There are many variations on the theme of dysfunctional eating with a variety
of consequences from mild discomfort to chronic illness. Dysfunctional eating is
a trap. Once people are in the trap, they tend to fall into more disorganized,
dysfunctional eating patterns. Chaotic food intake means chaotic body function
and a disturbed mind. Illness is the inevitable result.
Compulsive eating often emerges in early childhood as a dysfunctional
pattern. Dysfunctional eating patterns tend to persist into adult life with
obesity as one of the many consequences. Many writers relate the bingeing cycles
of some women to female political, social, and existential problems. The
projection of blame outward, while popular, is not correct and distracts from
the real issues of self control. While you can argue that the abundance of
relative cheap food and persistent advertising of food is not helpful, it is
more useful to argue that freedom of choice requires a well-informed,
responsible person who makes the right decisions and does not become a victim of
temptations, vices, addictions and other destructive behaviors.
Some diabolical genius, for example, invented food addiction to catch people
in an almost hopeless situation. You crave and eat only a few foods that make
you ill, but you cannot stop. You feel awful and confused. Or, because you feel
so sick, you do stop eating and starve yourself. Or, you binge eat and induce
vomiting to avoid the consequences. Or, you are an alcoholic and drink beer and
whiskey instead of eating proper food. Or, you consume 8 cups of coffee
per day and smoke, thinking that a greasy burger with fries is an adequate meal.
Proper diet revision can get dysfunctional-eaters out of trouble, but then,
they need to stay out of trouble. They often need a professional “mother”, a
full-time, caring custodian who would prepare proper meals and make sure that
they eat them. Their first task is to develop a support system that can provide
some of the features of mother, the benevolent custodian. The learning task is
to develop self-nurturing. I tell patients that they need to take care of
themselves in a loving and considerate fashion.
The tendency to relapse is greatest in patients who have disorganized and
dysfunctional eating patterns. They tend to crave food and eat compulsively when
they go off course. They tend to use anger and denial to support compulsive
behaviors. They follow an addictive path and may have a history of eating
disorders. Some patients who binge-eat have deeply incorporated secrecy and
denial in their compulsive patterns. Their spouses often do not know what is
going on. They even deceive themselves.
Psychogenic explanations of compulsive-eating focus on the personalities of
the women involved. The personality profile suggests that women who are
high-achievers, perfectionistic, lonely, dissatisfied, and frustrated are at
high risk. A phobic fear of being too fat is usually mentioned as the cause of
fasting, purging, and vomiting. The psychological or psychogenic explanations
take the easy route. They simply restate a description of the problem and say it
is the cause. If the patient says: "I am intense, frustrated, and concerned
about my body weight...", the psychological rendering just turns this around:
"Women become bulimic because they are intense, frustrated, and are concerned
about their body weight.
Many patients with compulsive eating and eating disorders wisely and
appropriately do not accept the psychological explanations. Patients often
describe, "...something inside is not working properly; there is something
chemically wrong with me". One patient stated it succinctly: "I think there is a
little gizmo in my brain gone crazy...if you can only get in there and fix it,
I'll be OK again."
We postulate a biological cause; an infectious agent, an environmental agent,
food allergy, or other problems in the food supply. If a similar endemic
involved more explicit physical symptoms, an epidemiological approach would
search for a physical or infectious agent as the cause of the malady. A good
biological theory would postulate "Agent X" in the food supply, which disorders
appetite regulation in a predictable manner. Agent X need not be a single
substance, but may be a collection of operators in the food supply, affecting
susceptible individuals. Agent X has the property of triggering compulsive
eating associated with aversion to the effects of overeating.