physiological factors.

Firstly, the disorder leads to a set excess weight, and after it comes obesity, metabolic syndrome, metabolic disorders, excessive stress on internal organs, hepatosis and other concomitant diseases. This whole bouquet will have to be treated.

Secondly, it is necessary to eliminate the root cause of overeating, that is, to pull a person out of a depressive state, reduce his suspiciousness and constant nervous breakdowns.

Psychotherapy

To overcome compulsive overeating, a psychotherapist can offer several treatment methods, depending on the condition and personal characteristics of the patient.

  • Group psychotherapy

If overeating is caused by insufficient socialization (a person is highly dependent on the opinions of others), special mutual aid groups are created. Their task is to relieve emotional and nervous tension by increasing self-esteem. The patient begins to communicate with other patients and realizes that he is not alone, that he can be treated well and in fact everything is not so bad with his communication skills. In 20% of cases this is enough to cope with the disease.

This also includes family psychotherapy if uncontrolled gluttony is dictated by problems with one of the family members. This technique is most often used to treat children.

  • Cognitive behavioral therapy

This course is considered the most effective and... fast (and it lasts up to 5 months, so imagine how long other directions will take). Here, tasks such as patient self-acceptance, overcoming stress, learning self-control, identifying opportunities to change habitual reactions to events and behavioral stereotypes, and improving the quality of life are solved.

  • Interpersonal psychotherapy

Allows you to achieve high efficiency in treatment. It is not inferior to cognitive behavioral therapy in this regard, but it requires a longer course - from 8 to 12 months. Allows the patient to feel part of society, learn to communicate adequately with other people, and get out of a closed state. When a person perceives himself as a self-sufficient person, he no longer treats every word from strangers as a personal insult. This reduces the degree of anxiety, allows you to be more stress-resistant, which means the end of gluttony.

  • Suggestion or hypnosis

A controversial technique, as it allows you to stop the development of the disease only for a certain period of time. But - quickly and immediately. If all previous methods turned out to be useless, resort to hypnosis. Just 3-4 sessions - and the person recovers. The downside is that he does not realize how he got rid of the problem. But he retains the same pattern of response to stress - overeating. In this regard, relapses are diagnosed in the future.

When going to a psychotherapist, you need to realize that no one will offer magic pills (antidepressants are not such). Recovery is a real fight against the disease, main role in which the patient himself plays. If he has an irresistible desire to get rid of the disease, if he has patience, then everything will work out. If the course of therapy is forced (the family insisted), the process may drag on for years, but still not bring results.

Nutrition

It is very important to properly organize nutrition for compulsive overeating: it is part of the therapy. Since the treatment is carried out on an outpatient basis, this falls on the shoulders of the patient himself. Due to the psychogenic nature of the disorder, it will be difficult for him and will probably require the help of someone close to him so that they can control his appetite, meal schedule and portion size. What recommendations should you follow?

1. Learn to distinguish psychological hunger from biological. Quench only the last one. Do not neglect the help of family and friends, let them take control of your meals.

2. Find an alternative way to relieve nervous tension (this could be a hobby, sports, music, cinema, books, dancing). As a last resort, if this does not happen, as soon as you feel an irresistible urge to eat something, go outside and breathe as deeply as possible.

3. Eat mostly low-calorie foods. Do not go to restaurants, cafes and fast food establishments. Don't buy a lot of products at once. Do not purchase unhealthy cakes, pastries, or sausages. Let them only be in the kitchen healthy fruits, vegetables, yoghurts, cottage cheese, etc.

4. Don't go on diets. Avoid aimless trips to grocery stores. Don't watch cooking TV shows or flip through recipe books. Do not discuss the topic of food with anyone. Stock up on small dishes that will prevent you from eating large portions.

5. Don’t put strict bans on your favorite foods - allow yourself to relax at least once a week (not to the point of gluttony, but 1 pack of chips won’t hurt). If you push yourself into too strict limits of limited nutrition, stress will increase, and with it the likelihood of relapse will increase.

The best option is to consult a nutritionist. Depending on the degree of advanced disease and the patient’s eating habits, he will be able to develop an individual diet and menu. This will promote faster recovery.

Medicines

Drug treatment involves the prescription of sedatives. Help to cope with nervous tension and, as a result, forget about food:

  • antidepressants, especially from the group of selective inhibitors - these are Sertraline and Fluvoxamine;
  • antiepileptic drugs: Valparin, Benzobarbital, Maliazin, Depamid, Sibazon;
  • anti-obesity pills: Orlistat, Senade, Glucobay, Goldline;
  • And there is also a drug, the only one of its kind, that was developed specifically for the treatment of binge eating disorder - Lisdexamfetamine, and in 2015 it was approved by the US Food and Drug Administration.

The drugs Vyvanse and Elvanse with lisdexamfetamine are psychostimulants from the amphetamine group used in the treatment of compulsive overeating.

Lisdexamfetamine is a psychostimulant from the amphetamine group, which is actively used in the West. Contains natural amino acid. It is sold under different names depending on the country:

  • Vyvanse ( Vyvanse) - in USA;
  • Venvanse ( Venvanse) - in Brazil;
  • Elvanse ( Elvanse) - in the UK and other European countries;
  • Teevense ( Tyvense) - in Ireland.

Available in capsules of various volumes - from 10 to 70 mg. Often provokes the development of such side effects, How:

  • insomnia;
  • dizziness;
  • diarrhea, constipation, nausea, vomiting, discomfort and pain in the stomach;
  • significant weight loss;
  • irritability;
  • too strong a decrease in appetite up to its complete absence;
  • dry mucous membranes;
  • tachycardia;
  • anxious state.

