I’m very ambivalent about the issue of keeping a food diary. I know that when people do it, the impact it has on their eating can be very impressive. So what’s the down side of recommending it? For one thing, when someone who is just trying to be helpful, tells you that you “really should” keep a daily food diary, that’s one more rock dropped into the pan that hangs on the external control side of the scale.  It’s just as likely to have a negative effect as a positive one.

People differ in how they feel about keeping journals, diaries, or scrapbooks. Personally, if I was told to record everything I ate, I would either give up after about a day, or if I did stick with it, the information wouldn’t be worth the electronic pixels that it’s recorded on. And I know from my patients’ responses to this recommendation that there are many people who have the same attitude toward recording everything they eat as I do.

Even dedicated diarists who are knowledgeable about nutrition can be way off in their estimates of portions and calories that they consume. A study published in 2002 showed that although dietitians who were asked to record their food intake over a seven-day period were more accurate than non-dietitians, they still underestimated the calories they consumed by more than 10 percent. The non-dietitians in the study were off by more than 20 percent!

I believe, however, that the accuracy of the details recorded is not the key factor in explaining the effectiveness of keeping a food journal. The real value of the diary comes back to mindful awareness. Just the process of thinking about what you have eaten forces you to stop and reflect on your eating behavior. That alone can be a very sobering experience for many people who eat so automatically they’re not even aware of having other more appropriate options. If you’re not aware that you have options then literally, you don’t have a choice. From a practical point of view, it’s no better than being forced to eat. More than that, the fact that what you’re about to put in your mouth will be recorded, makes a big difference in whether you eat it or not. Or, put another way, it allows you to make choices.

There’s an old joke about a couple on vacation in the Catskill Mountains in one of those old resorts. They were looking at their menus and pointed out to the waitress that under side dishes it just says “choice of vegetables.” “So?” asked the waitress. The man asked, “Well, what’s the choice?” The jaded server rolled her eyes and said, “The choice is, do you want it or don’t ‘cha?” When you consider any global behavior change on the microscopic, nano-level, it all comes down to individual decisions: Should I have this one or that one? Should I take another portion or not? Do you want this or don’t ‘cha?

How frequently are we confronted with choices about what we eat? A study done by Brian Wansink at Cornell looked at how many food-related decisions we think we make every day and compared it to how many we actually make. The results were pretty astounding. The researchers found that we’re aware of making about 15 daily decisions concerning food. The reality? We make over 200 food-related decisions every day! That difference is where most of your excess calories come from.

So the real low-hanging fruit, where a minor effort can have a major impact, lies in being more aware of even a small percentage of those 185 or so unconscious decisions you make every day. The accuracy and details of your food diary are not the critical factor in its effectiveness. Instead, the value of writing it down is that it encourages you to open your eyes to the many opportunities you have every day to make better decisions.

What does that mean for those of you who, like me, don’t care for keeping track of everything you eat? It means two things: one, you don’t have to obsess over the details. Just making a quick note – even a mental note – in the evening of whatever you can recall eating during the day can make a difference. Second, you don’t have to do it for the rest of your life. You can quit when you start thinking automatically about what you’re eating rather than just eating automatically.

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There is a concept in economics called diminishing marginal utility. This means that as a person increases consumption of a product there is a decline in the satisfaction or benefit that person gains from consuming each additional unit of the item. Applying this concept to eating may be one of the most useful things you will learn from this entire blog.

We have all had the experience of robotically eating something simply because it is in our line of sight and within arm’s reach. We may have a real desire for a piece or two of whatever it is, but if there is more than that available we are liable to continue eating far more than what it would take to satisfy that desire. Being mindfully aware of the enjoyment or pleasure that we are experiencing from that food is a critical element in preventing overeating.

