What Are Compensatory Behaviors in People with Eating Disorders?

Compensatory behaviors are meant to relieve the guilt from eating

Weight Loss Pills & Scale
Weight Loss Pills & Scale. Jeff J Mitchell / Staff / Getty Images

Compensatory behaviors are simply things people with eating disorders do in an attempt to make up for having eaten and consumed calories. They are an attempt to erase anxiety, guilt or other "bad" feelings about the food eaten and the act of eating it.

These behaviors are considered symptoms of bulimia nervosa, ​anorexia nervosa, and purging disorder, although they may also be seen in people with ‘disordered’ eating behaviors or other eating disorders.

 

Compensatory behaviors may occur when someone eats more than they had planned on eating or are comfortable with eating, after a binge-eating episode, after eating specific foods, or after a regular meal. As the name indicates, these behaviors are usually an attempt to compensate for the number of calories or amount of food eaten or to relieve the negative emotions triggered by eating. They are often driven by a fear of weight gain.

Examples of Compensatory Behaviors

The most well-known compensatory behavior is self-induced vomiting. However, other examples of compensatory behaviors in eating disorders include the misuse of laxatives, misuse of diuretics (pills intended to eliminate excess water), misuse of colonics and enemas, overuse of and compulsive exercise. It can also include engaging in cleanses and drinking special teas with laxatives.

Fasting or restricting food intake for a period of time after eating may also be considered a compensatory behavior.

In addition, researchers have found that some people with eating disorders chew their food and then spit it out as a compensatory behavior. One study found that nearly 25% of people with eating disorders engaged in this behavior. People who do this tend to have more severe eating disorders, that study showed.

Using Multiple Compensatory Behaviors

Unfortunately, many people with eating disorders continue to increase the amount or number of compensatory behaviors they engage in so that they can continue to achieve the same level of stress and anxiety reduction as when they first started with these behaviors.

In fact, people with eating disorders who use more than one compensatory behavior — for example, self-induced vomiting plus laxative use — are likely to have more severe eating disorders, one study showed. In that study, which involved 398 children and adolescents, nearly 38% of the subjects used more than one compensatory behavior.

Girls were more likely than boys to use more than one compensatory behavior, and those diagnosed with bulimia were more likely than those diagnosed with anorexia to use multiple compensatory behaviors, the study found. Those who did use more than one compensatory behavior had, on average, lower self-esteem and lower overall functioning than people with eating disorders who used one or no compensatory behaviors. Younger children with eating disorders are less likely to use compensatory behaviors.

Treatment for Compensatory Behaviors

The compensatory behaviors often serve to maintain a cycle of disordered eating.

Most of the compensatory behaviors carry a risk for potential medical problems. Treatment of the eating disorder should focus on stopping the compensatory behaviors. Cognitive behavioral therapy is one of the most successful treatments for addressing the compensatory behaviors of an eating disorder. Patients are taught about the dangers of the particular compensatory behaviors they are using. For example, self-induced vomiting can affect one's voice, damage the esophagus, and lead to a heart attack. Laxative abuse can cause damage to the colon. Excessive exercise can lead to overuse injuries.

In cognitive behavioral therapy, patients are taught alternative ways of managing anxiety and guilt. They also learn to tolerate negative emotions and feelings of fullness after eating. The goal is for patients to develop more appropriate coping strategies such as reaching out to others for support, journaling, or meditation. Specific cognitive-behavioral strategies for stopping compensatory behaviors may be found here

Sometimes stopping these compensatory behaviors can be very challenging, especially for people who have been using them for many years. In such cases, they have become habits and may feel "automatic." Professional help can help patients overcome these behaviors. In some cases, a higher level of care such as residential treatment may be necessary to interrupt frequent or entrenched compensatory behaviors. 

Sources:

Song YJ et al. Chewing and spitting out food as a compensatory behavior in patients with eating disorders. Comprehensive Psychiatry. 2015 Oct; 62:147-51.

Stiles-Shields CE et al. The use of multiple methods of compensatory behaviors as an indicator of eating disorder severity in treatment-seeking youth. The International Journal of Eating Disorders. 2012 Jul; 45(5):704-10.

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