Lisdexamfetamine is banned in Russia, as it is an amphetamine derivative. This drug is included in the list of narcotic and psychotropic substances under strict control in the Russian Federation.

Folk remedies

Besides the organization proper nutrition compulsive overeating can be treated at home by including foods in the diet that reduce appetite and at the same time have a calming effect. But you don’t need to select them yourself; it is advisable to discuss such issues in detail with your doctor. He may recommend increasing your intake:

  • pineapple;
  • oranges;
  • bananas;
  • dark chocolate;
  • grapefruit;
  • green apples;
  • leafy vegetables (cabbage, spinach);
  • legumes;
  • nuts;
  • bran;
  • dried fruits;
  • cottage cheese;
  • and etc.

In the morning (before breakfast) and in the evening (before bed), it is advisable to drink 200 ml of infusion of the following herbs and spices:

  • marshmallow;
  • hawthorn;
  • ginger;
  • cinnamon;
  • nettle;
  • burdock;
  • alfalfa;
  • mint;
  • flax seeds;
  • caraway;
  • fennel.

To cure compulsive overeating disorder, you will need complex treatment, which will include psychotherapeutic programs, the organization of proper nutrition, and medicines, and proper use folk remedies. Only in this case do doctors give comforting forecasts for the future.

Consequences

If overeating cannot be overcome for a long time, it can have irreversible consequences not only in physiological terms. As recent studies have shown, they will also affect human genetics.

Complications:

  • hypertension;
  • hormonal imbalance;
  • arterial blockage;
  • metabolic syndrome;
  • obesity;
  • weakened immune system;
  • elevated blood sugar levels;
  • diabetes;
  • cardiovascular diseases.

Genetics

Binge eating disorder disrupts the genetic structure. A person suffering from this disorder and refusing treatment will leave a legacy of obesity, diabetes and cardiovascular disease to their descendants. The genes responsible for the production of macrophages, which protect the body from infections and other negative factors, are also affected.

Considering the structural genetic changes that are so dangerous for subsequent generations, it is imperative to recover.

Books

To learn more about the disease, you can read the following books:

Jeneen Roth. Feeding the Hungry Heart. The author herself once suffered from this disorder, so her advice will be especially valuable.

Susan Albers. 50 Ways to Soothe Yourself Without Food. It describes in detail how to distinguish physiological hunger from mental hunger and be able to cope with the latter.

Susan Albers. I deserve this chocolate! (But I Deserve This Chocolate!). The writer explains why food should not be used as a reward.

Compulsive overeating is not just an eating disorder, but a serious disease that requires treatment in different directions. It is necessary and nervous system calm down, bring peace of mind back to normal, and eliminate concomitant illnesses. Therefore, the next time, while eating another problem with a piece of cake, think: is this not a pathology?

From time to time, anyone can afford an extra cake or chocolate. The main thing is that this does not become a way to compensate for failure or to distract from life's difficulties, because this is where uncontrollable gluttony begins - compulsive overeating, which leads to obesity, is a psychological disorder that requires special treatment.

What is compulsive overeating

Eating behavior associated with eating food in quantities greater than necessary, developing against a background of stress and leading to weight gain, is called compulsive or psychogenic overeating (EB). This psychological disease affects about 30% of obese patients.. They are characterized by a strong feeling of guilt due to the inability to control bad eating habits, leading to depression and an increase in the level of stress, to which the psyche reacts with new bouts of overeating.

Causes

Uncontrollable overeating has biological, psychological and sociocultural reasons. Heredity (genetic predisposition), hormonal disorders, leading to low levels of serotonin, features of the functioning of dopamine receptors, disruption of the endocrine system (including the activity of the hypothalamus) become risk factors for the development of compulsive eating disorder.

Psychology of gluttony

The psychological impetus, as a rule, is trauma (loss of a loved one, difficulties in building relationships with society, inability to establish relationships with others). The risk group includes people who are dissatisfied with themselves and their lives, who suffer from depression and, from childhood, have the habit of linking pleasure and eating.

The disease develops gradually, and from a mild stage it can progress to a severe stage, for example, develop into bulimia nervosa. Bouts of overeating have nothing to do with feelings of hunger; rather, they are caused by a bad mood.

One-time attacks of excessive consumption of food against the background of experiencing negative emotions are not yet a symptom of the described compulsive disorder. However, they may be a signal that a person is predisposed to developing compulsive eating disorders. The main symptoms are as follows:

  • the desire to hide one’s tendency to bury problems from others;
  • feeling guilty about your eating behavior;
  • frequent mood changes;
  • depression;
  • lack of appetite;
  • rapid absorption of food, the onset of a feeling of fullness;
  • moral self-flagellation after every meal;
  • awareness of the presence of problems with diet that you cannot cope with on your own;
  • repeated unsuccessful attempts to follow a diet with a stable, constant increase in body weight.

Consequences

The most common consequence of compulsive psychogenic binge eating is obesity and related health problems.

  • Due to constant weight gain, the patient gradually develops the following diseases and conditions:
  • diabetes mellitus and other metabolic disorders;
  • stomach diseases;
  • heart and cardiovascular diseases;
  • arthritis;
  • diseases of the musculoskeletal system;
  • high blood pressure;

depression.

