For the past 25+ years, I’ve been helping overeaters and imbalanced eaters heal their relationships with themselves, their bodies and food. I’ve helped them stop dieting, lose excess weight and keep it off. Even though overeating may seem like a simple act, it’s actually a complex behavior and its resolution requires a comprehensive, multidimensional approach.
We all love to eat and eating food beyond simple sustenance is a normal part of life. It becomes problematic when we overeat to such an extent that there is significant weight gain or health risk.
As a clinician, you will have in your practice (at some time or another) a client who:
- feels out of control with food
- feels addicted to certain foods
- expresses concern about her weight
- is ashamed of her body image
- restricts activities because of her body image
- is afraid of the health consequences of carrying extra weight
- may be using inappropriate compensatory behaviors to lose or maintain weight, such as vomiting, using laxatives and diuretics, fasting, severe dieting, or over-exercising and
- may have other disordered eating patterns such as chewing and spitting out, but not swallowing, large amounts of food, or night eating syndrome.
If your client expresses that she regularly eats when she is not hungry, eats beyond fullness, snacks mindlessly or routinely overeats or binges on favorite comfort foods, she may be an emotional eater who uses food:
to regulate, dull or tranquilize emotions that are difficult to cope with such as anxiety, anger, sadness, frustration, hopelessness, loneliness, shame, guilt and even happiness and joy
for soothing, comfort, and calming
for pleasure, escape, fulfillment and excitement
to silence negative, critical, judgmental self-defeating thoughts
to quiet the mind
to distract from unpleasant states such as boredom, apathy or overwhelm
to rebel against someone or something
to unwind from the day
to cope with stress
to feel safe
as a way to procrastinate
as a way to avoid moving forward in life
to fill up an inner emptiness.
There are basically three patterns of emotional overeating:
- Non-compulsive overeating: This pattern includes clients that regularly overeat at meals, graze all day, snack mindlessly. If they do binge, it’s just occasional. There is no separate DSM-V category for this pattern.
- Binge Eating Disorder: This is the most prevalent compulsive overeating pattern/disorder. It affects more than 8 million men and women and accounts for three times the number of those diagnosed with anorexia and bulimia together. The DSM-V includes this frequency duration criteria: one time per week for three months.
- Bulimia Nervosa: This includes binge eating plus inappropriate compensatory purging methods for weight control. The criteria include binge/purge episodes two times per week for three months.
At the core of overeating lies a disconnection from mind, body and spirit signals. As clinicians, we are well-trained to deal with imbalances in the emotional and spiritual arenas. One important area of focus must be assisting our clients with “going inside” regularly to check in with their internal world of emotions, needs and thoughts. We must teach our clients to be mindful of signals of distress so that they can make the required adjustments to meet their needs and stay in emotional balance.
In my 12-Week Emotional Eating Recovery Program, I teach participants an easy-to-practice, three-step self-care skill, called an Inner Conversation that helps them establish a regular practice of self-connection. (I also cover this skill in depth in my book, The Emotional Eater’s Repair Manual.). It also helps them begin to develop and strengthen an inner nurturing voice—an important resource capable of helping them regulate their emotions and address their needs.
When clients want to eat when they are not hungry, eat when they are already full, or if, when they are hungry, they want to choose unhealthy comfort foods, I ask them to stop for a brief period of time and have an Inner Conversation, as follows:
Step1. Ask yourself, “How am I feeling in this moment?”
Step2. Ask yourself, “What do I need?”
Step3. Use your wise Inner Nurturer voice to reassure and comfort your feeling self and address
Clients can also try engaging in Inner Conversations if
- They want to use additional distractions such as alcohol, drugs, shopping, working, sex, gambling, drama, television, Internet surfing, video games, busyness, or excessive sleeping;
- They’re experiencing unpleasant emotions like sadness, anxiety, depression, anger, loneliness, fear, guilt, shame, helplessness, or hopelessness;
- They feel numb, which may be experienced as emptiness, boredom, apathy, lack of motivation, or feeling “blah,” lost, or disconnected;
- Their thoughts are obsessive, such as when they’re thinking about food, meals, body image, or weight too much; or they are regularly recycling self-defeating, critical, judgmental thoughts; or worrying constantly about anything; or
- They encounter stressful situations such as difficult people, relationship struggles, social encounters, losses, disappointments, financial hardship or illness.
