ACCEPTING EMOTIONS: Supporting patients with emotional eating

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Emotional eating crops up across clinical settings and can have a significant impact on daily functioning. In this article, Dr Cinzia Pezzolesi looks at the reasons for emotional eating and how to help clients understand and manage their feelings in a healthier way.

Summary points

  • Humans are equipped with three different emotional systems that have distinctive roles and help us manage our emotions on a daily basis.
  • Research shows that eating certain foods has the temporary capacity to cause emotional homeostasis, e.g. to make a person feel better.
  • Using food to regulate emotions, either by overeating or restricting food, is often an attempt at self-soothing but can lead to a vicious cycle.
  • Clients benefit from understanding this cycle, and from training their ability to soothe themselves by practicing self-compassion and self-kindness

Sometimes a person eats in response to a feeling or emotion, instead of eating when physically hungry. In fact, the most powerful way to override the body signals of hunger and fullness is to eat in response to our social environment and/or our emotional states. This is what, in our field of work, is called emotional eating.

More specifically, emotional eating refers to eating in response to experiencing any basic human emotion, such as anger, anxiety, shame, joy, or happiness, that are part of our genetic inheritance. Everyone has emotions that are ready to be triggered and that are accompanied by urges or desire to act upon them, e.g. celebrate, fight, or flight. If a person is not used to recognising, understanding or coping with them, emotions can be overwhelming.

Reasons for emotional eating

There are many ways to handle emotions that might be different based on a person’s gender, their family culture, or wider social norms. Some people may have learnt to use food to deal with their emotions. Often as children those people were given food when upset instead of talking about their emotions and, for some, the consequence was to shut down or distract themselves from any emotion later in life. Over time such strategies may become a way of living.

There are several other reasons why people eat emotionally, such as social pressure, unawareness (mindless eating) or trauma that are beyond the scope of this article. However, regardless of its origins, emotional eating presents in many clinical settings, transcending specific psychology specialisms.

Further, there is much literature addressing binge eating disorder (BED) and night eating syndrome (NES) but relatively little is known about the common subthreshold of disordered eating patterns (DES) that are regularly encountered in clinical practice. Examples include grazing, which is described as repetitious, continuous and unplanned eating between mealtimes, with the feeling of losing control over food. The amount of food at each intake may be small, but the overall intake is relatively large. It stands apart from nibbling and picking, which is also characterized by eating in an unplanned, repetitious manner between meals and snacks, but does not include the feeling of loss of control. Snacking represents a very common eating pattern in modern society, but may also lead to mindless eating.

Any forms of disturbed eating—subthreshold or partial syndrome—may have a significant impact on daily functioning. Research involving non-clinical populations suggests that the prevalence of partial syndrome eating disorders is higher than that of full syndrome, and that non-clinical populations share the same disturbed eating behavior apart from the episode’s frequency or severity.

Supporting clients who engage in emotional eating

I worked with Victoria, a 16-year-old girl, who struggled with binge eating. Our first step together was to consider the role of emotions and how they interplay with food. We discussed plainly that, in very basic evolutionary terms, emotions might function as clear signals as to whether a person is achieving the fundamental human goals of survival and reproduction. In practice, emotions help us to attach meaning to events and relationships, and to recognize the things that a person needs.

In fact, as human beings we are equipped with three different emotional systems that have distinctive roles and help us manage of our emotions on a daily basis.

Safety system

The safety system is the most ancient system and it is concerned with keeping a person safe and away from threats. It is also the most powerful emotional system and it is designed to activate the fight or flight response. When switched on it brings about emotions like fear, anxiety, anger and disgust.

Drive system

The drive system is the system that gives vitality and makes a person focus on achievements. It anticipates pleasure and excitement related to achievements and it has evolved to motivate us to do things and to actively engage in the world. The downside of this system is that it can go on overdrive, i.e. if the person does not obtain what they want, they may experience a sense of failure, regret, guilt, or shame and get caught up in trying harder and harder to achieve a goal.

Soothing system

Our third emotional system is the soothing system, which is related to soothing oneself and to contentment arising by connecting to others (affiliation). It is developed in childhood as children are soothed by their significant adults through love and affection. This system can regulate the feelings of distress and anxiety the safety system generates by experiencing kindness, affection and compassion for others and for ourselves.

I also told Victoria that in a regular day a person moves across these systems to regulate their actions.

Also, if we think about a person’s relationship with food, it is easy to see how eating may interplay with these systems in the attempt to modulate them.

If a person is under stress (safety system) we can try to turn off such unwanted negative emotions by comfort eating, and this is entirely normal. We know from research that eating certain foods has the temporary capacity to bring emotional homeostasis, e.g. to make a person feel better.