The best way to illustrate this process is with what I’ll call the Food-Pleasure Curve, illustrated below. Think of each point on the curve as a unit of some food that you like but also recognize is an indulgence and can sometimes be a problem for you to resist. Let’s say it’s Hershey’s Kisses, which are about 25 calories each, and there’s a candy dish in front of you with eight individually wrapped candies in it. Seeing those makes you think about the taste and feel of what one would be like in your mouth, and that creates a desire for it, so you take one from the bowl.

The Food-Pleasure Curve

You unwrap it, pop it in your mouth and experience exactly what you imagined. The taste is very satisfying, it brings back memories of eating them when you were young and you get a fair amount of enjoyment from it. If you would rate it from 1 to 10 on a scale of chocolate pleasure, it would perhaps score a 7. That’s great! That’s what I would call an excellent return on a small investment. You’ve achieved a high degree of anticipated pleasure for a cost of only 25 calories. In fact, you’re so pleased with the outcome of the experience that you decide to have a second one.

You go through the same process and your pleasure from this one goes up from a 7 to, let’s say, a 9. After all, you’ve already experienced it once, which took you from 0 to 7. Now you just want to add to that experience so it’s likely to bring it up a just a few points. Now you’re at 50 calories and at 9 out of 10 on the pleasure scale, which is still what I would call a nice return. You know that your pleasure is not going to go any higher than a 9, but the experience was enjoyable and there are still six more pieces in the candy dish. You’re not quite ready to walk away from it so you eat one more to prolong the experience.

At this point you’ve had three candies and you’ve already maxed out at 9 on the pleasure scale, but you want just one more as a way of letting go and putting it aside. So you have one more for the road. Although it doesn’t increase your enjoyment, it also does nothing to diminish it, so the curve stays flat.

The bowl still has a handful of chocolates in it, though, and they’re still right there within easy reach; but you feel that you’ve already satisfied your initial desire to experience what you anticipated when you first saw the candies, and you’ve consumed 100 calories, so you decide to stop.

You distract yourself for a few minutes; you walk around a bit, and maybe do a little work. But on some level you’re still thinking about the chocolates in that dish. You finally convince yourself that you’re just going to have one more. So you eat it, but immediately feel a twinge of regret.

Now here is the important part: that small feeling of regret just cancelled out some of the pleasure you had initially experienced. This is where the marginal utility begins to diminish. It’s true that the fifth one tasted exactly the same as the first, which you fully enjoyed; however, you’ve already satisfied that initial desire, and in terms of your emotional state, you were kind of disappointed in yourself for not controlling that impulse to have more.

At this point, however, you also feel that you’ve already lost this round in your bout with self-control, and you think, why keep fighting it? So you have another, and adding that one to how you’re already feeling about yourself, you say “Oh, what the hell!” and, abandoning all restraint, you have the last few in the bowl. Now, in addition to the emotional letdown, you begin to feel a little physically disgusted. Your sense of self-loathing and weakness, to say nothing of queasiness, wipes out any enjoyment you got out of the first few chocolates. To add insult to injury, you’ve just taken in an extra 200 calories and have nothing to show for it.

We have all had this experience, even those who do not consider themselves emotional eaters. It’s not a sign of a disorder; it’s a sign of being human. The question is, what can you learn from it?

The part of this that is very human is our natural and mostly adaptive tendency to tune out our routine behaviors which allows us to focus on other, more complex mental processes. That’s what allows us to multitask; when we do that we’re really focusing on only one thing at a time, but we can accomplish other more routine tasks at the same time because they don’t require the same degree of cognitive effort.

The problem is that this “efficiency” comes at a cost. The lack of attention leads to errors, not because we’re using poor judgment, but because we’re not applying judgment at all! The process I described with the Hershey’s Kisses is actually an exaggerated version of reality. It’s typically not the way we consciously process the decisions we make, but it reflects what happens on the level just below conscious awareness.

The way to change this is to be mindfully aware of the following thoughts: your desire for something to eat, whether the item you are considering will satisfy that desire, how much it would take to do so, and at what point do you reach the maximum level of satisfaction that you’re likely to get without doing anything to diminish the pleasure you got out of it. Keeping the Food-Pleasure Curve in mind as a mental image can be very helpful in accomplishing that goal.

