Tuesday, August 12, 2008

Overcoming Binge Eating by Dr. Christopher Fairburn (Pt 1)

I finally finished the book this weekend. I really wish I'd been taking notes as I went along, so I don't have to go back and look stuff up to post about. I'm not that good with explanation and synthesis, and my thoughts tend to be scattered. Plus, I kept getting confused while reading because he was alternating between discussion of bulimia nervosa and binge eating disorder. I am definitely not bulimic, but I found it interesting that he never used that particular term after introducing the concept. I guess it's not politically correct to say someone is bulimic anymore. Instead, they suffer from bulimia nervosa. Same with anorexia. Not PC!

Anyway, as I started the book - especially as I started it - a lot of things hit home. I felt like I'd found the right path when he characterized binge eating:
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).

The loss of control is the central point of binge eating and reading that in black and white sort of knocked the wind out of me. I kept thinking back to the M&M incident last month and that was truly when I realized I had a problem that was bigger than just lack of will power. It scared me to realize that I, a control freak by nature, was not in control anymore. But at the same time, it opened my eyes to the problem and set me on a path of learning how to deal with it. And even on my own, I've been doing well - I haven't had a binge since. It hasn't been a month yet, so it's no major accomplishment, but it is a start.

But more on the book.

Dr. Fairburn offers the characteristics of a binge:

Feelings - short lived pleasure and enjoyment quickly becomes guilt and disgust. Yeah, I know that feeling well! As I shoveled the candy into my mouth, I loved it for all of 30 seconds, then cried as I continued to eat them.

Speed of eating - rapid. Oh yes, I can inhale a dozen donuts in no time flat.

Agitation - usually eat while pacing or wandering, almost desperately. Yeah, there's a definite route around the kitchen I take.

Feeling of altered consciousness - trance-like, automatic eating, like it's not really you eating; using music or tv or other distraction while eating. I do experience this some of the time. Not so much the trance-like state, but I definitely feel like I'm outside of my own body.

Secretiveness - hiding while you eat, hiding any evidence. YES, this is absolutely me! I'd buy candy bars at the store down the road and eat at least 2 on the 3 minute drive back. Any candy wrappers would be buried in the garbage.

Loss of control - feeling like you can't stop. Yes, a million times. Even though I know I should stop, I can't. And the feeling of failure just makes me feel worse, as in "I've already screwed up, I might as well keep that up."

Types of binges:

Fill-blown binge - usually quick, no enjoyment, you eat in one place until you just can't eat anymore
Half-binge - usually late at night and as a reaction to something stressful
Slow-motion binge - you can tell these are coming on, and you try to resist them for a while; you give in and feel a release of tension and stress. This is me. I can tell, 99% of the time, when I'm going to binge. I'll want something, say no repeatedly, and eventually eat it anyway.

Triggers of binges:

feeling fat
gaining weight
dieting and hunger*
breaking a dietary rule*
unstructured time*
being alone
premenstrual tension
drinking alcohol

* These are me. If I'm bored, I have a harder time resisting a binge. It usually also happens after I've been on plan for while. Then, when I fall off the wagon, I stay there for a while.

Types of dieting:

Avoiding eating - I don't generally do this.
Restricting overall amount eaten - I used to do this quite often, and when I get into "competition" type weight loss settings, I tend to drift this way. So, I now avoid those groups.
Avoiding certain types of food - Back when I did Atkins, I avoided carbs, obviously. Now, I am more free with the amount of carbs I eat. I try to avoid junk food, even the sugar free or fat free "healthy" kind because I have no portion control. And of course, when I finally snap, that's it! I pig out on everything I've been trying not to eat.

Personality characteristics of a binge eater:

low self-esteem*
all-or-nothing thinking*
borderline personality disorder

* Again, these are me, for sure. The others, I hesitate to claim. I'm impulsive, but only about food. Impulsivity, in the book, includes other activities, such as drinking, shopping, etc. I've had low self-esteem for ever, and being overweight just makes it worse. And I'm somewhat of a perfectionist - I do get upset if things aren't exactly right (though I am getting a lot better about that since having a kid). All-or-nothing is DEFINITELY me!!! I don't like to do things halfway and if I have to, I get extremely upset. So I can see how this all relates to my binges.

