The second part of this book begins with a chapter full of blank logs and questions for monitoring and analyzing your eating behavior. I won't be putting them here, but the log is very similar to Fairburn's.
Nash introduces the ABC Model of Behavior, to help identify when binges are likely.
Antecedents - the events and feelings that lead up to a binge
Behavior - the binge itself
Consequences - what happens after the binge
So, when monitoring your eating in the log, you would look for patterns in the A and C areas that will point out when and why your binges are likely to happen.
On this log, you include:
time of day
foods eaten
indicate whether you feel it was a binge
degree of hunger you felt before eating
where you were/what you were doing while eating
Nash provides a 21 item questionnaire for analyzing your logs. It looks at how often you binge, what may have triggered the binges, your thoughts and decisions made leading up to and during the binge. You're asked about consequences (both positive and negative), the types of foods you eat during the binge, and when and where you binge. Using your records and the questionnaire (do the analysis every week or two), you can determine which of the following is causing your binges:
hunger
deprivation
stress
seeking gratification
problem thinking
lack of consciousness
poor nutrition
So, now it's time to take action and change how you eat. Most of us bingers are also dieters, through not eating, restricting calories, or avoiding certain kinds of foods. In more extreme cases, some may use laxatives, diuretics, OTC diet pills, or exercise excessively to compensate for the caloric intake. This is the part of the self-help where we stop doing these things and start taking control over the forbidden foods.
Nash suggests introducing the forbidden foods a little at a time. Rather than having an all-or-nothing viewpoint, look at the foods on a continuum that allows you to make some not so great choices now and then. As often as possible, choose better foods, but don't ever consider something off limits.
This is where I run into problems, as a low carber. Nash recommends using the Food Pyramid to guide your choices, but this is so hotly debated among the different camps that I'm not even going to touch it here. I am not qualified in any way to say "do follow the food pyramid" or "don't follow the food pyramid" because it all depends on your own viewpoint regarding carbs, protein, and fat. There are the obvious things I agree with: occasional sweets and baked goods. But there are others on the list provided that I disagree with, just because I have history with lower carb diets. Should we stuff ourselves with peanut butter or ground pork or bacon or hot dogs? No, I don't think so, but I don't think they belong in the "Seldom" category. I eat bacon quite often. Sure, it's turkey bacon, but it's still bacon. I occasionally have peanut butter and pork. I do prefer to focus on some of the leaner diary and protein sources, but that doesn't mean I think we should all live on egg whites, skim milk, and spinach.
I also disagree with the number of servings given on the food pyramid - really, 6 to 11 servings of grains and cereals? I'd love to eat 11 cups of Cheerios a day, but I don't think that will help me at all. Vegetables, you can never go wrong with those, so I have no problem with the 3 to 5 servings recommended. Fruits, 2 to 4 servings, I'm not a big fan of fruit, but I suppose the quantity of fruit I eat in one or two sittings would fit (or maybe even exceed that some days). Dairy, 2 to 3 servings, sure. Protein, 2 to 3 servings, I don't agree with that one. Body for Life and Burn the Fat, Feed the Muscle, and all the other muscle-centric stuff I've read suggest protein with every meal, especially if it has a starchy component. Something about slowing the absorption or whatever - I can never remember details. Fats, oils, and sugars used sparingly, okay, I am mixed on this one. I prefer moderate use of good fats and oils. Sugar, I definitely try to avoid that!
Enough of my commentary - back on topic. Here are Nash's suggestions for normal eating. They sound a lot like Fairburn's suggestions.
Eat 3 meals and 2-3 snacks per day, preferably at a set time.
Eat every 3-4 hours.
At first, focus on eating at the right times, rather than what you eat.
Never skip a meal.
Only eat when planned.
If you do mess up, get back on track as soon as you can.
Once you establish your time pattern, begin to intodroduce healthier foods.
Don't diet by not eating, restricting calories too much, or restricting food groups or specific foods.
It might seem counter-intuitive to not restrict when you're trying to lose weight, but like Fairburn, Nash suggests that structured eating with healthy choices can actually lead to weight loss. Eating regularly will decrease hunger, and you'll be less likely to binge on the foods that actually do make you gain weight. Having set times to eat reduces the opportunity for grazing. Keeping a schedule of 3-4 hours also keeps your metabolism up and stabilizes you mood, reducing the negative feelings that often trigger binges.