This step is the take-away, bottom line, upshot, payoff, etc. for everything we’ve discussed up to this point. So pay close attention. Once you have identified the reason (or reasons) you feel controlled, the next step is to take a good look at the situation that is causing the stress to see if you can change how it impacts you.

The key to doing this successfully involves the effective use of coping mechanisms. In psychology, coping with stress is broken down into three basic strategies. Depending on the nature of the stressor, each of these can be used to reduce or eliminate the impact of the problem that is making you feel controlled. These are:

  1. problem-focused coping
  2. appraisal-focused coping
  3. emotion-focused coping

Problem-focused strategies are simply solution-oriented approaches to dealing with a situation that causes stress. If the problem is due to something that can be changed, you can solve it by reducing or eliminating the source of the stress. Let’s say you’re tense and anxious due to your hectic schedule. You feel like you’re running from one meeting to another, while always being afraid that you’ll be late to the next one. You would look at how you are managing your appointments to see how you can reduce the problem.

A patient of mine was dealing with an extremely stressful work situation. He is a doctor working in a busy outpatient clinic where there tends to be a lot of patients who don’t show for their appointments. As a result, the clinic administrators looked for a way to balance patient flow without causing too many gaps for the doctors or delays for the patients. They found a good balance by looking at the average number of no-shows for the clinic and developed a practice of triple-booking each appointment slot to manage the patient flow.

This worked well for the most part. The problem was that cancellations and no-shows varied according to specialty and my patient’s specialty area had fewer missed appointments than the others. As a result, he was constantly overbooked, running late for each appointment and working late every day. The simple fix was to show the administrator how his cancellations and no-shows differed from the others, and that his appointments should therefore not be triple-booked. Problem solved.

This simple approach is the best way to deal with problems that are causing stress, so it should be the first thing to look for when you identify the situation that is causing you to feel controlled. If you’re overwhelmed with work, hire an assistant or delegate responsibilities to others. If your office desk has developed geological strata and finding things you need requires the skills of a trained archeologist, enlist the help of an organized person to help you come up with a better system.

These are fairly straightforward solutions to problems that can really end up controlling your life. In reality, though, it’s usually not so simple. Most of the time, the problem you’re dealing with is not so readily solvable but is rather an ongoing situation that does not lend itself to a simple fix. That leaves you with the next option: appraisal-focused coping strategies.  This means reappraising and challenging your assumptions – or in plain English, turning on your mental crap detector.

Without getting too philosophical about it, when we respond to any event, we feel and believe that we are responding to the plain reality that’s out there. That’s a reasonable and common shortcut that we use to unclutter our brains and streamline how we think. Unfortunately, it’s not true. The idea that we see things as they really are is a simplified but wrong view of the cognitive process we go through when we respond to events. The truth is that we’re really responding to our interpretation of the experience, which can be very different from the reality. So it’s essential to challenge the assumptions we make about how we first view the event.

Everything we see and experience first has to pass through a process of perception and interpretation before we respond to it. That interpretation of what we perceive is our own addition to the experience and it colors or even completely distorts our understanding of the event. It’s like a filter that we use on the camera lens of our mind. It distorts the picture we take of reality in a way that is unique to us. Often, we may apply the same filter to many different experiences. We don’t give too much thought to it when we do this, because it occurs at a level beyond our conscious awareness, and besides, most of the time it has no practical impact.

However, when we respond emotionally to our experience of an event, and then behave in some way that is in turn triggered by that emotional response, how we filter reality can make a huge difference. For the purposes of our discussion, it can determine whether or not an event will trigger an episode of binge eating or not.

It’s too easy to accept the sense of being controlled as the reality and to respond to that perception by eating. But what if your perception is not the reality? It is very possible that your filter tends to allow perceptions of external control to pass through more easily than alternative interpretations. So the most important question to ask is, “Am I really being controlled or are there ways that I can look at this situation differently?”