Pathways to obesity and binge eating - Dr. Fairburn suggests there's a very complex relationship between the two and which causes the other is really unclear:

Binge eating --------> Obesity


Obesity -------->Dieting -------->Binge Eating


Obesity -------->Dieting -------->Binge Eating -------->Obesity

I really can't remember how I got fat. I was normal weight in high school. Oh, yes, I remember now. It was the Freshman 15 and the Depo-Provera shot. I gained quite a bit in college, but wasn't obese. In 1997, I enlisted in the Army, and my weight was 142, or thereabouts. When I went to leave for basic training, I found out I was pregnant, and that resulted in a miscarriage (or blighted ovum - a peanut shell with no peanut, is how they explained it to me). After that, life was pretty crappy and I coped by eating. I ate my way to 164 pounds or so before going on Atkins in 2003. I got down to 116 in about 7 months, then got pregnant. I used my pregnancy as an excuse to eat total crap. I weighed 175 when I went in to have my son, and 155 at 6 weeks post-partum. Then, somehow, I managed to jump back up to 195 in less than a year, and I hovered between there and 180 until 2007. At 191, I'd had enough. I low carbed (but not Atkins) until I got down to about 150, then did Body For Life, and got as low as 143. Then I fell off again at the beginning of this summer, and here I am, weighing more than I did a year ago - though only by a couple pounds. So I'd have to say I follow the last pathway to binge eating.

Is binge eating an addition, like alcoholism or drugs?

This section of the book confused the heck out of me, mainly because I don't understand the addiction model and treatment plans that go along with alcoholism and drugs. Dr. Fairburn suggests the following similarities, but labels them superficial:

Having cravings or urges to engage in the behavior
Feels a loss of control over the behavior
Is preoccupied with thoughts about the behavior
Might use the behavior to relieve tension and negative feelings
Denies the severity of the problem
Persists in the behavior despite its adverse effects
Often makes repeated unsuccessful attempts to stop

Yes, yes, yes, absolutely yes! But no - says Dr. Fairburn. There are two big differences between "regular" substance abusers and binge eaters:

The inherent drive to avoid the behavior. Dr. Fairburn uses a bulimic to suggest that this is different from alcohol or drug abuse. Bulimics avoid food, whereas drunks and druggies (my terms, not his) don't avoid alcohol or drugs (unless they are in treatment, of course).

Fear of engaging in the behavior. Bulimics are afraid of the consequences of eating, and D&Ds tend not to be. I don't have much experience with D&Ds, so I really don't know how true this is.

Regardless, I find these two statements to be unfairly dismissive of binge eating specifically because he uses bulimia as the disorder. I am most definitely not bulimic, and I don't purge through vomiting, laxatives, or diuretics. I also don't avoid food - I try to avoid the things that trigger my binges though. I'm certainly not afraid to eat - I am afraid of the trigger foods. But my trigger foods are mainly unhealthy, so what's so wrong with avoiding them? Except for Cheerios. Those are pretty healthy, but I know darn well they trigger a binge. I can't eat just one bowl, and after 3 or 4, there's just no sense in eating normally.

Overall, I'm not sure what to think about the first part of this book, the theory and facts about binge eating. There was so much bulimia discussion that I got confused at times. While I felt like a lot of things were relevant to me, others were not. At the recommendation of someone who has been there, I've ordered Binge No More: Your Guide to Overcoming Disordered Eating by Joyce Nash. I hope that will shed some additional insight on the problem.

Of course, Dr. Fairburn devotes the second half of the book to self-help, and I'll review that later this week. I've already started applying the steps, but a lot of them were things I've already been doing, so I sort of feel like I'm in limbo. But more on that later.



That is great information! Thank you for the summary and for sharing your struggles with weight. Can't wait to hear about the second part.

chia! said...

hi, sorry for bothering, I was wondering if you have the pdf of the book.. or know where I can find/download it? thanks heaps :) chiara

Becky said...

Sorry, I haven't seen it in electronic format. As far as I know, it hasn't been published in ebook form.