Eating Disorders and Irresistible Impulses

Monday, March 20, 2017

300300p27278EDNmain498ACUTE Medical Monday Dunn 400 v21Those struggling with an eating disorder often have a double curse. Sure, friends and family may worry about the woman who is too skinny. Roommates may fret over the girl that disappears into the bathroom after meals. But for some who have eating disorders, they also battle to control other impulses that are just as harmful. Jessica* started binging and purging in late high school to control her weight. As her eating disorder became severe and her weight loss endangered her health, Jessica started compulsively spending money. A credit card that was to be used for “emergencies only” fueled an online shopping spree. The card, soon maxed out, stopped working. So Jessica swiped her mother’s American Express. Knowing the billing address and having the card in hand, she charged over $10,000 in merchandise before her parents caught on and shut down the account. “I wasn’t even buying things I needed,” said Jessica.

Some other individuals with eating disorders suffer from impulsively making choices that they regret later. Emily* found that she routinely would have sex with men that she had just met. At her lowest point, she said, she even had unprotected sex with two men at the same time. “If I had been in a different place in my life, I would have never done something like that,” she said. “I hated myself for it later.” Emily estimated that during the times when her bulimia was at its worst, she was routinely having sex with strange men several times a week. “I couldn’t help myself,” she said.

Jessica and Emily are not alone. Several studies have shown that those who have eating disorders are at higher risk for impulse control problems. Such problems can include shoplifting for the thrill of it, or having problems keeping their temper under control. While those with bulimia seem to be at the highest risk (perhaps two out of three having problems with both eating and impulsivity), those with anorexia are not immune, with just less than one out of three reporting impulse control problems.

Why these conditions co-occur are somewhat of a mystery to the medical community and other researchers. Our best guess is that there seems to be an underlying problem with the part of the brain that controls impulsive behavior. Everyone (even those without impulse control problems) has had the thought of being in a quiet place, such as a movie theater or church service, and wondered what would happen if they stood up and started screaming profanity. Neuroscientists believe it is the frontal lobes of the brain that keep such impulses in check (most people will never actually get up and start screaming). Housing the “executive functions” of the brain, among the jobs that the frontal lobes do is provide a mechanism to stop us from engaging in behavior that may have harmful consequences. There seems to be a common circuit that affects both those with eating disorders as well as those who have trouble controlling impulsive behavior that has negative consequences.

While not all individuals with eating disorders will experience problems with impulse control, there is significant overlap between the two conditions. Those who commonly treat eating disorders would do well to also assess for impulse control problems in their patients. It is imperative that those with both an eating disorder and issues with impulse control seek treatment. There are some studies that suggest that individuals who have and eating disorder along with significant impulse control problems are harder to treat.

Warning Signs Regarding Impulse Control Problems

  • Repeated episodes of the shoplifting or stealing associated with a growing tension before the act and a pleasure release afterward
  • Engaging in reckless behavior without considering the consequences
  • Unwanted pregnancies or sexually transmitted infection from sexual promiscuity
  • Aggressive and/or emotional outbursts over trivial things
  • Compulsive spending that causes debt or turmoil with friends and family
  • Gambling debts
  • Fire setting
  • Any behavior that an individual feels powerless to control

Eating disorders and problems with impulse control can be severely impairing and can take a severe emotional toll on its sufferers. Get help today.

By Thom Dunn, PhD

*No real names were used in this column.