How to get through food addiction, compulsions, and hyperphagia

Is food addiction really what explains certain behaviors that are difficult to control? «As soon as I start eating chips, I can't stop.»

«When I'm stressed out, I eat.»

«Doctor, I think I'm addicted to sugar.»

« In the evening, I find myself in the kitchen pantry trying to pick up anything without really being hungry.»

«Sometimes I eat a lot and I feel like I completely lose control.»

These phrases are similar. They all come from stories told by my patients. Yet, they do not necessarily tell the same story, and food addiction is only one of the possible explanations.

Food addiction, compulsion, emotional eating, bulimic hyperphagia, craving, habit… All these words are used to talk about eating behaviors that are sometimes difficult to distinguish.

And when you live with obesity, a question is often asked of me:

« Do I have an eating disorder? »

The answer does not depend solely on what you eat or the amount you eat.

To understand what is happening, we also need to look at what triggers the behavior, what you feel before, during, and after, the degree of control you retain, the frequency of the episodes, and the function that eating has taken in your life.

And it’s important to remember an essential dimension: what happens in the mind when we eat is not solely psychological.

Hunger, satiety, reward circuits, stress, emotions, impulsivity, the foods around us, and learned behaviors all contribute to the equation. The body also sends out signals.

«Doctor, I'm addicted to sugar»

That is probably one of the phrases I hear most often.

However, having a strong desire for a food does not automatically mean that you are dependent on it.

We can seek out a food because it’s pleasant, associated with a moment of relaxation, because we’re very hungry after eating too little during the day, or because it temporarily soothes a difficult emotion. Our brain may also have learned that at 9 p.m., in front of the television, that’s what we do.

The sensation can be very strong, to the point of giving the impression that it is the food that is «ordering».

But the mechanism behind this desire is not always the same.

A strong desire is not necessarily an addiction food

The word craving refers to a particularly intense desire that is difficult to ignore.

One compulsion corresponds more to a push towards behavior: «I need to eat something.»

One habit It can become so automatic that the behavior begins almost before we consciously decide to do it.

Visit loss of control It means something else: once the episode has begun, the person feels that they no longer really have control over what they eat or their ability to stop.

These phenomena can overlap, but they are not synonymous.

That is why a consultation does not begin with:

« Let's eliminate this or that food item.»

but rather by:

«What happens just before you eat this food?»

Compulsion: when «I want to eat» becomes «I have to eat»

An eating disorder can be experienced as an emergency, even when the person knows that they are not hungry.

An emotion, a smell, the sight of a food, a place, an hour, or a situation repeated hundreds of times can trigger it.

The brain learns associations remarkably well. When a sequence is repeated, the trigger can gradually become a habit. guidance towards already known behavior. The behavior takes root. A path has been learned.

And what has been learned can often be observed, interrupted, modified, or replaced.

Emotional eating: eating to change what is felt

Eating is not just about satisfying hunger.

We also eat to celebrate, to comfort ourselves, to distract ourselves, to calm ourselves, or to please ourselves. Food can thus become a way of modifying an inner state: stress, boredom, loneliness, frustration, fatigue, anger, anxiety, sadness, but also sometimes joy or a need for reward.

If eating calms me down, my brain can hold on to: «When I feel this, this solution works.» Repetition then strengthens the behavior.

However, emotional eating is not, by itself, a psychiatric diagnosis.

It becomes especially important to explore when it constitutes one of the main strategies for regulating emotions or when it is accompanied by suffering, a loss of control, or consequences for health.

And ADHD in all of this?

ADHD does not mean that someone will develop an eating disorder or an anxiety disorder.

However, impulsivity, the pursuit of stimulation or reward, and the difficulties in organizing and regulating emotions that may accompany it can influence eating behaviors.

For example, one can forget or delay meals and arrive in the evening with a significant hunger. Internal tension, intense emotion, or impulsivity can also favor the search for relief or a quick reward through food.

A systematic review indeed finds an association between ADHD symptoms and various disordered eating behaviors, with a possible role of negative affect and emotional dysregulation.

Here again, a good question is:

« What are you trying to regulate at that moment? »

Hyperphagic bulimia: when you enter a defined eating disorder

Bulimic hyperphagia disorder (binge-eating disorder) is a recognized eating disorder.

An episode includes, in particular, the consumption, for a limited period, of a quantity of food significantly greater than that that most people would eat under comparable circumstances, with a feeling of loss of control.