Treatment of compulsive overeating

Psychotherapy

How to get rid of compulsive overeating and whether it is possible to do it on your own, without the help of a specialist, is a question that concerns most people suffering from this disease. Complex therapy - diet (not strict, to avoid breakdowns), taking concomitant medications (including antidepressants and sedatives), psychotherapy - the treatment regimen should be developed by a professional, since in most cases a person is not able to cope with himself (otherwise compulsive disorder eating behavior would not have arisen). Psychotherapy is a necessary treatment for compulsive disorders. Since one of the most important reasons provoking psychogenic overeating is the inability to cope with stress, fear and other negative experiences, An important step on the road to recovery is gaining the ability to control your emotions.

If the patient does not get rid of his psychological difficulties and disorders, it will be difficult to maintain the results achieved during the treatment process, and there is a high risk of resumption of overeating attacks.

During treatment, antidepressants of a certain group are prescribed - selective serotonin reuptake inhibitors (Sertraline, Citalopram, Fluvoxamine, etc.). They increase the activity of neurotransmitters in the body, due to which the level of serotonin increases, the patient’s mood stabilizes, overall well-being improves, and depression goes away. Medications, helping to control appetite during psychogenic overeating, as a rule, are not prescribed.

How to deal with compulsive overeating

An important aspect in the fight against psychological eating disorders (overeating, bulimia, anorexia) is the time factor. It will take a long time to obtain a sustainable positive effect; the patient must understand this and be prepared for it.

The answer to the question, what is KP in weight loss (disruptions while dieting) explains why the diet should not be strict - in this case, breakdowns will be inevitable, aggravating the emotional state of the patient. It is important to gradually establish a healthy diet.

Video Obesity

is a psychosomatic disease, in the pathogenesis and clinical picture of which both biological and psychological factors and symptoms are combined and interact. As is known, there is a close connection between, anxiety personality disorders obesity, And.

depression Anxiety disorders lead to obsessive-compulsive overeating disorder, Availability anxiety disorder increases the risk of developing, obesity obesity, in turn, causes depression

. A vicious circle is formed from which, as it sometimes seems, there is no way out. However, as recent research has shown, the connection between anxiety disorders, depression and obesity

those are as unambiguous as it seems at first glance. Availability depression increases the risk of developing in children and adolescents, doubles the risk of developing , but not vice versa. Yes, d depression in girls late adolescence increased the risk of obesity after 5-7 years by 2.3 times; among young men

there was no such pattern. A slightly smaller number of studies have shown the opposite sequence of events. For example, young men, obese both in children's and adolescence in turn, causes significantly more often had subsequently

and behavioral disorders than those who were obese either only in childhood or only in adolescence. Among women With body mass index (BMI) > 30 the relative risk of depression was 1.8, and women and men

with BMI > 40 it was increased almost 5 times. In persons over 50 years of age obesity Availability after 5 years of follow-up approximately 2 times, but the presence of depression did not increase the risk of obesity in the future.

So, depression often precedes the development of obesity, especially in adolescents and young women with major depression, but in some patients, on the contrary, depression develops after many years of obesity. This indicates the possibility of the existence of different pathogenetic variants of the association of obesity with depression.

Depression and compulsive overeating

Classic depression accompanied by insomnia, loss of appetite and body weight(MT), but atypical, erased and somatized depression more often occurs with drowsiness, increased appetite and weight gain.

Both obesity and depression are often accompanied by eating disorders(RPP), eating disorder syndrome(SPE) and bulimia nervosa. A history of depressive disorder is present in 54% of obese patients with FES and only 14% of obese patients without FES.

There are epidemiological and clinical associations between depressive and anxiety disorders, on the one hand, and obesity and associated somatic diseases, on the other.

In many cases, depression and anxiety precede the development of obesity, and the severity of psychiatric symptoms correlates with the anthropometric and biochemical abnormalities associated with obesity. Depression, anxiety and obesity have mutually negative effects on each other.

The connection between obesity and mental disorders (MD) is due to many factors, primarily the commonality of some links in the central regulation of food intake and mood, that is, the serotonin- and noradrenergic neurotransmitter systems of the central nervous system (CNS), as well as the similarity of the functional state of the neuroendocrine system and psychological characteristics.

Back in 1921, psychiatrist E. Kretschmer wrote that people with picnic build(abdominal obesity, in the modern sense) often suffer from depression, stroke, atherosclerosis and gout. In 1932, impaired carbohydrate metabolism, decreased sensitivity to insulin, and autonomic dysfunction were identified in individuals with this symptom complex.

These studies were the first to suggest a link between depression and the syndrome that later became known as "metabolic syndrome" (MetS). It has been proven that pre-, peri-, and postmenopausal women with initially elevated scores of depression, tension, and anger had a significantly higher incidence of metabolic syndrome (MetS) after 7 years.

In both obesity with metabolic syndrome (MetS) and depression, there is a high incidence of the same somatic diseases - arterial hypertension, coronary heart disease (CHD), stroke and type 2 diabetes mellitus.

Compulsive overeating - causes

S. Freud also pointed out that it is on oral stage of development For an individual, eating is one of the few ways to obtain instinctive satisfaction, which can last a lifetime for certain individuals and comes to the fore when a person feels danger and anxiety, despite the development of the “I.”

The psychodynamic approach to eating disorders is based on the postulate that this phenomenon is based on the child’s frustration with the so-called oral stage of development, and the unconscious basis of pathologically increased appetite is a passionate desire for love and aggressive tendencies to “absorb” or “possess.”

Food represents the first obvious satisfaction of the receptive-gathering desire. In a child's mind, the desire to be loved and the desire to be fed are very deeply connected. Parents often do not understand the reasons for the baby’s cry and try to feed him so that he calms down. Demanding attention, the child receives food, as a result, the infant develops a close association between feeding and care.