Appraisal-focused strategies are appropriate when there is no straight-forward solution to a problem. Instead of changing the cause, you modify how you think. This is what I wrote about in some detail concerning Hamlet’s prison. Whether you feel trapped or not may depend entirely on how you look at things.

Another patient of mine grew up as the oldest of six children. Her parents, whether by their nature or necessity, were very rigid about expectations of behavior and fairness. Among those rules were that the older children had to be responsible for their younger siblings. This wasn’t just a matter of watching out for their safety, but also making sure they were happy.

As a consequence, my patient had to do things like include her younger sister whenever she went out with friends, give up her right to an extra piece of pizza if her sister wanted it, and so on. Now, as adults, she doesn’t particularly enjoy the company of her younger sister, but feels incredibly guilty about not wanting to spend more time with her. Unlike the other person’s work schedule problem, this is not a situation that lends itself to an easy solution. So what does she do about the overwhelming stress that comes from the guilt she feels about not liking her sister? She had to reappraise the situation.

First, she had to recognize that perhaps her parents’ expectations were not fair to her. True, she was the oldest, but she was still just a little girl herself and had her own need to be a kid, not a nanny. So a lot of her resentment toward her sister was probably redirected from feelings she had toward her parents that were unacceptable for her to acknowledge. Second, she and her sister are very different people as adults, with different interests and personalities. Sometimes people who are members of the same family wouldn’t choose to be friends with each other if they weren’t related and they don’t have to feel guilty about that.

For this patient, of course, that was not an acceptable option growing up, and she never got the memo as an adult that this rule had ever been repealed. Allowing herself to admit that she would probably not choose her sister as a friend if they met as adults was a revelation to her. That doesn’t mean that she can ignore her as if they had no connection, but including her in her life her as one would any family member is not what was stressful to her. Essentially, she had to give herself permission to disregard rules that were at best obsolete and probably were never a good idea to begin with. This, not surprisingly, was a pattern that repeated itself in her relationships with friends, co-workers, and the men she dated.

This process of reassessing how one interprets and responds to reality is in fact the majority of what goes on in therapy. It’s what most of the talk in talk therapy is about. It’s a process that requires examining patterns of events and relationships and noting how you tend to respond to them until there are enough data points to connect the dots and see a consistent picture emerge.

Since the process relies on no one but you to accomplish, together with a therapist who supports your budding independence, it is a very good example of how to develop a sense of autonomous control in your life. If you commit to it and put what you discover into practice, it is usually a very effective and powerful way of implementing change. But even then, there will be lifelong habits of thinking and behaving that slip through, no matter how effective therapy is. That’s where the third coping technique, emotion-focused coping, can be very helpful.

Emotion-focused strategies involve dealing with the feelings that are stirred up as a consequence of the stressor. This can include managing hostile feelings by counting to ten, or reducing anxiety by meditating or using relaxation techniques. Unlike the first two strategies, which are directed at reducing the source of stress, emotion-focused coping is more tactical than strategic, since it is aimed at the effects of the stress. Distracting oneself from the urge to binge would be an example that is most relevant to emotional eating. This is what many therapists who work with emotional eating recommend when they encourage people to “surf the urge,” meaning, distract yourself from the urge to binge until it passes.

Other useful responses could include any type of pleasant activity that serves as a distraction and occupies your attention, preferably while occupying your hands as well. Any kind of needlework, doing crossword puzzles or taking a hot bath, might be some examples of emotional-coping behaviors. Going for a walk, exercise or reading could also work well. Watching TV might be an effective way to divert your attention, but it could also allow for having a snack while you watch, and the opportunity for habitual eating could defeat the purpose of distracting yourself from emotional eating.