What about cravings? I remember earlier this summer, I wanted ice cream so badly. Nothing I did made that desire go away. It persisted all day long. I can't remember now if I actually had ice cream, but I think I managed to stay away. To deal with cravings, Nash suggests following your schedule, don't think of something as a bad food - think of it as something you should limit, and try to catch the craving early (leave the area of temptation if you're around the food that you're craving, focus your attention elsewhere, or disrupt your senses by brushing your teeth, chewing gum or a mint, or smelling something strong). Have a list of alternatives to eating available. Remember the list of activities Fairburn suggested keeping with you at all times? Apparently a good strategy. If you really can't resist, go ahead and have just a little. (Of course, if you don't have issues with portion control, this is just fine. But I can never stop at just a little bit, so it's a big issue for me.) If you do indulge, do it without guilt. Guilty feelings lead to self-loathing, which leads to more binges. When you want something, give yourself 10-15 minutes to see if the desire passes. If it doesn't, try one of the alternatives mentioned above. Determine how important giving in to your craving is and decide how much you should eat. Then eat it and stick with your plan.
If you've been sticking to your plan, reward yourself. Use a star/sticker chart to illustrate your ups and downs. Set up a reward system. For example, no binges in 2 weeks, buy yourself a CD or a DVD. Don't punish yourself for not meeting a goal though! You don't need to be perfect. Be consistent instead, with the number of binges decreasing over time.
In order to change your behavior, you have to change how you think. We often make mistakes with our thought processes. We adopt all-or-nothing mentalities, or rely only on our emotions that are often negative. We overgeneralize the way we eat and/or look. We see doom and gloom in the future, or think we know how others view us. All of this negativity sabotages our efforts not to binge, and we all have these voices in our heads:
The Critic - the judgmental voice that chips away at our self-esteem
The Excuse-Maker - the coping voice that justifies your behaviors (boy, this is a big one for me!)
The Worrier - the voice that predicts disaster, that you'll get fat if you eat that potato chip
The Caretaker - the voice that puts our own needs on the back burner in favor of the needs of others
The Victim - the voice that says it's unfair to be afflicted with these problems (yeah, another one I'm guilty of - I've noted my resentment often, that I can't just eat what and when I want)
The Enforcer - the voice that cracks the whip and demands perfection in our eating and exercising
The Voice of Negativity - the voice that points out all your flaws
The Voice of an Eating Disorder - the voice that tells you "this is who you are and how it is" when it doesn't need to be that way
Nash provides a work sheet for identifying what your voices are telling you. You use this work sheet to reprogram your brain to become a more positive thinker. Nash suggests using index cards to write out positive thoughts. You could use anything - Post-It Notes, a computer program to send daily reminders, whatever. Post something positive in your blog every day. Find something every day, or as often as you need it, to remind yourself that you are not all of those things the negative voices say.
Nash also has a chapter dealing with body image, including a bunch of questions about how you perceive your body during various periods of your life. I'm not going to review specifics here because, quite frankly, it's hard for me to relate to any of it. I think my view of my body shape and size is very realistic, and it's not that I'm ashamed of my body in any way. Yes, I tend to keep it covered because really, no one should see that ghost white skin and stretch marks. I think my body size and shape goals are also realistic - I don't want to be thin. I want to be curvy and muscular. I think here are some parts of my body that look pretty darn good (I love my legs - they may be short, but I can see muscle and I think they curve in an appealing way. My husband loves my legs and never hesitates to tell me!)
Coping with disordered eating is an entirely different beast for me. Nash talks about problem-focused coping and emotion-focused coping. Problem-focused coping uses problem-solving strategies and other active methods of change that can influence a situation. I suck at problem solving. I'm not an outside-of-the-box thinker at all. In fact, even obvious solutions are often a mystery to me. Emotion-focused coping occurs when there isn't much about a situation that can be influenced, including negative feelings. For the disordered eater, this results in avoidance and escape.
Nash's strategy problem-focused coping looks a lot like Fairburn's:
Define the problem
Generate a list of alternative activities
Choose a solution and execute it
Fairburn's strategy is a little more complicated (off the top of my head, I recall a step that requires we consider the consequences of each possible alternative), but I think either one can be a good starting point.
Nash's strategy for emotion-focused coping involves relaxation and deep breathing:
Relax
Imagine a relaxing scene
When you're relaxed, end the imagery
If you want, pre-plan your imagery (even write it down) - I do this!! Well, I pre-plan the dreams I'd like to have when I fall asleep. Same concept. Yes, I'm weird.
Practice imagery. I do this too. I pre-plan the dreams several times a day. This is probably why I get so little done around the house.
There's more in the book's remaining chapter and a half that I just cannot properly summarize. There's a bit of psychology involved and I could just not do justice to any kind of write-up. I've covered the bare bones of both books here in my blog anyway, and if you think you may have binge eating disorder, I highly recommend either (or both) books. I'd start with the Joyce Nash book (Binge No More: Your Guide to Overcoming Disordered Eating) and if you feel you need more, get the Christopher Fairburn Book (Overcoming Binge Eating).