When in more mature age the desire to receive help from another in solving some of their problems or satisfying their needs causes shame or shyness, which often in a society whose main value is considered independence, this desire finds regressive expression in an increased craving for food absorption, i.e. it stimulates gastric secretion , which leads to the formation of ulcers if a person does not eat, or to obesity if he eats heavily.

Depression and anxiety are accompanied by the same central and peripheral symptoms as long-term stress. In addition, during physical and mental stress, neuropeptide Y concentrations increase, which increases food consumption (“stress eating”).

Stress reactions are triggered by psychosocial and economic problems, depression and anxiety, alcohol consumption and smoking. The risk of the final formation of a protracted stress reaction with the subsequent development of MetS is influenced by personality type, education, social competence, as well as genetic polymorphism.

Among close relatives of obese persons, the likelihood of depression and bipolar affective disorder, as well as antisocial personality disorder, is significantly higher than among relatives of persons with obesity. normal weight body (MT). A candidate gene for a genetic correlation between MT and depression is located at the ObD7s 1875 locus, next to the obesity gene OB on chromosome 7.

Anomalies common to obesity and depression are increased concentrations leptin, level C-reactive protein as a marker of mild systemic inflammation, insulin resistance, atherogenic dyslipidemia and increased deposition visceral fat. Parallels can be drawn between hormonal and metabolic changes in depression, Cushing's disease and MetS; similar abnormalities are found in post-traumatic stress disorder.

Bjorntorp explains the association of obesity with mental disorders (PD) through activation of the limbic-hypothalamic-pituitary-adrenal axis (LHPA) and the sympathetic nervous system (SNS) in response to stress.

The first type of stress response (“fight or flight”) is carried out mainly due to the activation of the SNS and ends favorably: after stress, “successful” animals occupy a higher position, receiving advantages in nutrition and reproduction, and testosterone levels increase in males .

The second type of stress reaction (“defensive”) is characteristic of animals that cannot cope with competition and helplessness and move to a lower level of the hierarchy. They experience activation of the LGGNS - increased cortisol levels, decreased levels of sex hormones, and subsequently - accumulation of visceral fat, insulin resistance, dyslipidemia, hypertension, impaired carbohydrate tolerance and early signs of coronary atherosclerosis, i.e. MetS.

Cortisol levels are affected not only by actual stress, but also by memories of past experiences and anticipation of future stress, as well as by mood.

Compulsive overeating - symptoms

F. Alexander believed that most (including food) behavior patterns are largely determined by psychological defense mechanisms. These mechanisms, in his opinion, are quite rigid and limit human behavior, although they perform an adaptive function and support the integration of the mental “I”, protecting consciousness from traumatic experiences.

Thus, as a result of research, it was revealed that in women who are overweight, compared with women with normal body weight, significant differences are observed on the scales of “denial”, “regression”, “repression” and “reactive formations”. Such a protective mechanism as “repression” simply does not allow into consciousness those thoughts, desires, and feelings that are psychotraumatic due to their social unacceptability.

Obese patients are also characterized by inflated claims, passive aggressiveness, increased, poorly controlled emotionality, passive forms behavior.

Symptoms of obsessive-compulsive disorder:

  • high anxiety (90%);
  • ritualization of routine daily actions;
  • obsessive phobias (frequent hand washing, checking door locks, etc.;
  • inconsistency with one’s ideal and inadequate self-esteem (84%);
  • presence of a feeling of internal emptiness (vacuum), loss, depression (59%);
  • tendency to somatization and excessive worry about one’s own health (70%);
  • difficulties in interpersonal relationships, the desire to avoid social contacts and responsibilities (82%);
  • “lack of strength,” psychological discomfort, poor health (26%);
  • Availability strong feeling guilt after bulimic episodes (24%).

The identified personality characteristics may be one of the reasons why the negative impact of overeating on the body is not noticed for a long time, since patients tend to refuse to recognize the fact that overeating is one of the most important reasons for the occurrence and progression of overweight.

Characteristic features of thinking and perception, common to both obesity and depressive-anxiety disorders, are rigidity, a tendency to get “stuck” in emotions, “black and white” thinking (according to the “all or nothing” principle), catastrophizing (expecting the worst). all variants of events), a tendency to unfounded generalizations (“I never succeed”), poor tolerance of uncertainty and expectation.

Symptoms of depressive-anxiety disorder with compulsive overeating:

  • decreased energy, feeling withdrawn and isolated;
  • obstacle to increasing physical activity;
  • decreased memory, attention, concentration;
  • difficulties in understanding, remembering and following recommendations for counting calories, keeping a diary, taking medications, etc.;
  • depressed mood, anxiety;
  • overeating, irregular eating, increased consumption of fatty and sweet foods, more active smoking for the purpose of relaxation;
  • pessimism, unreliability;
  • low self-efficacy, lack of belief in success;
  • difficulties with systematic, gradual and steady progress towards the task.

Obese people who consult a doctor for weight loss (BW), as well as women and people with morbid (excessive) obesity, are also characterized by impulsiveness, unpredictability of behavior, passivity, dependence, irritability, vulnerability, infantilism, emotional instability, eccentricity, hysteria, anxiety -phobic and psychasthenic traits.

Impulsivity is reflected in the alternation of overeating and fasting, attempts to reduce body weight (BW) and abandonment of them. Failures to reduce body mass or in other areas of life exacerbate the characteristic of obese people low self-esteem, a feeling of inadequacy, low self-efficacy (lack of confidence in one’s ability to change anything), closing a “vicious circle” of increased depression and anxiety.