Surfing the urge, and any other response that you might choose to take the place of emotional eating, can be helpful advice when you feel like bingeing and have no other way of dealing with it. However, I see this as a last resort, after the attempts to address the source of the stress has failed. That’s because emotional eating is the effect; the stressor, whether it is a problem that can be fixed or a perception that can be changed, is the cause. Whenever there is a cause and effect relationship, the most effective way to minimize the effect is to first address the cause.

With most of my patients, even those who have binged on a daily basis for years, I don’t begin treatment by getting them to change their behavior. If anything, that would just introduce a new form of external control that sooner or later would have the exact opposite effect of what we are trying to accomplish. Instead, I help them defuse the power of food by encouraging them to view all food as on the menu. Then we’ll look at their experience of external control and discuss the coping techniques I describe here. Often, after only a few weeks of therapy with someone who has been struggling daily, I’ll ask them how their eating has been. They’ll usually think about it for a few seconds and look up with an expression of puzzlement when they realize that it’s been a week or more since the last time they binged.

When it comes to emotional eating, perceived control is the cause; rejection of control is the effect. First try to solve the problem that causes the experience of feeling controlled; if that’s not possible, change your perception of that control. When that’s not enough, find better ways to respond to those feelings. The unwanted behavior will often take care of itself.

Have you ever found that it’s easier to diet when you’re doing it for yourself rather than to please someone else? If you have, research backs that up; people who make the effort to lose weight for their own reasons are more successful at it than those who are doing it for external reasons.

At least that’s what people in a six-month weight loss program said when they were asked about their reasons for dieting. The participants who reported more internal motivation to lose weight attended the program more regularly, lost more weight during the program, and maintained the weight loss better than those whose motivation was more external.

Mark Muraven was not involved in that study, but he is one of the researchers who helped develop the depletion model of self-control. In fact, as a graduate student working on his master’s thesis, he designed and carried out the original study that demonstrated how self-restraint has a negative impact on later attempts to control behavior, and concluded that it’s an indication that self-control or willpower  is a limited resource that gets depleted with use. Muraven is now an associate professor at the University of Albany and wanted to examine the effects of internal versus external motivation on self-control.  About five years ago he published an interesting paper that describes a study he carried out to explore this question.

He told participants (82 undergraduates) that the purpose of the study was to see the effect that sugar had on strength. It actually had nothing to do with that, but he needed the subjects to be blind to the real purpose of the study. (He straightened them out afterwards in a standard debriefing.) First, they were asked to squeeze a spring-loaded hand grip, which is a common task used to measure self-control. The more self-control they had, the longer they would squeeze the device before giving up. This was their baseline measure of how long they can hold it.

He then presented them with plates of assorted cookies and told them that he’ll be stepping out for a few minutes. Before he left, he explained that they can choose to eat the cookies or not. However, the researchers for the (mock) “sugar strength” test especially need participants who could be in the group of those who did not eat any cookies.  “The choice,” he emphasized, “is entirely yours. But we would really appreciate it if you would not eat the cookies.” When the investigator returned to the room, he administered the grip test again.

Only three of the 82 participants ate any cookies (their results were excluded), so the group was pretty compliant, but they had different motivations for not eating them. As they revealed on a questionnaire they were given afterward, some people endorsed internal reasons not to eat the cookies, like, “it’s fun to challenge myself,” which would be an internal motivation. Others didn’t eat them “because I want the experimenter to like me,” an external motive. The questionnaire was designed to measure autonomous self-control on a continuum from very internally motivated to very externally motivated.

They also measured the difference between the baseline and follow-up grip-strength endurance times for each person and compared the degree of drop-off in endurance with the degree of autonomy the subjects felt. The results? As the previous observations indicated, it confirmed that internal motivation for self-control was less “depleting” (in depletion model terms) than external motivation. The problem is, the resource-depletion theory has no explanation for why that should happen. As Muraven concluded, “this study indicates that the [depletion] model needs a significant revision, as autonomous self-control appears to deplete far less self-control strength than compelled self-control.”

