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Emotional eating may be one of the most disguised forms of escapism clients turn to when dealing with stress or trauma. Carolyn Russo, a licensed mental health counselor (LMHC) in Seattle, says fast-food drive-thrus have become a type of coping mechanism for clients who are stressed or struggling emotionally. That’s in large part because the consumption of processed foods has become more and more normalized in U.S. culture since it was popularized in the 1950s. According to surveys published by the Centers for Disease Control and Prevention in 2018 and 2020, more than one-third of adults, children and adolescents consume fast food on a daily basis. Emotional eating can also be a blind spot for professional counselors because it largely falls under the realm of nutrition, which is outside of a therapist’s purview. So a clinician’s instinct may be to pass off all or most eating-related emotions to a registered dietitian. However, Russo says that ethical tendency for therapists to stay in their own lane or look past a client’s eating habits can lead to a missed opportunity when assessing clinical care. “We’re trained as clinicians to be looking at other coping mechanisms and different patterns like a client’s failed relationship after failed relationship, not a client’s relationship with food,” notes Russo, a member of the American Counseling Association. “Emotional eating can be a little sneakier and more hidden because all forms of eating are intertwined in our culture as acceptable. We eat food at social gatherings and it’s so accessible.” Russo says she’ll always use an intake session with a client to gain a better understanding of what their relationship with food looks like. Even if emotional eating doesn’t present itself initially, she still regularly assesses clients’ relationship with food while building the therapeutic alliance with them. “The reality of the situation is our culture revolves around food, so it may not be something clients are even able to be honest with themselves about at first,” Russo says. It’s common in American culture for people to say, “Are you happy? Let’s celebrate by going out to dinner” or “Are you sad? Have another candy bar.” Because people’s emotions often influence their eating habits, a client’s relationship with food is not something counselors should ignore — even if their presenting concern is not related to an eating disorder, Russo continues. “For therapists, we have to identify the emotion that clients are eating or shoving down. Otherwise, we run the risk of having that coping mechanism stand in the way of processing that real emotion like sadness, loneliness, lack of acceptance [or] fear of vulnerability, these really deep and hard emotions. It can lead clients to stay [stagnant].”

The cycle of emotional eating

Natalia Buchanan, a licensed professional counselor (LPC) who runs a private practice called Emotional Eating Therapy in Austin, Texas, has been working with clients who struggle with disordered eating since 2007, and she specializes in emotional eating. She finds that clients who emotionally eat are often susceptible to a bad recipe: They don’t have the tools to cope with their feelings and their bodies naturally crave high-fat foods. That’s why drive-thrus become an offshoot form of therapy. “Too often I see clients psychologically go into a feast-or-famine mode, where they starve themselves or don’t plan a meal, and then their body takes over at some point to where they’re not wanting an apple or a Caesar salad; their body is wanting lots of calories,” says Buchanan, an ACA member. “Then they’re in this cycle where they want it again because the receptors in their brains say, ‘Oh yeah, that felt good last time.’ But then every time we eat fast food, afterward it’s not a [lasting] rewarding feeling.” Buchanan says she is still seeing the ripple effects of clients’ poor eating habits that are a byproduct of quarantine and isolation phases of the COVID-19 pandemic. “I think many are still feeling the fallout from” the pandemic, she says. “But the positive is that we’re becoming more aware of how prevalent it [emotional eating] is.” Brad Novak, an LMHC in Munster, Indiana, approaches emotional eating through a lens of deep empathy because he found himself using fast food to help him cope with his pain after his divorce six years ago. “I was emotionally eating and wasn’t fully aware,” Novak recalls. “I’d go through the drive-thru and come home and eat dinner still. I was definitely in a place where I was leveraging comfort foods to feel good when I was coming home to an empty house or to my ex-wife when things weren’t good between us. I was afraid of ending my marriage for years and McDonald’s french fries became my way of coping several times a week.” Now, as a clinician who specializes in eating disorders and emotional eating, Novak says targeting the behavior is the first step, but fully identifying emotional eating can still be difficult because guilt and shame can often mask a client’s potential accountability. “For me, I didn’t even know I was doing it, so I realize how difficult it can be for clients to see that they’re turning to it,” Novak says. “The first step for me was acknowledging the behavior and coming to terms with [the fact that I was] using emotional eating as a maladaptive coping mechanism.” “Before and during eating fast food, the feeling can be euphoric or numbing but then afterward there’s a lot of guilt and shame. The original emotion gets multiplied and you’ll feel worse,” he continues. “Then, that level of shame is in secret because eating is a part of life and something we’d need to do anyway.” Russo, the clinical training director and core faculty at the Family Institute at Northwestern University, acknowledges that once the behavior is targeted and accounted for, the shame cycle can be challenging to offset and the emotions underneath can be difficult to untangle because of the all-or-nothing thinking. In other words, a client can get stuck being aware of the behavior but unable to stop because they feel as if they’ve already failed at a certain dietary goal. “It’s hard to get out of that [cycle]: You’re ashamed of eating; then you eat more because you’re ashamed,” Russo explains. Russo advises clinicians to build clients toward acceptance while simultaneously supporting their goals. “That’s where the acceptance piece comes in. Knowing it’s OK to not be perfect,” she says. “It’s more about understanding the primary emotions. If shame is consuming you, we can’t target those original emotions.” Deborah Haugh, a licensed clinical professional counselor (LCPC) in Chicago, says helping clients accept themselves in the here and now can be integral for growth. Otherwise they’ll get tripped up in associating their self-worth with attaining a goal. “Turning to food for comfort sometimes leads to a loss of control over one’s impulses and feelings of shame,” she explains. “Our society can be obsessed with control, self-improvement [and] status, and folks who are overweight are often criticized, shamed or ignored by others to [where] that message becomes internalized.” Haugh finds that psychoeducation on both emotional eating, which she notes is an “unhealthy coping mechanism for dealing with difficult feelings,” and shame can be a meaningful intervention. “Life can be full of struggles, losses and sometimes trauma,” Haugh says. “What’s important is how we cope and understand and move through those struggles.”