Alexithymia and obesity

It turned out that the majority women those who are overweight suffer alexithymia, they have difficulty identifying and describing their own emotions and the emotions of others; difficulties in describing one's own feelings; lack of differentiation of feelings and bodily sensations combined with limited ability to imagine. Internal sensations that characterize emotional life, they express it in terms of irritability, boredom, emptiness, fatigue, undifferentiated excitement or tension.

Some scientists believe alexithymia an important factor predisposing to the development of obesity. Foreign researchers consider alexithymia as a factor complicating the treatment of obesity and note its high prevalence in combination with depression.

Alexithymia is present in approximately 8% of people with normal body weight (BW) and more than 25% of obese people, but usually only in those who have other psychopathological symptoms, such as anxiety. Persons with alexithymia exhibit an exaggerated reaction to stress: against the general background of “inexpressiveness” of feelings, episodes of anger suddenly arise, often “gratuitously.”

Psychological causes of obesity

A pioneer in the study and treatment of excess weight, Hilda Brush, argues that disturbances in the mother-daughter relationship lead to significant ego deficits in the child (including a lack of independence and control) and serious cognitive disorders, which together leads to obesity.

Insufficient differentiation of emotional and somatic processes, characteristic of infantile individuals. In case of destruction defense mechanisms under the influence of stress, regression to the physiological level of response occurs, and conditions arise for the formation of various disorders, including obesity.

Particularly pathogenic is upbringing in the absence of acceptance by the mother of the child, when she does not respond to his internal needs and does not distinguish the child’s hunger signals from other emotional states, which causes him to learn a mixture of hunger with other negative states, persisting in the future and leading to subsequent pathology. eating behavior.

Overweight people are characterized by an inability to distinguish between hunger and other emotional states, as a result of which they react to any stress as hunger; the need for food is a reaction more to conflict and personal problems than to internal physiological stimuli.

Thus, in psychoanalytic literature, the reason for increased food need is considered as a search for substitute pleasures for unsatisfied emotional claims; food is a substitute for absent maternal love, care, and protection against depression.

From the point of view of the psychology of physicality, the process of absorption, digestion and assimilation of food is a generalized metaphor of a person’s relationship with the world. The rhythm of feeding, its consistency with the true state of the child, is internalized into basal trust in one’s own needs, the ability, through initiative and activity, to evoke the appropriate behavior of a significant “Other” that satisfies these needs. Feeding, its regimen, its emotional accompaniment are for the child the primary model of his relationships with other people and the world as a whole.

Possible psychological mechanisms linking obesity and depression include stigmatization of obese individuals, development of low self-esteem, negative self-image, and subsequent anxiety and depression. Thus, in obese children exposed to ridicule about appearance, there is a significant increase in frequency dysmorphophobia and depression.

Symptoms of anxiety and depression in obese individuals increase in parallel with an increase in the score of psychosocial problems. Psychopathological distress is detected in 26% of obese individuals and worsens the quality of life significantly more than the somatic diseases accompanying obesity. Psychotraumatic childhood events increase the risk of obesity in adulthood by 4.6 times. In children who have experienced sexual, psychological and physical violence or its threat, the risk of obesity increases by 1.46 times, and morbid obesity by 2.5 times. Obese individuals often have a history of early loss or parental alcoholism, and in adulthood, poor family life and sexual relationships, which aggravates depressive and anxiety symptoms.

Psychoanalytic psychologists interpret obesity as a defense unconsciously formed by the patient against a traumatic situation (“shell”, “wall of fat”). One of the typical variants of such a situation is sexual violence experienced in childhood or its threat, after which the unconscious, as it were, gives the command “if you want safety, be scary, do not arouse the interest of men.” The patient is not aware of this mechanism, and on a conscious level she, as a rule, actively declares

The military goal is to reduce MT and become more attractive.

Compulsive overeating - how to fight it?

In obsessive-compulsive transmission, the decrease in body weight (BW) with initially high scores of depression and personal anxiety is inhibited, regardless of the prescribed diet. Patients with obesity and mental disorders (MD) reduce body weight worse (6.3% of the initial value after 1 year and 1.2% after 1.5 years) than persons without MD (12.6% and 7.8%, respectively).

Another practical aspect of diagnosing depression and anxiety is the ability to identify a group at risk for developing obesity. A prospective study in women of late reproductive age showed that the presence of depression or anxiety doubled the risk of weight gain over the next 4 years, while dietary factors, physical activity, and levels of gonadotropic, sex and adrenal hormones did not affect this. Screening for depression and anxiety helps identify women at greatest risk of menopausal weight gain.

Psychotherapy aimed at reducing anxiety is accompanied by a 7.5% decrease in body weight (BW) over the course of a year, without dieting. If there is a history of serious psychological trauma, especially childhood trauma, then conscious or unconscious sabotage of weight loss attempts is often noted, because obesity has a symbolic meaning of “protection and safety” for such patients.

It has been shown that survivors of sexual violence, on the background of the same weight loss correction program, have a much more difficult time losing weight than individuals who have not been subjected to violence. In such cases, reducing body weight is impossible without long-term psychotherapy, as a result of which the patient understands the cause of obesity, learns to interact differently with threats and build more optimal defenses.

All of the above determines the need for a holistic psychosomatic approach to the management of patients with obesity, combining traditional medical programs for weight correction with psychotherapy aimed at eliminating the psychological problems that caused the development of obesity or arose against its background.

Compulsive overeating - treatment

There is a commonality of pathogenetic mechanisms in obesity and mental disorders. Dysfunction of monoaminergic (serotonin, norepinephrine, dopamine) nerve signal transmission to the central nervous system (CNS), which underlies depressive and anxiety disorders, plays an important role in the pathogenesis of obesity.

