Compulsive overeating
Synonyms and keywords: Food addiction; Compulsive eating; Emotional eating; Stress eating.

# Overview
Compulsive overeating is characterized by an addiction to food. An individual suffering from compulsive overeating disorder engages in frequent episodes of uncontrolled eating, or binging, during which they may feel frenzied or out of control. They will eat much more quickly than is normal, and continue to eat even past the point of being uncomfortably full. Binging in this way is generally followed by a period of intense guilt feelings and depression. Unlike individuals with bulimia, compulsive overeaters do not attempt to compensate for their binging with purging behaviors such as fasting, laxative use or vomiting. Compulsive overeaters will typically eat when they are not hungry, spend excessive amounts of time and thought devoted to food, and secretly plan or fantasize about eating alone. Compulsive overeating almost always leads to weight gain and obesity, but not everyone who is obese is also a compulsive overeater.
In addition to binge eating, compulsive overeaters can also engage in grazing behavior, during which they return to pick at food over and over throughout the day.  This results in a large overall number of calories consumed even if the quantities eaten at any one time may be small. When a compulsive eater overeats primarily through binging, he or she can be said to have binge eating disorder. Where there is continuous overeating but no binging, then the sufferer has compulsive overeating disorder.

# Pathophysiology

## Addiction
During binges compulsive overeaters consume as much as 5,000 calories and up to 60,000 calories per day, which results as an addictive "high" not unlike those experienced through drug usage, and a release from psychological stress. In bulimics this high may be intensified by the act of purging. Some researchers have speculated that in binge eaters there is an abnormality of endorphin metabolism in the brain that triggers the addictive process. This is inline with other theories of addiction which attribute it not to avoidance of withdrawal symptoms, but to a primary problem in the reward centers of the brain. Further, research has shown that those with eating disorders most often crave "comfort foods" which are high in carbohydrates during binges. The ingestion of these foods cause release of the neurotransmitter, serotonin. This could be another sign of neurobiological factors contributing to the addictive process. Abstinence from addictive food and food eating processes causes withdrawal symptoms in those with eating disorders. There may be higher levels of depression and anxiety due to the decreased levels of serotonin in the individual.
There are complexities with the biology of compulsive eating that separate it form a pure substance abuse analogy. Food is a complex mixture of chemicals that can affect the body in multiple ways, which is magnified stomach-brain communication. In some ways, it may be much more difficult for compulsive overeaters to recover than addicts. There is an anecdotal saying among Overeaters Anonymous members that "when you are addicted to drugs you put the tiger in the cage to recover; when you are addicted to food you put the tiger in the cage, but take it out three times a day for a walk."
The physical explanation of compulsive overeating may be attributed to an overeaters' increased tendency to secrete insulin at the sight and smell of food. Though medical evidence supporting this is controversial.

# Causes
In common with other eating disorders, there is a significant emotional element to compulsive overeating. Although there is no known exact cause, there are several likely options. Most sufferers of compulsive overeating use food as self-medication to cope with overwhelming emotions of shame and depression. This self-medication may not only provide the emotional comfort of the act of eating, but may have the physiological effect of making the person actually feel "drugged," sluggish, sleepy,and focused on nothing but the sensation of fullness. This is especially the case when large amounts of sugar and simple carbohydrates are consumed. Many feel guilty that they are "not good enough" and are ashamed of their increasing weight. Most have very low self esteem.
Compulsive overeating normally begins in childhood, when eating patterns are formed. Most compulsive overeaters never learned effective ways to deal with stressful situations, and instead learned to turn to food as a way of blocking out painful emotions. Some compulsive overeaters consciously or unconsciously use excess body fat as a protective layer, particularly those who have been the victims of sexual abuse. They sometimes feel that being fat will make them less attractive, and therefore less likely to be abused further.
Although many sufferers of compulsive overeating try to combat their increasing weight through dieting, this can exacerbate the condition. Dieting can lead to feelings of deprivation, which the compulsive overeater is then driven to block out by further binging. Unless the emotional reasons for binging are resolved, the sufferer frequently becomes locked into an unending cycle of dieting and binging, with the accompanying feelings of guilt, shame, self-loathing and depression that result.

# Natural History, Complications and Prognosis
Left untreated, compulsive overeating can lead to serious medical conditions including high cholesterol, diabetes, heart disease, hypertension and clinical depression. Additional long-term side effects of the condition also include kidney disease, arthritis, bone deterioration and stroke.
Like other eating disorders such as anorexia and bulimia, compulsive overeating is a serious problem and can result in death.

# Diagnosis

## History
- Binge eating, or eating uncontrollably even when not physically hungry
- Eating much more rapidly than normal
- Eating alone due to shame and embarrassment
- Feelings of guilt due to overeating
- Preoccupation with body weight
- Depression or mood swings
- Awareness that eating patterns are abnormal
- History of weight fluctuations
- Withdrawal from activities because of embarrassment about weight
- History of many different unsuccessful diets
- Eating little in public, but maintaining a high body weight

# Treatment
Compulsive overeating is treatable with counseling and therapy, and approximately 80% of sufferers who seek professional help either recover completely or experience significant reduction in their symptoms. All eating disorders are behavioral patterns which stem from emotional conflicts that need to be resolved in order for the sufferer to develop a healthy relationship with food. Like other eating disorders such as anorexia and bulimia, compulsive overeating is a serious problem and can result in death. However, with the proper treatment, which should include talk therapy, medical and nutritional counseling, it can be overcome.