Another important area of focus is assisting clients in reframing their self-defeating thoughts. Self-defeating thoughts and beliefs are usually triggered by situations that cause distress: disappointment, loss, hurt, fear, rejection, criticism, shame, vulnerability, and exposure. The pioneers of Cognitive Therapy suggest that our core beliefs can predispose us to excessive sadness and depression. A major technique of cognitive therapy is to make these beliefs explicit, because we’re often unaware of them, and to decide if they are effective or self-defeating. When clients learn to identify and challenge their irrational thoughts and core beliefs and replace them with more objective, nonjudgmental, energizing thoughts, they often begin to feel better immediately. This translates into less emotional eating.
For many emotional eaters, self-connection—practicing Inner Conversations and catching and reframing self-defeating thoughts—may be all that’s needed to resolve their emotional eating. But for those emotional eaters who have experienced considerable loss, disappointment or trauma, these particular self-care skills may not be enough to restore emotional balance. For those emotional eaters who find themselves getting stuck in unpleasant emotional states and having difficulty reframing self-defeating thoughts, some form of trauma and grief work may be called for. Many different therapeutic modalities can be useful here: somatic experiencing, EMDR, emotional freedom techniques as well as talk therapy.
A few other important areas of focus in the emotional skill-building arena will include assisting our clients in learning to set limits with themselves and boundaries with others, as well as practicing self-acceptance and self-love, which includes work on body image.
In the spiritual arena, as clinicians, we’ll want to help our clients learn what I call “soul-care practices” which include: mind quieting, letting go of unhealthy attachments, attracting nourishing connections, creating purpose and meaning in life and practicing gratitude.
Brain and body imbalances can also cause food cravings, low energy and poor sleep, creating a vicious cycle of comfort eating, weight gain, and more dieting. Imbalances in this arena can be due to any of the following: chronic dieting, overconsumption of fiber-less processed foods and foods of animal origin, hormone and brain chemistry imbalances, food allergies and food addiction, environmental toxins, stress, inadequate sleep and a sedentary lifestyle.
As a clinician, you can begin to help your clients become mindful of their body signals by encouraging them to pay attention to hunger and fullness cues. Many emotional eaters are out of touch with these most basic body signals, so this is a good place to start. You can also ask them to begin to notice how they feel when they eat particular foods—do they feel energized, sleepy, bloated, etc.?
You’ll want to have referral resources in place for any areas you don’t feel qualified to treat, i.e., a dietitian or nutritionist for assistance with an eating plan, an integrative healthcare practitioner for hormone and allergy testing, a psycho-pharmacologist for non-drug approaches to adjusting brain chemicals, and a psychiatrist, for medication, if needed.
When our clients eat in the absence of physical hunger cues, regularly choose unhealthy comfort foods, or eat beyond fullness, something is out of balance somewhere. The resolution of emotional overeating requires you, as the clinician, to encourage your clients to be mindful of their mind, body and spirit signals and to respond with curiosity, love and care.
Julie M. Simon, MA, MBA, MFT is a psychotherapist and life coach, and the author of the best-selling book The Emotional Eater’s Repair Manual—A Practical Mind/Body/Spirit Guide for Putting an End to Overeating and Dieting. For the past 25+ years, she has been helping overeaters and imbalanced eaters heal their relationships with themselves, their bodies and food, stop dieting, lose excess weight and keep it off. She is also a certified personal trainer with twenty-five years of experience designing personalized exercise and nutrition programs for various populations. Julie is the founder and director of The Twelve-Week Emotional Eating Recovery Program, an alternative to dieting that addresses the mind, body and spirit imbalances that underlie overeating. Julie offers individual, couple, family and group psychotherapy as well as classes and seminars. Visit her website at www.overeatingrecovery.com.