The counselor’s role

Eunice Melakayil, an LPC and the clinical director at Serenity Found Therapy in Oklahoma City, stresses the importance of clinicians collaborating with nutritional professionals to ensure the client receives adequate care in recovering from emotional eating. At the onset, she informs clients about the limitations of counseling in treating nutrition. “I define my role as a guide in providing tools for living a mindful lifestyle, especially with being intentional in what we eat and do,” Melakayil says. “This also includes providing guidance in seeking mindful ways to take care of our bodies, including seeking medical services as needed.” Melakayil helps host and run nutrition-focused therapy groups that provide treatment for emotional eating. “We believe doing a group eating program would bring the most benefit since members will have other members to walk the journey with,” she says. Melakayil often refers clients who need nutritional advice to training courses provided by the Am I Hungry? mindfulness eating program, which was founded by a registered dietitian. She says separating the mental health and nutritional training roles is not only ethical but also vital from a collaboration standpoint to ensure clients receive proper treatment. Buchanan says she often sees mental health professionals struggling to decipher when to turn to a nutritional expert and refer out. “It’s important for a therapist to not offer advice where they’re not trained and to see [if] something may be out of their depth,” she stresses. “A clinician with a diet mentality and no understanding can make it worse for a client. That’s why collaboration [with dietitians] can be so important.”

The connection to childhood

Jamie Mykins, an LPC in Orlando, Florida, knows the struggle of emotional eating on a personal level. She lives with pulmonary arterial hypertension, a life-threatening illness. Several decades ago, she lost 50 pounds by making more nutritious eating choices, and she now uses her own personal growth as a way to build alliances with clients. She says her own journey with emotional eating allows her to be more empathetic when working with clients who battle poor relationships with food. “If it’s between Sour Patch Kids and strawberries, I want the sugar dopamine effect. Emotionally, Sour Patch Kids feel like a treat, whereas strawberries in comparison can feel too healthy,” says Mykins, noting that she will share a similar sentiment in session to build rapport with clients. “It’s tricky because food is also a part of self-care for clients. So it’s important to learn how to love food in a way that feeds you physically, not just emotionally.” Mykins often sees a direct correlation between clients’ childhoods and their unhealthy relationships with food. “If we suffered trauma as children as so many do, eating is one of the first coping mechanisms we develop,” she says. “You can’t really turn to drugs or alcohol when you’re 6 or 7 years old. So when we’re looking at emotional eating in clients, we have to recognize that chemical dependency came super early on.” “Clients can be programmed to believe food is a reward and we can be programmed that way too,” Mykins adds. For example, she was rewarded by her mom with ice cream if she did well on her report card when she was a child. Russo finds that viewing emotional eating through a psychodynamic perspective can help clients work through feelings of shame and lack of control because they can see the patterns in their family or upbringing that have led to them using food as a coping mechanism. “Often I’ll have clients who had caregivers who didn’t validate their emotions and they experienced a lot of neglect,” she says. “That childhood emotional neglect leaves a permanent scar on a person and then as an adult, there are active ways to fill that void. That’s why, as therapists, helping clients to be the emotional coach they didn’t have is important.” Haugh agrees that a client’s childhood is a good area for clinicians to explore because it can outline the genesis of when food became a source of comfort or perhaps of deprival that now plays out in adulthood. “Our relationship with food is developed in childhood,” she explains. “Food may have been used to treat or reward for doing something [of value] or as a way to soothe hard feelings. It is also common for food to be a central element in celebrations like birthdays and holidays, which for some was a time when kids could get more attention and freedom.” “And for some children, scarcity of food was associated with basic hunger, fear and anger over unmet needs,” she adds. This leads to some clients overindulging as adults to mitigate long-held feelings of fear and anxiety around lack of food growing up. Caitlin Ziegler, an LPC in the Milwaukee area, specializes in working with clients struggling with eating disorders and disordered eating. She says identifying wounds from a client’s upbringing can help to pinpoint what’s missing and that incorporating what’s missing into treatment can provide motivation for clients to let go of the behavior. “Emotional eating is about filling some type of void; there’s something missing for the client and eating gives them something more than getting full,” Ziegler notes. “For a majority of clients, that void started in childhood as a form of comfort they couldn’t get somewhere else. Outlining ways to heal the void is where [therapists can be] most effective.”

