Eating Disorder Compensatory Behaviors

What Are Compensatory Behaviors?

Compensatory behaviors are activities people use to counteract the effects of eating to avoid weight gain or relieve guilt experienced from eating. Looking deeper into compensatory behaviors, we learn that these behaviors are often associated with individuals suffering from eating disorders and are also a leading criteria for a bulimia nervosa diagnosis. Many engage in high-risk behaviors that may lead to medical complications and major psychological implications.¹

In eating disorders, emotions such as guilt, shame, and anxiety can be challenging to tolerate, and there is a huge fear of gaining weight due to the pressures of diet culture, all-or-nothing thinking, and fat-shaming. In addition, the culture’s obsession with thinness and visual appearance all play an integral role in influencing our society, whether one’s aware of it or not.²

Common examples of compensatory behaviors include:

Purging

Purging is a behavior that needs quick attention due to the medical implications that it may have on a person. The physical consequences that may occur include dehydration, hospitalization, or even death.³ Purging sometimes plays a role in managing difficult emotions. For example, it may help a person numb intense feelings of anger, sadness, and loneliness.³ It is also influenced by society’s diet culture and fat-shaming ideals.

Self-Harm

Self-harm is when an individual intentionally produces harm to one’s own body. Self-harm can often be alarming, but it is not always an indication of an attempt at suicide; however, it does place the individual at higher risk of suicide. Self-harm behaviors are most often manifested in behaviors such as “cutting one’s skin with sharp items, hitting oneself, burning oneself with cigarettes or candles, or intentionally breaking one’s bones or inflicting bruises.”⁴

For those with eating disorders, emotions can become unbearable, and people may use self-harm behaviors as a way to relieve their uncomfortable emotions of anxiety, guilt, and shame. For those who also struggle to feel emotions, it is reported that self-harming will activate the body’s endorphins, which in turn will improve their mood.⁴

Compensatory behaviors, due to the nature of harm they can have on the individual, can also be a form of self-harm for those struggling.

Food Restriction & Fasting

Diet-culture’s influences and high value on thinness also play a role in the increased anxiety some people have regarding their food consumption. This may lead to disordered eating patterns in the form of chronic dieting, food restriction, or fasting. Food restriction is any time someone does not consume enough calories that the body needs to sustain itself to function properly. It is important to remember that food restriction or fasting can happen in any body size, with any eating disorder, or when exhibiting disordered eating patterns. It commonly occurs when people diet or want to engage in fasting or a detox “cleanse.”³ People might do these behaviors to maintain control over their body and weight.

Excessive Exercise

It is well known that exercise can provide many health benefits to people with a healthy relationship with movement. It is also shown to be an effective treatment for certain psychological disorders such as depression, bipolar disorder, schizophrenia, grief, chronic pain, and addictions.⁵ However, the relationship with exercise can become toxic and sometimes dangerous when done excessively as a compensatory behavior in eating disorders used as a way to control body shape.

Associated Disorders

Eating disorders often involve more than one compensatory behavior, which can lead to detrimental physical and mental health consequences. Compensatory behaviors such as restricting food intake, engaging in food rituals, or purging may seem like a way for your mind to cope with guilt over consuming calories. However, these behaviors can be rough on the body and impact someone’s emotional well-being. Individuals can learn healthier and safer ways to manage uncomfortable emotions in therapy.

Compensatory behaviors can be exhibited within these eating disorders:

Anorexia Nervosa

Anorexia nervosa (AN) is defined by the DSM-5¹ as severely restricting food intake that is required by the body to function. Anorexia leads to significant low body weight in relation to age, sex, and physical health. People with anorexia have an intense fear of gaining weight or becoming fat despite having low body weight.

Compensatory behaviors can be found in both subtypes of anorexia, including restricting type and binge-eating/purging type. For example, restriction behaviors are found in the restricting anorexia type, but no binging or purging behaviors. In the binge-eating/purging subtype of anorexia, binge eating behaviors are found, followed by self-induced vomiting, misuse of laxatives, enemas, or use of diuretics.

Bulimia Nervosa

Bulimia nervosa (BN) is defined by the DSM-5¹ as multiple episodes of binging followed by recurrent inappropriate compensatory behaviors to prevent weight gain from occurring. Behaviors such as self-induced vomiting, misuse of laxatives, fasting, excessive exercise, or other medications can be found. These behaviors can be found to occur at least once a week for three months. Distorted views on body image are also common in individuals with BN.

Binge-Eating Disorder (BED)

Binge-eating disorder (BED) is defined by the DSM-5¹ as having multiple episodes of rapidly eating large amounts of food to the point of discomfort and pain. A person may report feeling a loss of control over their food intake while experiencing feelings of guilt, shame, and depression. Compensatory behaviors in BED might be manifested by people feeling as though they need to eat in secret while binging. Restriction and dieting behaviors may be found after binging episodes due to fear and pressures placed by diet culture to be thin or due to anxiety over health concerns.

Purging Disorder

Purging disorder does not have its diagnosable disorder in the DSM-5¹; therefore, if searching for it, you would have to find it under “Other Specified or Eating Disorder.” Despite not being its own diagnosis, purging disorder causes significant distress and has health consequences. Compensatory behaviors are repetitive purging behaviors to influence their weight, including self-induced vomiting and misuse of laxatives or medications such as diuretics. Binging is not a behavior that is found in purging disorders. This is a notable difference between Bulimia Nervosa and BED.

