Binge eating and sexual compulsion

The present text is a research on the literature of pathological impulses and compulsions. The objective is to inform about two specific compulsions, being them the binge eating and the sexual compulsion showing professionals in the area and people who are interested in the subject so present in our daily lives. We use the psychoanalytical approach to define compulsion, impulsion, how these pathologies arise and how they are classified.

The methodology used was the qualitative method. The concepts presented are binge eating disorder (BED), bulimia nervosa (BN), anorexia nervosa (AN), sexual compulsivity, sexual impulsivity and sexual addiction.

Freud believed that instincts are primary impulses and the other impulses are elaborations of the first ones organized throughout psychic development. In 1915, Freud highlighted the following components of the instinctual response:

– Pressure: the essence of instinct is represented by its energy.

– The purpose according to Freud, “the purpose of the instinct is always satisfaction, which can only be achieved by suppressing the state of stimulation of the source of the instinct”, in other words, it always seeks satisfaction.

— The object by means of which the instinct attains satisfaction.

– The source is the somatic process from which the instinct originates.

Later, Freud divided impulses into two categories: life instinct (Eros) and death instinct (Thanatos) (ABREU; TAVARES; CORDÁS; 2008)

The impulse, for psychoanalysis, designates the sudden appearance, felt as urgent, of a tendency to carry out this or that act, this one being carried out beyond any control and generally under the domain of emotion; neither the fight nor the complexity of the obsessive compulsion, nor the organized character according to a certain fanciful staging of the compulsion to repeat, is found in this concept.

PEREIRA (2012) refers to impulsive acts as resulting from the imbalance between the strength of impulses and affections and the ability to modulate the ego and have the function of relieving anxiety through drive discharge. In impulsive subjects, the fragile ego, with little capacity for continence, does not prosper in containing the instinctual demand.

Compulsive behaviors are the result of the ego’s attempt to contain the instinctual expression. The anxiety generated by the instinctual movement signals the ego to mobilize specific defenses and, in the normal individual, the psychic instances would form an agreement in which both poles of the conflict would obtain partial satisfaction. In compulsive subjects, the intrapsychic conflict between the ego and the drives coming from the id would not be completely resolved, originating the compulsive symptomatology with specific patterns of defensive maneuvers against the drive demand. (PEREIRA, 2012)

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Periodic binge eating

The most common eating disorders are periodic eating disorders (BED). It is characterized by the presence of recurrent episodes of ingestion of large amounts of food in a short period of time, followed by a feeling of shame, guilt, anguish at the loss of control over the act of eating, over what is eaten and what later regret for having eaten (CIENTIFÍCA, 2011)

The TCAP identifies people who have recurrent episodes of binge eating during which they eat, in a defined period of time, large amounts of food and with a feeling of loss of control. These episodes are bulimic, but unlike what happens in bulimia nervosa, people with BED do not systematically adopt inadequate compensatory mechanisms to avoid weight gain due to the overeating that occurred in the episode. (PASSOS; YAZIGI; CLAUDINO; 2008)

Obesity is not a diagnostic criterion for BED, but it is a clinical condition that almost always accompanies the condition.

The age of onset of the condition is around 20 years old, but people with BED usually seek treatment after the age of 30; it is more common in women, although 1/3 of those affected are men (AZEVEDO; SANTOS; FONSECA; 2004).

It is important to clarify that the DSM-IV criteria, then proposed for the diagnosis of BED, were thus characterized from recurrent episodes of binge eating, such as:

1) eating, in a limited period of time, an amount of food that is definitely larger than most people would consume in a similar period of time under similar circumstances;

2) feeling of lack of control over the episode. It is also noticed that episodes of binge eating are associated with three or more criteria, including:

I. eat more quickly than usual;

II. eat until you feel uncomfortably full;

III. eating large amounts of food, even when not physically hungry;

IV. eating alone, out of embarrassment, due to the large amount of food consumed;

V. feeling disgusted with yourself, depressed, or too much guilt after overeating;

SAW. marked anxiety related to periodic binge eating.