The drive system gets activated when it is possible to foresee a potential positive outcome, for example when a person is about to start a new diet. The story goes as follows, as a person notices that they have lost a few pounds, the drive system anticipates how exciting it will be to be thinner and leads the person to wrongly believe that life will be better that way. After a few weeks however, the person may also realise that being on a diet is not sustainable over time, and that food may be experienced as something good or bad, or even dangerous. In turn they can then feel disappointed, even angry with themselves, or become afraid of failing at losing weight.

To summarise, when using food to regulate emotions, either by overeating or restricting food, we are trying to self-soothe but, in fact, may get caught up into a vicious cycle and gravitate between the safety and drive system respectively which create more negative emotions.

Emotional clarity: Soothing without food

Once a client has a clear idea of how they may shift from one system to the other and how this cycle is maintained, it is then important to address a crucial question that I often hear in my practice:

‘If I can’t eat or restrict my eating, then what can I do with my overwhelming emotions?’

Although emotions can give us a hard time, it is always important to keep in mind that they are designed to send us a message, they are not our enemies, and they should be listend to.

I often use this phrase, ‘Imagine that you can take any emotion and sit it on your lap, then you can talk and listen to it instead of running away from it’. Once this idea became acceptable for Victoria there was an opening that helped us to begin working with feelings of anxiety, anger or loneliness. Victoria slowly learnt to respond to emotions in ways that had fewer unwanted side-effects and that helped her to manage life’s challenges without food. Again, I often asked her:

“Have you ever tried sitting with your ‘stress’? What does it feel like? Does it look like a bundle of physical tension or agitation and fast, pacing thoughts? Perhaps it is worth doing such exploration for a few seconds next time a strong emotion arises.”

And so she did, beginning to explore rather than escape.

Clients can also engage the soothing system to answer their emotional needs in a more appropriate fashion. Genuinely, a psychological need cannot be met by putting energy (food) in the body. To use a metaphor, it would be like taking paracetamol (food) when we have fever (emotional pain). It may temporary reduce the fever, but we are not addressing the underlining inflammation (need) causing the fever.

Together with our clients we can therefore train their ability to soothe themselves by practicing self-compassion and self-kindness. This allows them to develop a gentle, kind inner voice, whenever they notice that they are struggling with their emotions, or that they have dealt with a stress or pain by overeating or undereating. This self-compassion and kindness has the potential to heal the relationship with food. In our current world, food is readily available for most and, through advertising, heavily encouraged as part of a reward system (you deserve this ice cream) or social interaction (let’s meet for coffee and cake) that is separate from the real need for food, i.e. to satiate hunger. As a result, for many it is tricky to separate their eating from their emotions, but developing understanding and kindness for themselves is the first step towards dealing with their emotions in a healthier way.

Further information

  • D. Benton. ‘Carbohydrate ingestion, blood glucose and mood’, Neuroscience & biobehavioral reviews, 26 (3), 2002.
  • F. A. Carter, A. Jansen. ‘Improving psychological treatment for obesity. Which eating behaviours should we target?’, Appetite, 58 (3), 2012.
  • P. Gilbert. ‘Introducing compassion-focused therapy’, Advances in psychiatric treatment, 15, 2009.
  • L. K. Hsu, S. P. Sullivan, P. N. Benotti. ‘Eating disturbances and outcome of gastric bypass surgery: A pilot study’, International journal of eating disorders, 21 (4), 1997.
  • M. Tanofsky-Kraff, S. Z. Yanovski, N. A. Schvey, C. H. Olsen, J. Gustafson, J. A. Yanovski. ‘A prospective study of loss of control eating for body weight gain in children at high risk for adult obesity’,  International journal of eating disorders, 42 (1), 2008.
  • L. Tam, R. P. Bagozzi, J. Spanjol. ‘When planning is not enough: The self-regulatory effect of implementation intentions on changing snacking habits’, Health psychology, 29 (3), 2010.
  • R. Saunders. ‘Grazing: A high-risk behavior’, Obesity surgery, 14, 2004.
  • R. Saunders. ‘Binge eating in gastric bypass patients before surgery’, Obesity surgery, 9, 1999.
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About Author

Dr. Cinzia Pezzolesi

Dr. Cinzia Pezzolesi is a chartered Clinical Psychologist, Mindfulness-based cognitive Therapist, Mindful Eating Specialist. In addition to her private therapy practice, she serves as the Head Teacher and Clinical Director for The Mindfulness Project (UK) and is on the board of the Centre for Mindful Eating in the USA.

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