Emotional eating disorder -
These foods, often referred to as comfort foods , include ice cream, cookies, chocolate, chips, french fries, and pizza, among others. Consequently, stress is associated with both weight gain and weight loss. The primary difference between emotional eating and binge eating is in the amount of food consumed.
By definition, binge eating refers to eating to a highly uncomfortably full point, whereas emotional eating may involve lower caloric consumption or irregular meal volumes. Emotional eating may also be part of an emotional disorder, such as depression, bulimia, or other mental illnesses.
Emotional eating is thought to result from a number of factors rather than a single cause. Some research shows that girls and women are at higher risk for emotional eating and therefore at higher risk for eating disorders. However, other research indicates that, in some populations, men are more likely to eat in response to feelings of depression or anger and women are more likely to eat excessively in response to failure of a diet.
The pathophysiology of emotional eating is insufficiently known. Glucagon-like peptide 1 GLP-1 , a postprandial hormone, plays a role in feeding behavior by signaling satiety in the brain.
GLP-1 receptor agonists, which are used to treat type 2 diabetes, promote weight loss. Many studies have investigated the association between emotional eating and responses to food cues in brain areas involved in satiety, as well as GLP-1 receptor agonist—induced effects on these brain responses.
This disruption of cortisol secretion not only can promote weight gain, but also can influence where on the body excess fat develops. Some studies have shown that stress and elevated cortisol tend to cause fat deposition in the abdominal area.
This fat deposition is strongly correlated with the development of cardiovascular disease, including heart attacks and strokes. Part of the stress response often includes increased appetite to supply the body with the fuel it needs for the fight-or-flight response, resulting in cravings for so-called comfort foods.
People who have been subjected to chronic rather than short-term stress e. The goals for treatment of BED are to reduce eating binges and to achieve healthy eating habits. Because binge eating can correlate with negative emotions, treatment may also address any other mental-health issues, such as depression.
Whether in individual or group sessions, psychotherapy can help teach patients how to exchange unhealthy habits for healthy ones and reduce binging episodes. Cognitive Behavioral Therapy CBT : CBT may help patients cope better with the factors that can trigger binge eating episodes, such as negative feelings about their body or depressed mood.
CBT can also lead to an improved sense of control over behavior and can help regulate eating patterns. Interpersonal Psychotherapy: This form of therapy is a reasonable alternative to CBT as first-line treatment for BED. According to the theoretical foundation of interpersonal psychotherapy, binge eating results from an unresolved problem in at least one of four possible areas: grief, interpersonal-role dispute, role transition, and interpersonal deficit.
Interpersonal psychotherapy focuses on relationships with other people, with the goal of improving interpersonal skills how the patient relates to others, including family, friends, and coworkers. This may help reduce binge eating that is triggered by problematic relationships and unhealthy communication skills.
Dialectical Behavioral Psychotherapy: Dialectical behavior therapy consists of teaching skills for management of problematic behaviors, such as binge eating, that are associated with emotional dysregulation.
This type of therapy includes protocols for managing therapy-disrupting behavior and more severely affected patients who exhibit self-injurious and life-threatening behavior.
Dialectical behavior therapy promotes skills related to mindful eating, emotional regulation, and the management of unpleasant or painful circumstances and feelings associated with binge eating.
Although medication is useful for treating BED, it is generally regarded as less efficacious than psychotherapy; therefore, most patients may prefer psychotherapy. However, pharmacotherapy may be less time-consuming or less expensive.
On that basis, it is reasonable to employ pharmacotherapy as first-line treatment for patients who prefer medication and decline psychotherapy, as well as for those who do not have access to psychotherapy. It should be noted that although the following agents can be helpful in controlling binge or emotional eating episodes, they may not have much impact on weight reduction.
This stimulant can be habit-forming and abused. Common side effects include dry mouth and insomnia, but more serious side effects can occur.
Also ask yourself: Am I stressed, sad, or anxious over something, like school, a social situation, or at home? Has there been an event in my life that I'm having trouble dealing with? Am I eating more than usual? Do I eat at unusual times, like late at night? Do other people in my family use food to soothe their feelings too?