Periodic binge eating occurs at least twice a week, over a period of six months, and is not associated with the regular use of inappropriate compensatory behaviors, such as fasting, excessive exercise and purging, as in bulimia nervosa, in which binge eating occurs. , as can occur slightly in anorexia nervosa. (AZEVEDO; SANTOS; FONSECA; 2004)

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There is evidence that patients with BED eat significantly more food than obese people without binge eating. BED can occur in normal weight individuals and obese individuals. Most have a long history of repeated dieting attempts and feel hopeless about their difficulty controlling food intake. Some keep trying to restrict their calorie intake, while others abandon any dieting efforts because of repeated failures. In weight-management clinics, individuals are, on average, more obese and have a history of more marked weight fluctuations than individuals without this pattern (KELNER, 2004).

In psychoanalytic treatment, the updating of primary processes exalts the place of food orality and the image of obesity. It is the constitution of an inner space that finally ensures the conditions for a new narcissistic image and it is from there that the patient can find his balanced diet and the physical and sports activities that suit him, without attributing the solution to the outside. of all your psychic difficulties. (KELNER, 2004)

anorexia nervosa

Anorexia nervosa is characterized by intense weight loss at the expense of rigid diets that are self-imposed aiming at an unbridled quest to achieve the condition of thinness, accompanied by a significant distortion of body image and manifestation of amenorrhea. (ABREU; FILHO; 2005)

The main components pointed out in the literature that reinforce the search for incessant weight loss are low self-esteem and body image distortion, leading patients to an exaggerated practice of compulsive physical exercises, prolonged fasting or even the use of laxatives and diuretics as a form of weight loss. aid for weight loss. (ABREU; FILHO, 2005)

There are two types of clinical diagnosis, the restrictive type, patients employ restricted diet behavior. And the second purgative type occurs binge eating, with self-induced vomiting, use of laxatives and diuretics. The ICD 10 no longer restricts anorexia only, anorexic patients can also have bulimia. (APPOLINÁRIO; CLAUDINO, 2000)

The most frequent psychological characteristics: (a) low self-esteem, (b) pronounced feeling of hopelessness, (c) unsatisfactory identity development, (d) tendency to seek external approval, (e) extreme sensitivity to criticism, (f) lack of assertiveness and (g) lack of autonomy and independence. (ABREU; FILHO, 2005)

The diagnosis of anorexia nervosa is made according to the criteria established by the DSM-IV (Table I), and it is essential to rule out tumor, hormonal, gastrointestinal diseases, in addition to certain psychiatric conditions, such as depression and schizophrenia (Table II). (RIBEIRO; SANTOS, 1998)

Table I – Diagnostic criteria for anorexia nervosa (307-1) – DSM IV:

Nervous bulimia

Bulimia nervosa is characterized by a very rapid and intense intake of food associated with a feeling of loss of control – the so-called bulimic episodes. Which are accompanied by compensatory methods so that weight control is maintained, that is, after the ingestion of large amounts of food (around 3,000-4,000 Kcal in a single compulsive episode, episodes with an intake of up to 20,000 Kcal), patients engage in purging behaviors such as self-induced vomiting (in more than 90% of cases) or using large amounts of medication (diuretics, laxatives, appetite suppressants), diets and physical exercises, abuse of caffeine or even cocaine use. (ABREU; FILHO, 2005)

Patients with Bulimia Nervosa have a range of maladaptive thoughts and emotions regarding their eating habits and body weight. They have inconsistent self-esteem, which makes them think that one of the most appropriate ways to solve their problems is to obtain a well-shaped body and, to achieve this goal, they end up developing diets that are impossible to follow. In other words, they seek to “compensate” a subjective problem through the adoption of imperative weight loss strategies, resulting in a continuous state that we call “emotional roller coaster and their attempts to regain control of this fluctuation”. As this, although very intense, is not something clear, such patients cling to the idea that being thin is one of the shortest paths to obtain some form of stability. They believe, therefore, that having control over their measurements will provide them with some form of control and peace of mind by believing that “being thin is the way to be happy”. (ABREU; FILHO, 2005)

The diagnosis of bulimia nervosa is made according to the criteria established by the DSM-IV (Table I), in addition to certain psychiatric conditions, such as depression and personality disorders (Table II). (RIBEIRO, SANTOS, 1998)

Table III – Diagnostic criteria for bulimia nervosa (307.51) – DSM IV

1 – Recurring episodes of binge eating,…