I’m pretty sure I’m not the only one who has had this experience: You’re rushing to get out of the house on a winter morning to drive the older kids in carpool, and as you struggle to get the youngest into his snowsuit he’s screaming, “No! I want to do it myself!!”  Or you might be old enough to remember the tagline from the Anacin commercial, “Mother, please! I’d rather do it myself!” Young or old, people have a need to feel that they are the source of their own actions. Why is the need to do it by and for yourself so important?

The need for autonomous control, or the self-driven motivation to act, has been explained by two psychologists at the University of Rochester, Richard Ryan and Edward Deci. According to this idea,  called Self-Determination Theory, a feeling of autonomy is, along with competence and relatedness, one of the three main elements of intrinsic motivation. For a good non-technical explanation of these ideas, read Edward Deci’s Why We Do What We Do. In it, he relates an old Jewish fable told to him by a friend.

It seems that bigots were eager to rid their town of a Jewish man who had opened a tailor shop on Main Street, so they sent a group of rowdies to harass the tailor. Each day, the ruffians would show up to jeer. The situation was grim, but the tailor was ingenious. One day when the hoodlums arrived, he gave each of them a dime for their efforts. Delighted, they shouted their insults and moved on. The next day they returned to shout, expecting their dime. But the tailor said he could afford only a nickel and proceeded to hand a nickel to each of them. Well, they were a bit disappointed, but a nickel is after all a nickel, so they took it, did their jeering, and left. The next day, they returned once again, and the tailor said he had only a penny for them and held out his hand. Indignant, the young toughs sneered and proclaimed that they would certainly not spend their time jeering at him for a measly penny. So they didn’t. And all was well for the tailor.

As long as their motivation was their own sheer pleasure at giving this poor tailor a hard time, they would do it for free. But once they got used to doing it for a reward, their internal motivation was replaced by the external reward. When the incentive ended, the behavior stopped. (Think about the implications for corporate wellness programs that rely on incentives to get employees to lose weight and exercise!) Similarly, the surest way to doom whatever you might accomplish on a diet is to lose the weight for someone else rather than for yourself. At some point, the pay-off ends while the deprivation continues and is no longer worth it.

But what does all this say about whether self-control is the result of willpower, as the depletion-resource-strength model theorists contend? If you recall from my previous post about why people would repeat something that they know will cause them to feel worse afterward, my conclusion was that the reinforcement for that behavior was actually very powerful; it was all about freedom, autonomy, and control, as self-determination theory has been saying all along.

When Muraven says that the results of his study on autonomy and self-control indicate the need to revise the depletion model, I would agree.  It seems that when there is a sense of imbalance between having control over your own choices versus feeling forced or pressured to behave according to expectations – even self-imposed expectations – that balance must be restored. Sometimes, that may even be at the expense of having to deal with unpleasant consequences later .

When the depletion theorists describe certain behaviors, such as emotional eating, as a “breakdown” of restraint, it is not due to a passive depletion of the strength to resist; rather, it’s an active strategy to restore an imbalance in autonomy. In the next post I’ll describe in more detail this idea of balance, imbalance and restoration, and how it can be applied to improve the self-regulation of behavior.

When I was a clinical intern in the last year of my doctoral program, I worked in a hospital outpatient clinic that specialized in the treatment of eating disorders. Among the patients I had treated in that program were many young women who suffered from bulimia. Each had unique issues and different histories leading up to the problem, but when they described how they experienced their episodes of compulsive bingeing and purging, they did so in almost identical terms. I wasn’t surprised to hear them describe purging as a very negative experience, but if I was asked to guess how they would describe the food binges that preceded them, I would have expected them to say that they were in some way positive or enjoyable. But that was rarely if ever the case.