Can You Have More Than One Compensatory Behavior?

It is common to find individuals with eating disorders will often have more than one compensatory behavior. It’s similar to how people can develop more than one way to manage uncomfortable situations and feelings. Common compensatory behaviors people have together include restricting food intake and then over-exercising after a meal to control their body weight and shape.

How Are Compensatory Behaviors Treated?

Due to the nature of the harm of compensatory behaviors, treatment is necessary. Many tools and therapeutic modalities can treat and address compensatory behaviors, such as cognitive behavioral therapy (CBT). CBT helps people connect how their thoughts and feelings influence their behaviors.  It can also help people develop new coping strategies to prevent the need to turn to compensatory behaviors.

It is also important to work with a dietitian for nutritional counseling and weight restoration monitoring if needed. If children or adolescents are involved, involving the whole family to help increase the success in recovery is important.⁶

There are some cases where higher levels of care might be necessary to help people overcome these obstacles, such as in residential, hospital, partial hospitalization, or intensive outpatient therapy. What is needed is always determined by each individuals’ treatment team in order to keep them safe.

Coping With Compensatory Behaviors

Together with your therapist, you can explore how to utilize coping skills within the treatment plan to help decrease any urges for engaging in compensatory behaviors. You’ll think of ways to manage emotions over food and your body image in an emotionally safe way.

Ways to help improve negative patterns of behavior can include:

• Meditation: Meditating is the act of practicing stillness and training your mind to focus on the quiet and eliminate distractions.
• Mindfulness: Practicing mindfulness is training your mind to stay in the present moment
• Journaling: Journaling is a coping skill activity that helps you reflect on your emotions and thoughts.
• Art therapy: Expressive arts is the ability to put into drawing your emotions and feelings.
• Support system: Connecting with loved ones and friends is always refreshing to the soul.
• Self-care: Practicing daily self-care is the daily discipline of learning to take care of your emotional, physical, and spiritual needs emotionally. Each person’s self-care tasks will look different.

Treatment Options for Eating Disorders

Treatment for eating disorders varies depending on the severity and the needs of the person.  Examples of treatment may include individual therapy sessions at the outpatient level with an eating disorder specialist. Family therapy can also be included to provide additional support, especially when involving children and adolescent clients. Treatment is often combined with nutritional counseling and with a medical provider as needed.

Treatment options for eating disorders also include:

• Enhanced cognitive behavior therapy (CBT-E): Enhanced cognitive behavior therapy(CBT-E) can help treat eating disorders by focusing on one of the individual’s disordered eating patterns and distorted views on body image and weight. It has been demonstrated as helpful with a variety of eating disorders.⁷
• Online eating disorder treatment programs: Online eating disorder programs such as Equip Health and Within Health offer virtual eating disorder care involving multiple providers to assist clients in recovering from eating disorders such as anorexia nervosa, bulimia nervosa, binge-eating disorder, and avoidant restrictive/food intake disorder(ARFID).The virtual platform makes it more flexible for clients and more accessible for those who can not drive or have a facility close by.
• Group therapy: Group therapy for eating disorders can be beneficial for people living with eating disorders because it can provide a safe place to express thoughts and feelings with others who are living the same experience.This can help with feelings of isolation and loneliness that eating disorders can bring. In group discussions, individuals can find new coping strategies, support from one another, and develop meaning through their journey towards recovery.
• Meal support: Meal support is a service that can be offered by any trained eating disorder professional. An eating disorder trained dietitian who is collaborating with an individual might have a set meal plan or goal that the individual is trying to work towards to heal their relationship with food. However, the individual may struggle to eat alone. Eating disorder professionals will sometimes eat with their clients in order to offer support and encouragement during this time of recovery.

How to Find Treatment for Compensatory Behaviors

Finding and gathering a support team to help in the process of recovery is key to future

success and relief from an eating disorder. Finding a therapist from an online therapist directory that specializes in eating disorders can be beneficial, as well as finding local support groups.

Awareness and understanding if you have an eating disorder is the first important and brave step towards a person’s recovery from an eating disorder. It is a sign of strength, and not weakness, when deciding to take that step forward because it does take a lot of mental energy to heal. However, people who have recovered from an eating disorder have reported that it is always worth it. It is also important to remember that the individual is not doing this alone but is part of a treatment team of support and encouragement to help them on each step of the journey.

How to Help Someone Experiencing Compensatory Behaviors

Supporting someone who is suffering from compensatory behaviors associated with eating disorders can be tough, there are ways to offer support to someone with an eating disorder. Friends and loved ones play a very important role in their journey as they can offer compassion and provide a safe space for them to grow and heal.  Providing them with the ability to communicate and express what their concerns are is very important to know exactly what kind of help they need.

Recovery takes time. It is also vital to get educated on eating disorders and attend support groups for those who have loved ones struggling with an eating disorder. Assisting and offering help to find professional treatment is also very valuable to someone who is struggling.

You can offer support to a loved one struggling with compensatory behaviors by:

• Being patient
• Encouraging therapy
• Listening
• Attending therapy sessions as needed for support
• Reading material on eating disorders
• Being mindful on diet culture’s influences in your daily life