Satiety Dysfunction: a Novel Eating Disorder?

Binge eating disorder is discussed less frequently than most eating disorders. There is a specific subtype of binge eating disorder that has even more limited exposure. It involves people who have obsessive thoughts about food all day, intense cravings for various foods and who compulsively eat all day. Many if not most days, they eat until they are in pain and can hardly move or breathe. However, they never binge in the typical sense by eating a much larger than normal meal in a short period of time. Instead they eat constantly without cease all day.

For most eating disorders there is a clear emotional connection to the eating, but in this circumstance, it is often difficult to find immediate connections between behaviors and emotional or psychological needs. Eating is almost a constant, physiological need.

In treatment or circumstances without access to food, these people can refrain from binging. With any access, the thoughts and urges are almost impossible to resist.

Unlike many eating disorders, I have wondered if this type of eating disorder may turn out to have clear biological underpinnings. We all have cravings to eat food and then are satisfied once the meal is done. These people don’t seem to have the mechanism of satiety which leads to feeling satisfied, both physically and mentally, followed by the decreased desire to continue eating. As we learn more about the gastrointestinal hormonal system, it is possible these people have an abnormality in this system which inhibits their ability to respond to satiety appropriately.

The reality of this kind of eating disorder is constant physical discomfort and often pain. Endless binging leads to chronic gastrointestinal pain and stretching out of the stomach. Sometimes people can get so full that it takes hours if not a full day to digest the food. The energy needed to digest and process this amount of food takes away from energy for the rest of life, and functioning in school or work can suffer. The effects can be debilitating.

In my experience, many of these patients try a sufficient round of therapy and treatment to no avail. Medications such as Topamax, Vyvanse and even an old medication no longer available in he United States called Meridia can be effective. When a medication helps, it is as if a light is switched off. People suddenly feel able to withstand mental cravings for food and can heed satiety cues. The result feels miraculous to them. It’s very rare for people with eating disorders to have such an immediate and potent response to medications.

These symptoms seem to function as a different kind of eating disorder. I consider the symptoms as a problem with satiety more than anything else. Recognizing this illness as a distinct entity in the eating disorder treatment community would help these people get care tailored to their specific issues.