Serotonin accelerates satiety, influences appetite and macronutrient selection, suppressing the desire to consume carbohydrates and fats. It mediates some of the effects leptin to reduce body weight (BW). Shortage serotonin in depression, it increases the craving for carbohydrates, the intake of which reduces the vegetative symptoms of depression, but also increases body weight (BW).

Norepinephrine affects food intake in two ways: stimulation of ag and p2 receptors of the paraventricular nucleus and lateral hypothalamus reduces it, and stimulation of a2 receptors of the paraventricular nucleus increases it. Norepinephrine modulates food intake by influencing neuropeptide Y and leptin.

Stimulation dopamine receptors is accompanied not only by a decrease in the volume and number of meals, but also by a direct effect on energy expenditure. Action dopamine enhances the pleasant sensations of consuming delicious food.

The approach to the treatment of obesity should be differentiated, since it is obvious that individuals with obesity and BD should be treated differently than those without BD. In the presence of clinically obvious depression or anxiety, it is advisable to begin with the treatment of the corresponding disorders, and only then begin the actual weight correction program, in otherwise the likelihood of a positive result is low.

If the symptoms of depression are less pronounced or erased, preference may be given to the management of an obese patient. Sibutramine, if possible, in combination with psychotherapy or its elements.

Anti-overeating pills

There are several groups of drugs that are used for both depression and obesity. Thus, psychostimulants were previously prescribed for the treatment of obesity. amphetamine And Methylphenidate. Currently, they are not used to treat obesity due to the risk of addiction, but in psychiatry they are still successfully used for certain types of depression and other disorders.

Serotonergic anorectics fenfluramine And dexfenfluramine(withdrawn for safety reasons) reduce BW, but also reduce the severity of symptoms in some types of depression and bulimia nervosa.

Psychotropic drugs in the treatment of obesity

Antidepressants

1. Selective serotonin reuptake inhibitors (SSRIs):

  • Fluoxetine - short-term decrease in BW, disappearance of the effect after 5-6 months of use; in case of obesity + SPE, the effect on MT remains unchanged after 1 year of use;
  • Sertraline, Fluvoxamine - ineffective; for obesity + SPE - short-term decrease in BW;
  • Citalopram - ineffective; for obesity + SPE - short-term decrease in BW. Improves neuroendocrine, autonomic and metabolic parameters associated with obesity.

2. Selective serotonin and norepinephrine reuptake inhibitors (SNRIs):

  • Venlafaxine* - reduces appetite and body weight in patients with depression;
  • Sibutramine refers to selective serotonin and norepinephrine reuptake inhibitors and was originally developed as an antidepressant. However, its main effect is an increase in the feeling of satiety and a decrease in the need for food intake, leading to a decrease in BW, which persists with long-term use of the drug. (For this reason Sibutramine is the only SNRI registered for the treatment of obesity). Sibutramine recommended for the treatment of obesity caused by mental problems, as a centrally acting drug that, through the serotonin and norepinephrine systems, simultaneously affects both food consumption and the psycho-emotional state of obese patients.

3. Selective norepinephrine and dopamine reuptake inhibitors:

  • Bupropion* - reduces weight loss and symptoms of depression in depressed patients and obese individuals; reduces BW in obese individuals without depression; effective with long-term use.

Antiepileptic drugs

  • Topiramate - reduces body weight in obesity, effective with long-term use; not well tolerated

* Not registered in Russia

Table. Psychotropic drugs in the treatment of obesity

The WHO report on obesity lists SSRIs under “drugs not indicated for the treatment of obesity per se”; they are recommended only for the treatment of depression in combination with obesity.

Among mental disorders, eating disorders occupy a special place. Many people know about the dangers of diseases such as bulimia and anorexia, but experts rarely talk about compulsive overeating. However, this type of disorder occurs quite often in both women and men of different ages.

What is compulsive overeating? This term refers to excessive consumption of food, which is popularly called gluttony. But the reason for this behavior is not a lack of willpower, natural laziness or a person’s temperament. Psychological factors underlie overeating. That is why the problem can only be dealt with with the help of an experienced psychotherapist specializing in the correction of eating behavior.

Features of the disease

There have been times in every person's life when he ate more food than necessary. The result of such overeating: heaviness and discomfort in the stomach. But such situations happen extremely rarely, and, as a rule, during festive feasts. For a person with a psychological disorder, the process of eating almost never ends. With compulsive overeating, the patient may go on a diet at some point, but this only leads to another breakdown and even greater gluttony.

The main difference between this type of eating disorder and bulimia is that the person does not try to get rid of what he has eaten artificially (by inducing vomiting), although the feeling of shame torments him quite strongly. However, the amount of food eaten at one time should be really large. The fact is that often people suffering from eating disorders believe that they eat a lot, but the amount of food they consume does not exceed the norm. In this case, we can talk about other types of pathology.

People around you may not always understand that the person next to you has an eating disorder. The patient eats a lot only when he is alone; he can store food for future use, so that later he can indulge in gluttony.

Often the body weight of a person suffering from compulsive overeating disorder is normal. The first signs of obesity appear some time after the onset of the disease.

You can judge the presence of psychological problems by the following symptoms:

  • food is consumed in quantities significantly exceeding the norm (the amount of food sufficient to satisfy the hunger of an average adult);
  • the time between meals is short - it rarely reaches 2 hours;
  • a person eats greedily and very quickly, from the outside it may seem that he is experiencing extreme hunger;
  • the patient does not eat because he is hungry. Often the reason for the next meal is stress, a feeling of loneliness or another emotional reason;
  • with compulsive overeating, a person realizes that he is unable to control his appetite and stop;
  • the process of food absorption often stops only when pain appears in the stomach;
  • After another bout of gluttony, a person experiences a feeling of guilt. He is upset and unhappy to the point that he may become depressed, which leads to another binge eating episode.