Showing posts with label self help. Show all posts
Showing posts with label self help. Show all posts
Sunday, August 31, 2008
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
Teeth
* 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
Trauma
* 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.
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
Teeth
* 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
Trauma
* 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.
Wednesday, August 13, 2008
Overcoming Binge Eating by Dr. Christopher Fairburn (Pt 2)
Part 2 of Dr. Fairburn's book describes the steps one should take to deal with binge eating. He also provides blank forms for readers to copy and use, but I won't be putting them here because of copyright issues. You don't really need the form, anyway. I'm doing all my journaling right here in my blog. This is just a very general outline of the self-help section.
Step 1: Self-Monitoring & Weekly Weighing
Monitoring your food intake and related information will help you determine when a binge episode is likely to happen. Record:
the time you ate/drank
what you ate (not necessarily how much in terms of specific amounts - don't worry about writing down the calories), and include everything you put in your mouth (food and liquid), as soon as possible after eating/drinking
location - did you eat in the kitchen? sitting at your desk? the couch? table?
do you perceive the episode as excessive?
did you use laxatives or diuretics or vomit after eating?
relevant notes - record your feelings about the food/drink you just consumed, were you hungry? how did you feel?
As for weighing, pick a day and time each week and only weigh on that day. Many people with weight issues are compulsive weighers, often getting on the scale several times a day. STOP!!!
I've been doing this, for the most part. I usually track all my food, but I've started adding the other information as suggested. And I only weigh once a week anyway, so this was no big deal.
Step 2: Establish a regular eating pattern and stop using laxatives/diuretics/purging
Eat 5-6 times a day - 3 regular meals and 2-3 snacks. Try not to go more than 4 hours without eating, to keep yourself from getting too hungry. Don't skip meals and try to plan as best you can. If you're not used to eating frequently or are a regular meal-skipper, start by eating a meal you would normally miss. Every few days, add in a snack/meal until you're consistently eating 5-6 times a day.
I already do this, and have done this since I started Body For Life last year. Even when I'm off the wagon, I eat every 3-4 hours, except when I'm eating constantly. Sometimes I miss a meal or really delay one, usually when I'm upset, so this is something I can work on. Laxative and diuretics and vomiting don't apply to me.
Step 3: Find alternatives to binge eating
Actually make a list of activities you can do instead of binge. I haven't done this yet. I'll do it right now:
exercise (nothing strenuous because I have my regular exercise - probably the Wii or go for a walk)
read a book
clean my house
practice my violin/keyboard
play games with my son
The key is to find something that will take up time and make it difficult for you to eat.
Step 4: Practice problem-solving and review your progress
There are 6 steps to efficient problem solving:
Identify the problem
Specify the problem accurately
Consider as many solutions as you can
Consider the implications of each solution
Pick a solution or combo
Act on the solution
I suck at problem solving, so this is going to be a challenge for me. Usually by the time I'd get to the implications stage, I'm already stuffing my face.
Step 5: Tackling dieting and other forms of avoidance
Sadly, Dr. Fairburn suggests we may have to actually stop dieting and get the binge eating under control. If you remember from part one, there are the various pathways to binge eating and dieting is seen as a big stepping stone. He doesn't go into details of the studies he's done, but I really have to wonder how many subjects were significantly overweight and obese. Just "learning to live with" our current, overweight selves IS NOT AN OPTION for me, and he does suggest that some of us might have to do that. I would love to see some studies that deal with overweight binge eaters (who don't purge).
Regarding the avoidance of certain types of food, Dr. Fairburn suggests introducing them back into your diet, in limited quantities. I have issues with this because I try to avoid junk food, and I don't find any reason to introduce those into my diet because they have no nutritional benefit at all. I can understand introducing other foods that are commonly avoided, say nuts for example. People avoid nuts because they are high in fat, but some fat - expecially the right kind - is good for you. But really, what's the benefit of eating sugar and trans fats? I do understand learning moderation, and I guess that's his point. Even healthy version of my "bad" foods are something I try to avoid. So I suppose this is where this step applies to me.
Step 6: Preventing a relapse and dealing with other problems
Ah, the main test of this whole thing. Can we stop binge eating long term? Here, we have to have realistic expectations. I know I cannot say I will never binge again. That would be absurd! I probably will, and all I can do is keep going through the steps. Hopefully, though, going through them the first time, especially with the monitoring and problem solving steps, will help me learn when I'm likely to binge and how to better deal with it.
So how do you go through the steps? With each step, review every few days and write a weekly summary. Start with Step 1, obviously. After a couple weeks, if you feel you're doing well, move on to Step 2. After a couple weeks, move on. The time frame in the book is about 6 months for all the steps, but it really depends on what you're already doing. I know you're supposed to go step-by-step, but I was already doing half of these steps anyway, that I am trying to start off with Steps 1-3 right now. I'll reassess things in a week or two, and go from there.
