Saturday, August 30, 2008

Binge No More by Joyce Nash (Pt 1)

Like the Fairburn book, I could identify with a lot of the stuff in here immediately. In the preface, the opening statement is really important, and it made me feel a lot better about myself:

Binge eating is a not a moral failure.

We're not bad people because we binge. We're not weak. We're not less of woman/man/parent/friend/human being because we binge. I know it's hard not to hate ourselves when we're in the middle of a binge, and even after one. But we need to remember that were are not failures because of it.

Nash sums up binge eating rather nicely:
The eating binge is often the paradoxical consequence of attempts to restrict caloric intake with the intention of losing weight or maintaining weight loss. Unable to cope with hunger or deprivation, the eating disordered person succumbs to the overwhelming urge to eat. For many, stress and associated negative emotions trigger the binge. Many failures at weight management occur because bouts of excessive dieting cancel out efforts at caloric restriction.

Every single word of this paragraph applies to me. Whenever I diet, I try to avoid certain things. Sometimes it's fat, sometimes it's carbs, always it's junk. And after a few successful weeks, I begin to obsess about that which I "can't" have. The dam bursts and I eat everything I shouldn't, which leads to more unhealthy eating, and before I know it, I've gained back everything I managed to lose.

According to Nash, binge eating disorder (BED) - also called compulsive eating or emotional eating - affects 2% of the population. BED sufferers may also be overweight, and the more overweight someone is, the more severely affected they are by the disorder. A binge eating disorder is defined as:

persistent and frequent binge eating that is not accompanies by the regular use of the kinds of compensatory behaviors (for example, vomiting, abuse of laxatives) that characterize bulimia nervosa.

Nash cites the American Psychiatric Association for an official definition of binge eating disorder, which is pretty much the same as the one Fairburn provided:

An episode of binge-eating is characterized by both of the following: (1) eating, in a discrete period of time (e.g., within any two hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances, and, (2) a sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).

In layman's terms: a loss of control over eating! Binges can occur in a definitive period of time or over several days. The latter is called a grazing binge. That's me. I'm a grazer most of the time. Sometimes my binges are short, but more often than not, I'll eat junk for days. The triggers are the same - anxiety, depression, loneliness, and boredom. For those with eating disorders, eating shuts us off from these things.

I think anorexia and bulimia are the eating disorders that come to most minds when the subject is brought up. I know I didn't realize that binge eating was a disorder all its own until very, very recently. I knew bulimics binged but that didn't apply to me because I never purged. It's nice to belong to a category!

Speaking of categories, Nash introduces the concept of subclinical eating disorders. Basically, if all the conditions for any of the eating disorders (anorexia, bulimia, or binge eating) aren't met, one may still have a sub-disorder. People who binge, but not often, are thought to have subclinical binge eating disorder. I'm not sure how I feel about this "sub" component. I haven't really seen anything in this book or the Fairburn book that describes the frequency of binges, so where is the line between frequent and infrequent binging?

Nash also talks about night eating and sleep-related disorders. Neither applies to me, but they are worth mentioning. With night-eating syndrome, people skip breakfast and lunch and consume the bulk of their calories during the evening and night, sometimes even during the night when they can't sleep. I used to skip breakfast and sometimes lunch and definitely eat most of my calories at dinner and after, but I never woke up in the middle of the night to eat. Nocturnal sleep-related eating disorder is when someone (usually a woman) wakes in the morning to find evidence of having eaten, but no memory of it.

So, who is at risk to binge? Young women, particularly those who diet. Overweight & obese people who go through repeated cycles of dieting and regaining weight. Homosexual men are more likely to binge than heterosexual men. Certain athletes, such as gymnasts, figure skaters, jockeys, and wrestlers, who need to keep weight down or within a certain class for competition. Military personnel and people with high profile occupations, such as those in the fashion industry, are also at risk.