Breaking the Cycle Managing emotional eating means finding other ways to deal with the situations and feelings that make someone turn to food. Tips to Try Try these tips to help get emotional eating under control.
Explore why you're eating and find a replacement activity. Too often, we rush through the day without really checking in with ourselves. Pause before you reach for food.
Are you hungry or is it something else? For example: If you're bored or lonely: Call or text a friend or family member. If you're stressed out: Try a yoga routine or go outside for walk or run.
Or listen to some feel-good tunes and let off some steam by dancing around your room until the urge to eat passes. If you're tired: Rethink your bedtime routine. Set a bedtime that allows you to get enough sleep and turn off electronics at least 1 hour before that time. If you're eating to procrastinate: Open those books and get that homework over with.
You'll feel better afterward truly! Write down the emotions or events that trigger your eating. One of the best ways to keep track is with a mood and food journal.
Write down what you ate, how much, and how you were feeling e. Were you really hungry or just eating for comfort? Through journaling, you'll start to see patterns between what you feel and what you eat.
You can use this information to make better choices like choosing to clear your head with a walk around the block instead of a bag of chips. Practice mindful eating.
Pay attention to what you eat and notice when you feel full. Indeed, in EE, Kornacka et al. Similarly, people with BED are more inclined than healthy people to use rumination as a negative emotion regulation strategy [ 27 ].
Wang et al. We hypothesized that there would be a continuum between EE nonpathological eating behavior and BED pathological eating behavior. Three studies focusing on BED mentioned this idea of a continuum in the severity of eating disorders. Mobbs et al.
Moreover, Svaldi et al. However, none of the reviewed studies directly compared EE to BED regarding ER or inhibition performances, neither in a longitudinal nor cross-sectional design.
Thus, a gap can clearly be identified in this specific field since there is a complete lack of experimental data about an increased severity in ER and inhibition deficit between EE and BED. We identified some limitations between studies, and some of them were quite redundant in our corpus.
First, half of the included studies recorded only self-reported data using scales, questionnaires, or interviews. These declarative measures often suffer from memory bias or social desirability concerns [ 40 ]. Moreover, these measures are often carried out for a particular purpose, and this purpose may differ from study to study, depending on the research question being asked [ 40 ].
Strikingly, Thus, there is a lack of experimental data to address the issue of ER in BED and EE. Second, Sample size is a critical issue for quantitative analysis. This sample size must be large enough to achieve the appropriate level of measurement precision.
Third, most of the participants enrolled in these studies were women, compromising the generalizability to the global population Eating disorders are more frequent among women, and for BED, the ratio varies between and [ 42 ].
Thus, while the lack of men in BED studies is understandable, future studies should consider recruiting more men to properly balance the experimental groups. Finally, a recurring limitation emphasized by many authors of the included studies is that their research was cross-sectional.
Indeed, given the short duration of these types of studies, it was impossible to reveal some causal links between different phenomena e. However, in our opinion, this is not a limitation per se, as cross-sectional and longitudinal studies are two very different types of research.
Therefore, we did not report this limitation in Table 1. The main objectives of this scoping review were to explore the idea of a continuum between EE and BED as well as explore the idea of a gradation in emotion regulation and inhibition deficits along this continuum.
This hypothesis is supported by some authors and is widely discussed in Davis [ 14 ]. It should also be noted that this idea of a continuum is shared by many physicians in their daily clinical practice and that this idea needs to be verified.
The most striking result of our scoping review is that there are strong similarities between EE and BED, with emotional eaters and BED patients sharing the same difficulties in emotion regulation and inhibition. Some of the included studies seem to be compatible with the idea of a gradation of ER and inhibition deficits following this continuum.
For instance, Mobbs et al. Concerning EE, the results of Sultson and Akkermann [ 19 ] showed that participants with EE have more binge eating behaviors than participants without EE but do not meet all the DSM-5 criteria to be diagnosed with BED.
