Compulsive eating: a neuropsychologic approach to certain eating disorders.

The view advanced here suggests that compulsive eating should be regarded as a separate psychiatric syndrome and not as an integral part of other eating disorders. The syndrome is characterized, in general, by a primary neurologic dysregulation and secondary psychological reactive disorder, which varies among different patients. This variation has led to considerable conceptual confusion and deprived these patients of a possible successful pharmacologic intervention. The confusion stems in part from the fact that persons who appear to be very different (vis. fat or thin) may be quite similar in that they both suffer from some common neurologic disease. They appear different because they resort to different psychological defense mechanisms. In contrast, confusion is more easily elicited when persons who appear to be very similar (viz. obese) are so for very different reasons. That is, excessive weight gain (or loss) is the final common pathology resulting from more than one possible etiology. It may now be possible to distinguish between neurogenic compulsive eating and other psychogenic or medically based eating disorders. The former may be amenable to successful pharmacologic treatment as well as psychological.