If the symptoms described above are present for a sufficiently long time, at least 3 months, then this may indicate the presence of serious eating disorders. You won’t be able to cope with this problem on your own with the help of diets; to achieve lasting results, you need to undergo a course of special psychotherapy.

Causes of compulsive overeating

No one can name the exact cause of the development of eating disorders. Today there is an opinion that the disorder arises as a response of the body to stressful situation. The following factors can give impetus to the onset of psychogenic overeating:

  1. Uncontrollable hunger can be caused by problems with the hypothalamus. This part of the brain is responsible for the feeling of fullness - when it stops sending signals, a person experiences constant hunger. Among other biological causes of overeating, experts call a decrease in serotonin levels.
  2. Often the reasons for overeating are the characteristics of the cultural and social environment. From birth, the child gets used to the idea that food can serve as a reward. Or the norms accepted in society can lead to the development of nervous disorders in people who do not comply with them. A compulsive eater feels his inadequacy, and against this background he develops secondary depression, leading to another attack of gluttony.
  3. Overeating can also have psychological reasons. The relationship between uncontrolled eating and depression has been identified by researchers for quite some time. People with low self-esteem, suffering from loneliness and misunderstanding are prone to gluttony.

In addition, it was noted that the tendency to psychogenic overeating may be hereditary.

What are the dangers of psychogenic overeating?

Perhaps some people think that gluttony is not the worst of psychological disorders. But problems with excess weight, which arise as a result of eating a huge amount of varied food, is the most harmless consequence of this pathology. A sick person is more often than others in a state of depression; he is constantly tormented by feelings of anxiety, worry and fear. In some cases, people resort to alcohol or drugs in an attempt to cope with binge eating, but this only makes the situation worse.

Against the background of obesity, problems with physical health. Most often, obese people suffer from diabetes; they have a several times higher risk of developing cancer; heartbeat and hypertension develops. Other problems include joint diseases, snoring, thyroid pathologies, various diseases of the digestive and intestinal organs.

Recognizing overeating due to psychogenic causes

Diagnosis, as well as treatment of this type of eating disorder, requires the participation of several specialists. The examination is carried out on both psychological and somatic profiles. Doctors will conduct a general examination of the patient and study his entire medical history. Predisposing factors are identified, such as stress, hormonal imbalances, psychogenic disorders, and a period of prolonged fasting (voluntary or forced).

Instrumental studies are also needed. In the laboratory, cholesterol levels and blood sugar levels are determined, and gastric secretion is examined. Using special equipment, the stomach, intestines and other organs involved in the process of digesting food are examined.

The diagnosis will be made if there are persistent symptoms of overeating and other types of diseases that can lead to loss of appetite control are excluded.

Therapy

If a patient has been diagnosed with psychogenic overeating, then drug treatment is unlikely to help. Some medications may be prescribed to relieve symptoms or treat underlying conditions, but they must be used to treat the underlying problem. various methods psychocorrections.

Treatment for such a psychological disorder is quite long. Some patients achieved success within a year of working with a psychotherapist, others needed more time.

The main task of specialists treating compulsive overeating disorder is to convey to the patient the idea that food can become an assistant in the process of getting rid of the pathology. To solve the problem, you do not need to completely give up food. You should learn to control your daily diet; it should be based on nutritious and healthy foods.

Among the methods of psychotherapy in the treatment of eating disorders, the most effective are cognitive and behavioral psychotherapy, as well as suggestion and hypnosis. However, this should be done by an experienced doctor specializing in the treatment of psychogenic overeating, since this type of disorder often goes unnoticed by doctors of other specializations.

Often people suffering from compulsive overeating are offered gastric reduction surgery. But in the case where gluttony is caused psychological reasons, the effect of resection will be minimal, since the patient is not able to control the attacks.

How to deal with the problem yourself

If the disorder is in the early stages of development, you can try to overcome it yourself. This will be the first step on the road to recovery. If alarming symptoms appear, you should:

  • ask for help. This is not about visiting a psychotherapist. Tell a loved one about your problem. In some cases, speaking out about a problem allows you to find ways out of it. In addition, the support of loved ones gives us strength and confidence in success, relieves us of feelings of insecurity and loneliness;
  • Don't stigmatize yourself. The negative labels that sick people place on themselves interfere with recovery. Even if you eat too much food, you do not become bad. Overeating is not a crime, but a disease that requires treatment;
  • There is no need to classify all foods as good or bad. It is important to understand that you can eat everything, but in small quantities. If you adhere to this rule, then you can allow yourself some French fries or a piece of cream cake;
  • try to pause while eating. Take a break and evaluate your feelings. If a person uses food as sedative, then it may miss the saturation signal sent from the brain;
  • change habits or environment. What surrounds us has a great influence on our lifestyle and food culture. A compulsive eater should try to eat in company as often as possible. Go to a cafe or invite friends over;
  • give yourself the right to be weak. Many people who suffer from gluttony and excess weight make a list of prohibited foods. This should not be done, because it is unlikely that you will be able to cope with the temptation. And after a while of abstinence, you will again indulge in gluttony. If you want something, then eat it now, but just a little. In this case, there will be no feeling of guilt, which is the key trigger for compulsive overeating;
  • a person suffering from this psychogenic disorder can have only one prohibition - dieting. It is necessary to forget about dietary restrictions once and for all, since they only lead to additional stress. It would be better to create a balanced diet. If you can’t do this on your own, you can seek help from a nutritionist.