Instead, they depicted their emotional state during a binge as, at best, emotional numbness. They would turn off the thinking and feeling parts of the experience, and almost mechanically, would proceed to stuff themselves with a large amount of food. They described a sense of disconnection from the behavior, not enjoying it and barely even tasting it. It was as if the outcome was so inevitable they might as well just turn on the autopilot and quickly get it over with. If they were aware of any feelings at all they were negative: self-loathing, guilt, disgust. When I heard this same theme repeated by many of these young women, I recalled something I had learned in one of my undergraduate psychology classes that should have contradicted their accounts, and I couldn’t make sense of it.

In 1905, one of the earliest American psychologists, Edward Thorndike, discovered a principle of behavior that he called the law of effect. We now consider the idea so basic and intuitive that it seems surprising anyone even had to “discover” it. In simple terms, the law of effect states that if a behavior produces a satisfying effect in a particular situation it is more likely to occur again under similar circumstances, and if it produces a negative or uncomfortable effect it is less likely to be repeated.

The problem that bothered me may by now be obvious to you. According to Thorndike, even a puppy can be trained to be housebroken if  some negative experience follows the behavior. So why did my patients with bulimia continue to engage in a behavior that left them feeling physically ill, depressed, guilty, and out of control? Not only were they willing to repeat the behavior in spite of the known consequences, but they felt compelled to do it! This was troubling to me, and I was given a variety of unsatisfying explanations by people more experienced than I. But as a trainee I figured I must be missing something that was obvious to everyone else so I put the question aside.

A few years later, I began a clinical practice treating patients with a wide range of psychological problems. After about ten years in practice, I became interested in the area of health psychology, and narrowed the focus of my practice to work with people who wished to improve their health behaviors and lower their risk of chronic illness. Since obesity is the primary preventable cause of heart disease and diabetes, I began to specialize in helping people who had difficulty managing their weight and eating behavior. Most of these patients struggled with emotional eating.

As I have always done when I meet and evaluate patients with a behavioral problem, I would ask them to describe their thoughts and feelings while they engaged in the unwanted behavior. Almost all of them conveyed their experience in negative terms, or like the bulimic patients I had treated as an intern, as emotional numbness. It wasn’t long before I recalled the puzzle I had set aside years before: Why would anyone repeat a behavior that makes them feel worse? This time, however, I was not going to let go of it. If there was one thing I had learned by then, it was that many experienced people tend to take things for granted and fail to ask the most obvious questions. And often, it is the obvious questions that are most important. The answer to my question took a while longer to find, but I finally solved it with the unintentional help one of my patients.

Lauren was a very successful and driven sales manager. She was able to lose more than 15 pounds over a six month period. Around the time that she lost the weight, she was in the process of changing jobs in a very high pressure industry because she was feeling under utilized. She had started a new job, but with less time flexibility and increased responsibility, she became quite busy and was soon no longer able to continue coming in for therapy. Although she had not yet reached her desired weight, she was happy with her progress and felt she had a good sense of what she needed to do to continue on her own.

After about eight months without hearing from Lauren, I received a call from her asking to set up an appointment. She explained that she had gained back all of the weight she had lost, plus six more pounds. Although she loved her new job, she was very stressed, traveling four days a week. With a husband and two young children, along with many social and volunteer responsibilities, Lauren was pulled in so many directions that she felt she was not fully meeting any of her obligations, especially in her personal and family relationships.

She knew that her overeating was not about enjoying the food itself. As with virtually all of the other patients I was seeing for binge eating, she did not enjoy any part of the eating itself. This behavior was also not directly a result of her frequent travel and lunch meetings in restaurants. In fact, she was always very careful about what she ate when she was with other people because she was self-conscious about what they would think.

She explained that several times a week she would binge when she was alone in her hotel room and needed to take a break from her tightly-packed schedule and responsibilities and just let go. As she described it, “Eating without thinking about it is like taking a mini-vacation or going to a spa whenever I need it. I’m not enjoying what I eat; I just need to let go every once in a while.”