Binge eating disorder may occur with other problems, such as substance abuse, depression, anxiety disorders, and personality disorders. I don't have any experience with substance abuse, fortunately. Depression - I've never been officially diagnosed with it, but I know that when I experience the regular (as in, not chronic) depression, I tend to want to binge. I don't think I suffer from anxiety disorders, or OCD. Of course, I do experience those phenomena, but not nearly enough to be classified psychologically. I also do not suffer from any of the personality disorders discussed in the book.

Borderline personality disorder: unstable, intense, or chaotic relationships in which they vacillate between idealizing and devaluing the other person. They are extremely sensitive, which can result in anger-triggered binges.

Histrionic personality organization: persistent need for attention, acceptance, and approval by others. They are also sensitive, but to the moods of others, and often manipulate others, sustaining superficial relationships. In addition, they are moody and become easily bored and frustrated, which can trigger binges.

Avoidant personality organization: shy individuals who want to have relationships, but their fear of disapproval, ridicule, and rejection by others keeps them from reaching out. They keep to themselves and often have low self-esteem and avoid social situations. Hmmm, this sounds like me, a little bit.

Dependent personality organization: have a pervasive sense of inferiority and helplessness. They can't make decisions for themselves and have a need to be taken care of. In order to keep their relationships intact, they often keep feelings to themselves, remaining passive, and sometimes becoming victims of abuse.

Obsessive-compulsive personality organization: overly concerned with orderliness and logic (which is different from obsessive-compulsive disorder - characterized by intrusive and unwanted thoughts or images). This might be me. I like things "just so" and it makes me crazy when things are not in their place, physically and logically.

So, what does binge eating do to the body? I don't recall this being covered in too much detail in the Fairburn book, but there is an entire chapter here devoted to the discussion. I'll just briefly outline it here:

Gastrointestinal Disturbances
* bloating, constipation, and abdominal pain because food stays in the stomach longer when restrictive dieting occurs (I had no idea!!)
* stomach dilation, perforation, or bleeding due to rapid overeating

Fluids and Electrolytes
* certain minerals (such as sodium and potassium) are necessary for our nerves and muscles to function properly, and when binge eaters purge, they lose these electrolytes, resulting in muscle cramps, spasms, and in extreme cases, cardiac arrest

Cardiovascular System
* irregular heartbeat, cardiac arrest, slowed heart rate, low blood pressure are all common
* high cholesterol and high blood pressure are often seen in obese bingers

Bones and Metabolism
* low estrogen levels lead to loss of bone mass and osteoporosis
* problems with mineral absorption
* low blood sugar
* loss of muscle mass when dieting slows metabolism

Skin and Hair
* loss of hair on head while soft body hair develops
* dry skin of unhealthy color
* brittle nails

* vomiting of purgers leads to enamel loss

Menstrual/Reproductive System
* with anorexia, loss of menstrual cycle
* with obesity, less frequent ovulation and pregnancy complications (I couldn't get pregnant until I lost 50 pounds back in 2003)

Other Problems
* kidney and liver damage
* weakened immune system
* cold intolerance
* fainting
* sleep disruption

Nash's chapter on the causes of disordered eating offers a lot of information. From cultural factors (such as the popularity of super-thin models) to biological and psychological influences, it's packed full of discussion that I cannot possibly convey here properly.

Family Influences:
* bulimic and BED - controlling parents, families are conflicted and disorganized, seldom express feelings
* anorexic - controlling, overprotective parents, rigid, avoid conflict
* mother/daughter relationships - if the mother exhibits disordered eating, the daughter is likely to
* father/daughter relationships - father's attitude towards food/weight influence daughter's perception of food/weight

* abusive/unsafe environments lead to anxiety, low self-esteem, desire to please at any cost

Self Concept (role one plays in family)
* Worthless Self - unsupportive families lead to using food as a way to cope
* People Pleaser - self-worth is related to how others see them and will do whatever necessary to gain approval, including giving in to pressures related to food and weight
* High Achiever - pressure to be perfect leads to stress and need to be in total control

Environmental Influences
* School - peer pressure, adolescent vulnerabilities affect self-esteem
* Peers - teasing and sharing of diet related information make dieting more likely

Psychological Factors
* Comparing oneself to others
* Calorie restriction
* Low self-esteem and stress
* Desire to escape negative feelings

Biological Influences
* Hormone changes
* Carbohydrate craving (like Fairburn, Nash thinks there are problems with the theory:)

When carbohydrate cravers consume carbohydrates such as chocolate, they experience improved mood and less fatigue, whereas non-cravers report feeling more depressed and more fatigued after eating carbohydrates.