These results suggest that EE could lead to BED and thus support the idea of a continuum. It is, however, crucial to remember that none of the articles included in this review directly compared EE and BED in the same study, neither in a longitudinal nor cross-sectional design.
To ascertain the existence of a continuum between EE and BED, the increased severity of ER and inhibition deficits between EE and BED still need to be proven.
One of the main goals of this scoping review was also to identify knowledge gaps, and indeed, we found a gap in the literature regarding the increased severity in ER and inhibition impairments from EE to BED. Such a lack of experimental work is truly surprising given the feelings shared by many caregivers in the field of eating disorders as well as the thoughts shared by some authors [ 14 , 25 , 38 , 39 ].
Among the thirty-two articles reviewed, only one focused on the relationship between ER and inhibition in EE. Indeed, Wolz et al. This outcome should be taken into account in further studies, since ER and inhibition deficits are often studied separately [ 7 , 43 , 44 ].
Indeed, the direct relationship between ER and inhibition remains poorly studied in BED, as well as in EE, but is an important question to explore the idea of a continuum. The third objective of this scoping review was to address the ill-defined concept of overeating.
Unfortunately, only two studies focused on overeating [ 32 , 33 ], and it is thus difficult to clearly define this concept. For both authors, overeating is not an eating disorder per se since participants were healthy volunteers with no prior diagnosis of an eating disorder.
However, in both studies, overeating is measured with questionnaires widely used in medical contexts to assess eating disorders, such as the Eating Disorder Examination-Questionnaire EDE-Q or the Binge Eating Scale BES.
Thus, overeating may be seen as pathological eating. Moreover, Racine and Horvath [ 33 ] used the Eating Disorder Diagnostic Scale and the Questionnaire on Eating and Weight Patterns-5 QEWP-5 to determine experimental groups.
Thus, this inclusion criterion could be a suitable definition of the concept of overeating, but it must be emphasized that there is too little information to properly define this concept. Most of the studies only measured EE and binge eating episodes in response to negative emotions.
However, few articles specifically focused on positive mood or emotions. Due to a lack of consensus among studies, it was impossible to strongly conclude that positive emotions can affect eating behaviors. Indeed, some data support this idea [ 19 , 34 ], and others are less affirmative [ 22 , 35 ].
Last, concerning the weight profile, it was not one of the aims of this scoping review, but our results showed that emotion regulation deficits were more severe in obese participants than in normal weight or overweight volunteers. Thus, the weight profile seems to be an important parameter when addressing the question of an increased severity in ER deficits between EE and BED.
This scoping review presents some limitations. Second, the examination was based on a list of terms describing emotional eating, binge-eating disorder, emotion regulation and inhibition.
The possibility that additional articles would have been identified by adding other terms cannot be completely excluded, although the search was intended to be as extensive as possible. Indeed, given that one of our questions was about the possibility that positive emotions can, like negative emotions, trigger emotional eating episodes, we could have perhaps included it in our search equation.
Finally, in this review, only studies in French or English were included, which did not allow us to be exhaustive in our conclusions. In conclusion, this scoping review fully confirmed the presence of inhibition and emotion regulation deficits in both EE and BED, showing strong similarities between these two eating behaviors.
However, the lack of experimental data coming from direct comparisons between EE and BED did not make it possible either to confirm the existence or the absence of a possible continuum between EE and BED or an increased severity in ER and inhibition deficits between EE and BED. Thus, this scoping review helped to identify a knowledge gap, and the question of the existence of a continuum still needs to be addressed in further research.
If such a continuum exists, we think it could greatly impact the clinical care of eating disorders. Indeed, if EE can become BED, early care of emotional eaters becomes essential, and early diagnoses could be made. Additionally, prevention could be improved in emotional eaters and even in the general population to avoid progression to an eating disorder i.
Given the variety of symptoms psychological and physical , monitoring of emotional eaters could be performed by a multidisciplinary medical team, especially for children and adolescents. The existence of a continuum between EE and BED could also have implications for eating disorder research.
