Q Since I was in my teens my weight has fluctuated very widely. I am now in my late thirties and have an eating disorder. I find that when my weight is low I feel very sexy and flirtatious and act quite promiscuously. When my weight is high I want to hide and I’m much less friendly and outgoing. I don’t want my weight to dictate my attitude to sex — what can I do?

A Sexual promiscuity is not uncommon in compulsive overeaters (COs). One woman I know will gain up to 4st (25kg) and then go on a diet of shakes and drinks to lose the weight. Slim again, she starts to socialise more. She drinks alcohol as a way of avoiding eating and then ends up in unhealthy and often unwanted sexual situations. Feeling out of control once more, she puts on the brakes by overeating again, thereby physically sabotaging her sexual feelings. Retreating into her other addiction is a comfort, initially, but as her eating becomes more disordered she finds herself back at square one.

As Mary George, of beat (www.b-eat. co.uk), the charity for people with eating disorders, says: “Very often issues around eating, body shape and weight are down to control — overeating can be self- gratification and undereating a punitive way to deal with difficult thoughts and emotions.” Compulsive overeating is often dismissed as obesity and GPs often offer the same unhelpful advice about diet and exercise. But obese people often have their weight problems caused by bad diet and ignorance, and tend to lose weight efficiently because they have higher metabolic rates than thin people. Whereas most COs — who eat due to deep psychological problems - cannot control their diet on a permanent basis without psychiatric support.

The psychologist Paul Ekman once said that a key goal of psychotherapy is to “increase the gap between impulse and action”.

The ability to delay gratification was identified as significant in the 1960s when Walter Mischel carried out his “Marshmallow test” on a group of four-year-olds who were offered one marshmallow immediately or two if they waited 15 minutes. The children were then monitored for ten years and those who were able to control their impulses proved to be better adjusted and more dependable, and scored significantly higher in aptitude tests. Daniel Goleman, the author, psychologist and science journalist, describes a child’s emerging capacity to “squelch an impulse” as one “basis for free will” — which may be more aptly described as “free won’t”.

Scientists have pinpointed the dorsal fronto-median cortex in the brain as the area responsible for restraint and suspect that if this area does not develop properly in childhood it may lead to disorders ranging from attention deficit to addictions or compulsive overeating.

The psychologist Deanne Jade, founder of the National Centre for Eating Disorders (www.eating-disorders.org.uk), a private organisation that offers counselling, says that “people who binge-eat are significantly more likely [than someone who does not] to have a history of trauma or neglect. They are also more likely to have a history of other problems, such as anxiety, depression, obsessive compulsive disorder or personality disorder and they lean significantly towards a history of current substance abuse like drink and drugs.” This is not true, however, of all people who suffer from eating disorders.

People with such disorders do get better. Acknowledging that you have a problem is an important step, but compulsive eaters may find it hard to get help because the condition is so often overlooked.

Fifty per cent of eating disorders in the UK are treated privately. Your GP does have the power to refer you to the right experts, so be persistent, research all the different kinds of help available.

Call the beat helpline (0845 6341414) or e-mail help@b-eat.co.uk for guidance. Explore cognitive behavioural therapy at www.psychnet-uk.com. There is also an NHS directory of approved alternative therapists at www.nhsdirectory.org .

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