So what is wrong with the theory that eating carbs increases serotonin levels in the brain? The research did not involve human subjects - though, I would sure sign up to eat chocolate!! Nash also questions whether binge eaters really have low levels of serotonin. I say, do some darn studies!! I know eating chocolate makes me feel good (at least at first) and I still can't wrap my head around the "myth" of carbohydrate craving. I feel like I experience it - how can it be a myth?

Other Influences
* Genetics - possibly, but more studies are needed
* Hunger and Starvation - obsession with food, mood swings, irritability, loss of control lead to binge eating

Chemical Dependency - like Fairburn, Nash doesn't think there's a complete parallel between binge eating and alcoholism/drug addiction
* primarily because no studies show direct biochemical influences of consuming a forbidden food
* "cravings" for foods, like sweets, are more like learned responses - the increased serotonin from consuming sweets "trains" us to want those foods when we're experiencing negative feelings
* the addiction model encourages "all-or-nothing" thinking, which can lead to more binges

Types of Binges

* The hunger binge is triggered by physical deprivation. Restricting food can cause mood swings, obsessive thoughts about food, suppression of hunger (especially when endorphins are released from exercise). Eventually, something is going to give, and it will most likely be your control. The best thing to do? Eat regularly - most of the recommendations I've seen say 3 meals and 2-3 snacks. I try to do it that way, and eat every 3-4 hours.

* The deprivation binge begins with a sense of wanting or needing something but not knowing just what it is that is wanted. This is most often seen when the dieter has forbidden foods. For me, it's the chocolate and other sweets. Sometimes, it's all I think about and I focus more and more on what I can't have. Then I lose it.

* The stress binge, sometimes called "emotional eating," serves to alter moods and can produce dissociation - a state in which emotion is split off from reality - allowing the person to feel less overwhelmed. Eating is a way to escape from whatever we're experiencing. I know there are times when I'm stressed and all I want is to stuff my face. My son's first day of preschool is a good example. I was so upset when I bough that ice cream for him that I really just wanted to eat it all up right there in the grocery line. (Though, I am proud to say that I have not touched that ice cream at all!)

* The opportunity binge occurs because of the combination of boredom and unstructured time. When I have nothing to do, I tend to want to eat, but if I am constructively occupied, I barely think of food!

* The vengeful binge is a way of venting hostility. Oh, this is definitely me! When I get mad, I eat. It's probably the one emotion most likely to trigger a binge for me. Then I get angrier, of course, and binge some more.

* The pleasure binge is triggered by the desire for stimulation and entertainment. Eating as a reward. I'll admit, I do this on occasion. When I was doing Body For Life, I had a "free" day every Sunday as part of the plan, and I could eat whatever I wanted. I quickly learned that I cannot handle a free day because it would be a binge and not just overeating or a small cheat. I found Mondays extremely difficult for getting back on plan.

*The habit binge is the binge that is on automatic pilot. Also called a grazing binge, it involves almost non-stop eating without effort to control of feel guilty about it. I've done this many times. Overeating at a restaurant, I'd have excessive dessert. Then I would buy more junk food on the way home and eat all of it. Then I'd raid my freezer or pantry for whatever else I could get my teeth into.

Stages of a Binge
* Tension Buildup - whatever factors lead up to the binge
* Tension Release - the eating itself, and any behaviors (such as purging) that bring the binge to an end
* Recovery - a low energy phase with symptoms that may include headache, nausea, fatigue
* New Beginning - often just a short period of time when the individual attempts to stop binging and lose weight, and usually leads to another binge cycle

Triggers of a Binge - Nash lists an entire page of triggers, which I won't copy here. The usual suspects are there: stress, anxiety, hunger, obsessions, boredom, low self-esteem.

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