In our view, this could lead to further research to develop more specific screening instruments, such as scales and questionnaires. Such instruments might indeed be helpful to classify emotional eater participants into more relevant experimental groups that take into account the severity of EE.
To go even further, one could imagine a new scale that would assess the level of eating behaviors across the entire continuum. Moreover, regarding data analysis, data could be analyzed in a discrete way in addition to group comparisons between EE and BED.
Moreover, to test the idea of a continuum from a different angle, it could be interesting to see if there is an evolution of some other markers between EE and BED, such as biomarkers. Some of them are well known in BED but remain rather poorly studied in EE.
Several fMRI studies have shown that brain activation patterns are different in BED patients, especially in the reward system, which explains why this eating disorder is often associated with food addiction [ 14 ]. For example, the ventral striatum and the medial prefrontal cortex seem to be underactivated during a rewarding task.
Moreover, the ventral putamen, orbitofrontal cortex, amygdala, and insula respond less in BED patients than in controls [ 8 ]. EEG studies have also provided a valuable understanding of neurophysiological markers.
In their narrative review, Berchio et al. Finally, animal studies allow us to better understand the functioning of some molecules. For example, the role of dopamine, oxytocin, and opiate in eating disorders is well understood [ 46 ], and this could be an interesting focus to measure the gradation between EE and BED.
Original records before screening can be found using the search equation that was used in both databases: "Binge-Eating Disorder"[Mesh] OR BED OR Binge eater OR Emotional Eating OR Emotional Overeating OR Overeater OR Emotional eater OR Overeating AND "Emotional Regulation"[Mesh] OR Emotion regulation OR Reappraisal OR Rumination OR Attentional deployment OR Mood regulation OR "Inhibition, Psychological"[Mesh] OR Inhibitory control.
The 32 articles included after the screening steps are listed in the References section. van Strien T, van de Laar FA, van Leeuwe JFJ, Lucassen PLBJ, van den Hoogen HJM, Rutten GEHM, et al. The dieting dilemma in patients with newly diagnosed type 2 diabetes: does dietary restraint predict weight gain 4 years after diagnosis?
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Leehr EJ, Krohmer K, Schag K, Dresler T, Zipfel S, Giel KE. Emotion regulation model in binge eating disorder and obesity—a systematic review. Neurosci Biobehav Rev. Steward T, Menchon JM, Jiménez-Murcia S, Soriano-Mas C, Fernandez-Aranda F. Neural network alterations across eating disorders: a narrative review of fMRI studies.
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Obes Silver Spring Md. Article Google Scholar. Greeno CG, Wing RR, Shiffman S. Binge antecedents in obese women with and without binge eating disorder. J Consult Clin Psychol. Nicholls W, Devonport TJ, Blake M. The association between emotions and eating behaviour in an obese population with binge eating disorder: emotions and binge eating disorder.
Obes Rev. Stein RI, Kenardy J, Wiseman CV, Dounchis JZ, Arnow BA, Wilfley DE. Int J Eat Disord. Davis C. ISRN Obes. PubMed PubMed Central Google Scholar. PRISMA extension for scoping reviews PRISMA-ScR : checklist and explanation. Ann Intern Med. Arexis M, Feron G, Brindisi MC, Billot PE, Chambaron S.
Impacts of emotional regulation and inhibition on Emotional Eating EE and Binge Eating Disorder BED : Protocol for a scoping review.
Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan—a web and mobile app for systematic reviews. Syst Rev. Stapleton P, Whitehead M. Dysfunctional eating in an Australian community sample: the role of emotion regulation, impulsivity, and reward and punishment sensitivity. Aust Psychol.
Sultson H, Akkermann K. Investigating phenotypes of emotional eating based on weight categories: a latent profile analysis.
Kornacka M, Czepczor-Bernat K, Napieralski P, Brytek-Matera A. Rumination, mood, and maladaptive eating behaviors in overweight and healthy populations.
Eat Weight Disord EWD. Deroost N, Cserjési R. Attentional avoidance of emotional information in emotional eating. Psychiatry Res.
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