As I listened to her describe her experience, I realized that I had the answer to my question about what triggered her behavior and what maintained it. The reinforcement was powerful; it was just not as obvious a reward as enjoying a snack or giving a treat to a puppy. Call it defiance, rebellion, or self-determination; people have a need to abandon restraint when they feel controlled. Even though the experience was always brief and had a bad outcome, it allowed her to satisfy a much stronger need: to feel free. Thorndike’s law of effect had not, after all, been repealed.

My approach to treating emotional eating had shifted from that point forward. I realized that it was not about food, eating, or even loss of control; it was about gaining autonomy. Instead of viewing it as a passive breakdown of resistance, I see it as an active need to let go by abandoning control and relieving the pressure of restraint.

Why do we have such a strong need to be free of control? Coming up.

What do we mean when we refer to emotional eating, and how does it differ, if at all, from compulsive overeating, binge eating disorder, and bulimia?

It may surprise you but there is still, as of this writing, no official diagnosis for binge eating disorder, much less emotional eating. This is in spite of the fact that it is the most common of all eating disorders. It affects almost half of all adult women who have any type of eating disorder, and one-third of all people who diet. For the time being, it’s officially categorized in the diagnostic manual as Eating Disorder Not Otherwise Specified. It may not be necessary to stick a label on every problem, but it is useful to have a widely agreed upon and accepted way to define a common syndrome so we’ll know if a treatment that has been found effective for some people can be expected to help many others with the same symptoms.

There is a behaviorally-based definition for binge eating disorder that has been proposed for inclusion in a future edition of the Diagnostic and Statistical Manual. The central features of this diagnosis include eating an excessive quantity of food “that is definitely larger than most people would eat…under similar circumstances” and consumed within a “discrete time period,” accompanied by feeling a loss of control and followed by marked distress. There are a few other associated behaviors like eating quickly and feeling uncomfortably full that are added, but the basic definition is virtually identical to that of bulimia but without compensatory behavior, such as purging.

This similarity to bulimia, plus the vagueness of the supposedly objective criteria in the definition may be an indication of why there is not yet an official diagnosis for such a common syndrome. That’s because this behavior is not only a mental disorder, but it’s also a very common though maladaptive coping mechanism that virtually everyone has experienced at one point or another. In other words, it includes a very broad gray area that gets darker and darker until everyone would agree that it is no longer grey. The problem that the DSM people seem to be struggling with is agreeing on how to define the point that it turns black.

This reflects a larger problem with defining many disorders that are dimensional or based on frequency and severity. When does daydreaming or restlessness become attention deficit disorder or hyperactivity? At what point does apprehension become anxiety? Where do we draw the line between a burst of creative exuberance and hypomania? These are easy to identify as pathological at the extreme end of symptom frequency and severity, but defining that boundary can be very subjective. It’s different than a diagnosis that’s defined by categorical symptoms, such as many that accompany psychosis, which are either present or they’re not.

Emotional eating is an example of a dimensional behavior. Rather than viewing bulimia, binge eating disorder, and compulsive overeating as unique disorders, they can be seen as a subset of emotional eating. The difference between them is that the behavior may differ in frequency and quantity, and people vary in how they deal with the anxiety caused by it – some try to compensate by trying to undo it while others don’t – but the emotional eating may really be just one very common coping mechanism to ease stress. If that’s the case, how does this coping mechanism help?

To explain that will require a separate post (or several). But it’s helpful to first understand the current thinking about self-control and what causes it to break down. In a nutshell, this theory proposes that self-control, or willpower, is a limited resource like muscle strength that gets weaker each time we use it. That means that the more you have to restrain your behavior, the worse your self-control will be. The theory is well summarized in David McRaney’s blog post and it offers a very compelling explanation that’s based on a slew of studies. Keep an open mind while reading it though, because there are a lot of problems that this theory does not address and there are other ways of interpreting the research.

Meanwhile, ponder this: why would anyone try to cope with distress by doing something that will make them feel worse? Rather than solving the problem it just adds to it! Even if it happens once or twice, don’t we learn from doing something that turns out badly and try to avoid repeating it? Stay tuned.