Effective treatment approaches

John Deku, an LCPC at Centennial Counseling Centers in St. Charles, Illinois, says exploring a client’s past can be helpful, but too much focus in that area can delay addressing the behavior head-on. Instead, he often relies on motivational interviewing, behavioral modification and acceptance and commitment strategies for treating emotional eating. “I find addressing what is underneath the emotional eating to be a double-edged sword,” Deku says. “Clients may want to explore their past for weeks, months or even years to find what caused the emotional eating. Most of the time, clients feel some satisfaction but end up asking, ‘So what do I do about it?’” He likes to address this question as soon as the client is ready to think pragmatically about it and is willing to change their emotional eating habits. “I think clients can get hung up on trying to make the change feel ‘right,’ rather than letting go of what hasn’t worked and finding the bravery to try new things,” Deku adds. Novak caters the treatment approach to the individual client because everyone has their different journey toward effective change. He says he leans heavily on mindfulness approaches looped in with dialectical behavior therapy, cognitive diffusion to outline if a client’s behaviors don’t align with their values, and the interpersonal effectiveness of acceptance and commitment therapy to help clients “gain some distance from their thoughts.” “Emotional eating can be impulsive in nature, so one thing I’ve tried with clients is giving them the tools to break from the impulse,” Novak continues. “If a client has [a] desire to eat fast food on [their] drive home out of convenience, I’ll suggest putting their wallet in the trunk. Just that extra step of pulling over and getting your wallet out helps offset that impulse.” Novak has also put a lot of consideration into the terminology he uses with clients, and he says that he is “on the fence” about labeling emotional eating of fast food as an addiction. “I’m mindful of not introducing addiction words with clients because there isn’t enough research on it in my opinion,” he says. “But the behavior is nearly identical to addictive behavior.” Neither is Buchanan prone to using the term “fast-food addiction” because that sounds more condemning and less like an accepting, balanced approach. “I struggle with the idea of calling it fast-food addiction,” he says. “The only other addiction you can equate it to is sex because people need to have sex, but even then it’s different than eating. If I’m [a person with alcoholism], I don’t need to have a drink to survive like I do with food. So to me it’s more about the relationship with food. If it is addictive, what makes you sober? We have to be careful not to villainize foods because that can work against improved behavior.” It’s also important to identify that emotional eating is situated between regular eating habits and eating disorders, Buchanan notes, because that distinction outlines severity, need for collaboration and what roles clinicians can play. And if a client doesn’t have a diagnosable eating disorder, then their emotional eating may go unrecognized or be disguised, he adds. “I cannot tell you how many people have been in therapy for five years and will say they binge Wendy’s or Sonic in the parking lot,” Buchanan notes. “They’re ashamed of it. That’s why psychoeducating can be so important because then clients will have an understanding of their behavior and come to terms with it when they’re emotionally ready.” Deku often makes it a priority to differentiate between a diagnosable eating disorder and emotional eating to inform his treatment and collaboration approaches. “I don’t find professional collaboration as necessary with emotional eaters as I do with [clients with] eating disorders,” he says. “Eating disorders can be dangerous and historically, they’ve had some of the highest rates of mortality compared to other disorders. … I find that emotional eaters tend to know what is healthy or unhealthy but they struggle to change habits. They may feel they’re stuck in their routines and not know how to cope without food.” Melakayil says she’s found the Am I Hungry? mindfulness eating program to be a universal resource for clients who struggle in their relationships with food. It also helps to create a clear separation between therapists’ and nutritional experts’ roles in treating emotional eating. “The program helps in deepening one’s understanding of root problems or identifying their true need — connection, conflict resolutions, breaking habits, working through traumas, restoring or resolving relationship issues,” she says. “Meeting one’s true needs helps reduce emotional eating and promotes intentional or mindful eating over time.” Mykins stresses the value of defining healthy eating and self-care based on what feels true to clients, not based on external influences. She says, as much as any treatment plan, therapists can play a clear role by helping clients release the notion of being perfect. “As clinicians, we need to be able to say, ‘we’re human,’ and so are our clients,” Mykins says. “Finding that line where we know we’re going to make mistakes but also push ourselves to be the best version of ourselves is what I strive for with myself — and with my clients.”

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Scott Gleeson is a licensed clinical professional counselor in the Chicago suburbs, specializing in trauma and relational dynamics. He spent over a decade writing for USA Today, where he won national writing awards from the Associated Press and NLGJA: The Association of LGBTQ Journalists. His debut contemporary novel, The Walls of Color, and its sequel, Spectrum, will hit bookshelves in 2024 and 2025, respectively.

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.