These methods of getting rid of eating disorders are quite effective. But only in rare cases can sick people cope with bouts of gluttony on their own. In severe forms of the disorder, the help of specialists is simply necessary. Only with a combination of psychotherapy and self-control can sustainable results be achieved.

According to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, binge eating disorder is a disorder in which a person experiences an uncontrollable and persistent desire to eat. Typically, compulsive overeating is a problem in people who are obese. However, in some cases, people who do not have this problem can also suffer from psychogenic overeating. Frequent episodes of overeating can harm your physical and emotional health. Binge eating can lead to stress. However, there are no hopeless situations. Binge eating disorder can be successfully treated.

Steps

How to overcome desire

    Get rid of junk food. There should be no products in your home that can be harmful to your health. Don't pile up unhealthy, ready-to-eat foods on your kitchen shelves. These are usually unbalanced foods that contain large amounts of calories, carbohydrates and sugar. Make a conscious effort to stock only healthy foods in your kitchen.

    • Prepare your own food and eat it only when fresh. You may be used to your lunch consisting of a pack of cookies or ice cream. You will have to make a conscious effort and make a decision by which you will remove all unhealthy foods from your kitchen.
    • Remove unhealthy food from any places you might have it hidden.

  1. Stay active and don't give yourself the opportunity to get bored. People suffering from overeating eat even when they are not hungry in order to “eat up” boredom. If you have some free time and don't know what to do, get out of the house, walk the dog, take a walk in a nearby park, or ride a bike. Boredom often leads to unhealthy food cravings.

    • Regular physical exercise Increase stress resistance and help manage stress properly.

  2. Follow healthy diet . Don't skip meals. Choose products with high nutritional value. Start your day with a healthy breakfast and continue with a balanced lunch and dinner. By eating healthy throughout the day, you can control unhealthy food cravings.

    Keep a food diary. Write down everything you eat during the day. Also, keep track of your eating behavior when you overeat. This will help you be more attentive to your eating behavior. Thanks to this, you can change your eating habits.

    Practice deep breathing . Deep breathing allows you to relax and cope with stress. Many people with eating disorders also suffer from anxiety disorders. Very often the cause of overeating is anxiety. For many people, the main trigger for overeating is stress. By learning to cope with stress, you are less likely to feel the urge to overeat.

    • Do yoga. Yoga requires awareness in every movement. In addition, various breathing techniques are used during classes.

  3. Get enough sleep. Sleep disturbances are usually associated with eating disorders. Some chemical substances, which affect our appetite, also play an important role in regulating sleep. Proper sleep patterns promote hormonal balance, which has a positive effect on appetite.

    • Follow certain rituals before bed to establish a proper sleep pattern. Go to bed at the same time every night and follow a bedtime routine. Over time, you will begin to feel sleepy when you first begin your usual activities.
    • Avoid daytime naps. If you sleep during the day, you will have a harder time falling asleep at night. If you feel tired during the day, fight sleepiness until it's a good time to sleep.

    How to treat the disorder

    1. See a psychotherapist. Psychotherapy is one of the most effective ways treatment of psychogenic overeating. Psychotherapy may include cognitive behavioral therapy (CBT), which aims to identify and change the thinking patterns that may be causing overeating. Self-awareness is the main goal of this type of therapy; Through CBT, patients can identify risk factors and avoid them. Cognitive therapy also helps promote healthy habits.

      • Interpersonal psychotherapy helps people with compulsive disorder interact better with friends, family, and others. This allows people with binge eating disorder to build healthy relationships with others, which is essential to maintaining good emotional health. Emotional support is extremely important for people who have uncontrollable food cravings.

    2. Join a group of people with binge eating disorder to gain support. Thanks to this, you won't feel lonely. Also, the experiences of others will help you deal with similar problems. You will have the opportunity to communicate with people who are experiencing similar feelings. You will be able to feel the necessary support from them and gain knowledge that will help you cope with problems.

      • Find out if there are similar groups in your city.

    3. In addition to psychotherapy, it is sometimes necessary to take medications. Topamax and similar antidepressants may help you control this disorder; however, any medications work best when combined with psychotherapy and/or a support group. Discuss with your doctor the possible advantages and disadvantages of the drug you choose.

      • To start a course of medication, you will need a prescription from your doctor or psychiatrist.

    4. Read as much as possible. Reading is in a good way understand your experiences and understand the essence of the existing problem. Make it a habit to read stories of people who were able to overcome this disorder. Thanks to this, you will have the right motivation.

      • When reading such examples, remember that each case is individual. Pay attention to similarities, but never compare yourself and your achievements to other people.

    5. Understand that recovery is a long process that does not always go smoothly. You will experience unpleasant symptoms from time to time. It is very important to continue to stick to your chosen course of treatment, despite the difficulties along the way.

      • Don't be too hard on yourself if you fail. Focus on overall success rather than minor failures. If you experience failure, focus on future success.

    Know what binge eating disorder is

    1. Learn about the symptoms. Anyone can overeat from time to time, e.g. holidays or at special events, however, compulsive overeating has a chronic course and is fraught with serious consequences. Symptoms of compulsive overeating:

      • fast eating (eating a large amount of food within two hours or less);
      • the desire to continue eating until a feeling of discomfort or nausea appears;
      • desire to eat even in the absence of hunger;
      • preference for eating alone due to embarrassment about the amount to eat;
      • feeling of shame, guilt and disgust after another episode of overeating.

    2. Understand the connection between emotional distress and compulsive overeating. Psychogenic overeating usually occurs in secret and often causes feelings of guilt or shame.