One can also eat very quickly, without being hungry, until one feels uncomfortably stuffed, eat alone out of embarrassment, or subsequently feel guilt, sadness, or self-disgust.

To talk about a Bulimic hyperphagia disorder, Episodes must be recurrent, associated with significant distress, and meet specific criteria for frequency and duration. Unlike nervous bulimia, they are not regularly followed by compensatory behaviors such as induced vomiting.

Eating too much on occasion is therefore not synonymous with bulimic hyperphagia disorder.

And living with obesity no longer.

Is food addiction even a real thing?

The question is more complex.

Food addiction is an active area of research, but it is currently not recognized as an independent psychiatric diagnosis.

To study it, researchers developed the Yale Food Addiction Scale, Then the YFAS 2.0.

This tool looks for several characteristics similar to those observed in addictive behaviors: craving, loss of control, a desire to reduce without succeeding, continued use despite the consequences, and distress and impairment of functioning.

It is therefore not simply a matter of asking:

«Do you really like chocolate? Are you passionate about chips?»

It is rather a matter of identifying a an eating profile that, in several dimensions, resembles an addictive behavior.

Food addiction: Can food itself be part of the problem?

This is one of the major current issues.

The research focuses in particular on Highly processed foods, They are often rich in refined carbohydrates and added fats, very appetizing and quickly consumed.

Some researchers believe that these foods could have an addictive potential in some people. Others believe that the analogy with substance addictions should be cautious.

The debate is therefore not completely settled, and it is simply not possible to say «Sugar is a drug» That would be far too reductive.

We never eat in a brain isolated from its history, its metabolism and its environment.

What happens in the head is not just «in the head»

Our eating behavior results from several systems that communicate with each other.

The mechanisms homeostatic they participate in hunger, satiety and energy needs. The mechanisms hedonistic are linked to pleasure, motivation and reward.

Thus, emotions, stress, fatigue, the available foods, our ability to inhibit a response, and our learning all play a role.

A significant restriction can increase the Hunger and food concerns. Stress can alter the search for reward. An emotion or the sight of a food can trigger a learned association.

Because reducing all food difficulties to a lack of willpower doesn’t make much sense.

Schemas learned: when the brain already knows the way

We all have learned behaviors. Some are useful. Others end up trapping us.

Stress → chocolate → relief.

By dint of Repetition, Stress can trigger chocolate even before the person has consciously decided to eat it.

Or also:

Restriction → significant hunger → loss of control → guilt → new restriction.

To understand the scheme, however, one must look not only what the person eats and also What precedes and follows behavior.

What is the trigger? What emotion is present? What thought? What relief or reward is obtained?

This is often where the pattern becomes visible.

So, am I «in the turmoil» of food addiction, compulsion, and hyperphagia?

A few questions can help us understand what is happening:

Do I feel a real loss of control when I eat?

Are the episodes occasional or recurring?

Am I eating a very large amount of food in a relatively short time?

Do I sometimes eat in secret?

Major distress, shame or guilt—is that what I’m feeling?

Do I eat primarily to satisfy an emotion?

Do certain foods almost systematically trigger a sequence that is difficult to interrupt?

Does my diet affect my health or my quality of life?

And above all:

Does this behavior make me suffer?

These questions do not replace a clinical evaluation. They allow us to understand why two people who say «I eat too much» may need very different support.

And what if several mechanisms were present at the same time?

It’s common.

A person may eat when they are anxious, have very ingrained habits, be particularly sensitive to certain foods, and experience episodes of loss of control. ADD/ADHD, anxiety disorders, sleep difficulties, or other factors can also be involved.

Looking for a single cause therefore risks missing part of the story.

Understanding before dealing

For a long time, the difficulties related to weight were reduced to a too simple equation: We eat too much and we don't move enough.

The eating behavior is much more complex.

Metabolism and hunger count. The reward circuits, emotions, food, and our environment also play a role. Sleep, stress, attention, impulsivity, and our learning history can also play a role.

This does not mean that every food difficulty requires psychotherapy, that every intense craving is an eating disorder, or that all emotional eating constitutes a disorder.

Before trying to eliminate a behavior, it is especially useful to understand What it serves and what keeps it going.

The question then becomes less:

«How can I get this person to stop eating?»

and more:

« What triggers and maintains this behavior in this person? »

And sometimes, the first change consists simply in replacing:

«What's wrong with me?»

by:

«What's going on in my house?»