Step 1: Self-Monitoring & Weekly Weighing
Monitoring your food intake and related information will help you determine when a binge episode is likely to happen. Record:
the time you ate/drank
what you ate (not necessarily how much in terms of specific amounts - don't worry about writing down the calories), and include everything you put in your mouth (food and liquid), as soon as possible after eating/drinking
location - did you eat in the kitchen? sitting at your desk? the couch? table?
do you perceive the episode as excessive?
did you use laxatives or diuretics or vomit after eating?
relevant notes - record your feelings about the food/drink you just consumed, were you hungry? how did you feel?
As for weighing, pick a day and time each week and only weigh on that day. Many people with weight issues are compulsive weighers, often getting on the scale several times a day. STOP!!!
I've been doing this, for the most part. I usually track all my food, but I've started adding the other information as suggested. And I only weigh once a week anyway, so this was no big deal.
Step 2: Establish a regular eating pattern and stop using laxatives/diuretics/purging
Eat 5-6 times a day - 3 regular meals and 2-3 snacks. Try not to go more than 4 hours without eating, to keep yourself from getting too hungry. Don't skip meals and try to plan as best you can. If you're not used to eating frequently or are a regular meal-skipper, start by eating a meal you would normally miss. Every few days, add in a snack/meal until you're consistently eating 5-6 times a day.
I already do this, and have done this since I started Body For Life last year. Even when I'm off the wagon, I eat every 3-4 hours, except when I'm eating constantly. Sometimes I miss a meal or really delay one, usually when I'm upset, so this is something I can work on. Laxative and diuretics and vomiting don't apply to me.
Step 3: Find alternatives to binge eating
Actually make a list of activities you can do instead of binge. I haven't done this yet. I'll do it right now:
exercise (nothing strenuous because I have my regular exercise - probably the Wii or go for a walk)
read a book
clean my house
practice my violin/keyboard
play games with my son
The key is to find something that will take up time and make it difficult for you to eat.
Step 4: Practice problem-solving and review your progress
There are 6 steps to efficient problem solving:
Identify the problem
Specify the problem accurately
Consider as many solutions as you can
Consider the implications of each solution
Pick a solution or combo
Act on the solution
I suck at problem solving, so this is going to be a challenge for me. Usually by the time I'd get to the implications stage, I'm already stuffing my face.
Step 5: Tackling dieting and other forms of avoidance
Sadly, Dr. Fairburn suggests we may have to actually stop dieting and get the binge eating under control. If you remember from part one, there are the various pathways to binge eating and dieting is seen as a big stepping stone. He doesn't go into details of the studies he's done, but I really have to wonder how many subjects were significantly overweight and obese. Just "learning to live with" our current, overweight selves IS NOT AN OPTION for me, and he does suggest that some of us might have to do that. I would love to see some studies that deal with overweight binge eaters (who don't purge).
Regarding the avoidance of certain types of food, Dr. Fairburn suggests introducing them back into your diet, in limited quantities. I have issues with this because I try to avoid junk food, and I don't find any reason to introduce those into my diet because they have no nutritional benefit at all. I can understand introducing other foods that are commonly avoided, say nuts for example. People avoid nuts because they are high in fat, but some fat - expecially the right kind - is good for you. But really, what's the benefit of eating sugar and trans fats? I do understand learning moderation, and I guess that's his point. Even healthy version of my "bad" foods are something I try to avoid. So I suppose this is where this step applies to me.
Step 6: Preventing a relapse and dealing with other problems
Ah, the main test of this whole thing. Can we stop binge eating long term? Here, we have to have realistic expectations. I know I cannot say I will never binge again. That would be absurd! I probably will, and all I can do is keep going through the steps. Hopefully, though, going through them the first time, especially with the monitoring and problem solving steps, will help me learn when I'm likely to binge and how to better deal with it.
So how do you go through the steps? With each step, review every few days and write a weekly summary. Start with Step 1, obviously. After a couple weeks, if you feel you're doing well, move on to Step 2. After a couple weeks, move on. The time frame in the book is about 6 months for all the steps, but it really depends on what you're already doing. I know you're supposed to go step-by-step, but I was already doing half of these steps anyway, that I am trying to start off with Steps 1-3 right now. I'll reassess things in a week or two, and go from there.
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*
perfectionism*
all-or-nothing thinking*
implusivity
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
or
Obesity -------->Dieting -------->Binge Eating
or
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.
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*
perfectionism*
all-or-nothing thinking*
implusivity
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
or
Obesity -------->Dieting -------->Binge Eating
or
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.
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