Brain Over Binge (28 page)

If I looked hard enough, there was always something negative going on in my external or internal world before each binge, so I was always able to find a negative trigger. Furthermore, there was a benefit for me in the negative: it let me off the hook in my mind. If I could identify a negative trigger, I didn't feel as accountable for my own actions. I could blame the trigger for the binge, and this felt much better than blaming myself. If, in my mind, the binge was due to a fight with my boyfriend, a feeling of loneliness, or stress about an upcoming exam, I had an excuse for having engaged in such a disgusting and shameful activity.

But reporting bias aside, it did make some sense that my binge eating occurred more often following stressors than positive experiences. Why? Because of the secondary benefits of binge eating. It made me feel good, temporarily; so I automatically craved it when a little pleasure, distraction, numbness, or stress reduction was enticing. It's well known that eating reduces stress,
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even in those without eating disorders and even in animals. In some of the rat studies I've mentioned, the previously food-deprived rats binged on highly palatable foods after exposure to stress, whereas previously food-deprived rats not exposed to stress did not binge.
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In other words, stress did induce binge eating in the rats that were already rendered susceptible through a history of food deprivation. Stress and eating are certainly related, and this relationship is most likely mediated by the opioids.
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Like the food-deprived rats, I was probably susceptible to stress-induced binge eating. However, stress never triggered my binge eating, it only triggered my urges. Unlike the rats, I always had a choice—because of the capabilities of my highest human brain—of whether or not to follow those urges.

That my lower brain automatically produced urges to binge when I encountered negative thoughts, feelings, and events in my life was
not
an indication that I somehow needed to binge to cope with those things. There were simply strong patterns of association, so that my urges arose more often in the wake of negative circumstances and stressors; but always, I binged only to cope with the urge to binge. Negative thoughts, feelings, and events didn't cause binge eating prior to the development of my bulimia, and they don't cause binge eating now.

WHY DEALING WITH TRIGGERS WAS INEFFECTIVE

In the view of traditional therapy and specifically CBT, learning to cope with triggers—whether the trigger is a difficult external circumstance or a negative inner thought or feeling—should prevent most urges from arising and make existing urges go away. If, for example, I determined that feeling anxious led to binge eating, I could practice relaxation techniques as soon as anxious feelings arose, which should have prevented an urge to binge or stopped it once it started. If being alone at night led to binge eating, I could plan activities, and engaging in them should have prevented an urge to binge or stopped it once it started. These types of strategies were never effective for me, and I believe there were two reasons for that.

1. Dealing with the Triggers Was Not Addressing the Real Problem

In therapy, I identified my triggers and developed plans to deal with them, and I even tried avoiding some triggers altogether. Sometimes I decided not to go out drinking, solely because I feared I would binge when I got home; sometimes I stayed away from social situations, solely because they left me feeling inadequate—a feeling I believed triggered binges; sometimes I tried to avoid certain foods that I thought triggered binge eating. I had a long list of positive things to do when I felt lonely, sad, depressed, or anxious; I had action plans to deal with relationship conflicts and stressors at school and work.

Now that I know that the real problem was my urges to binge, I can see how unnecessary all of this was. Urges to binge led me to binge all those years—triggers didn't. Once my brain produced its response to a stimulus, trying to cope with the original stimulus did not erase the response.

Trying to substitute an alternative and emotionally fulfilling activity to deal with the trigger—like calling a friend to deal with loneliness—would be like the mother of the misbehaving boy in my example giving her child a hug instead of the toy for which he is screaming. The child will mostly likely reject the hug and escalate his tantrum. Even if he does have some unfulfilled emotional needs—as nearly everyone does, young or old—he isn't screaming for a hug; he is screaming because he wants the toy, and only the toy will do.

Moreover, dealing proactively with triggers—giving myself comfort and emotional fulfillment before urges could surface, as my therapists suggested I do—was also ineffective. To explain this, I'll return to the previous example of binge eating after going out with my parents.

When I began therapy, my therapists wanted to explore family dynamics and conflicts to see from where any stress might stem. In therapy, I pondered questions like these:
Am I binge eating to rebel against my parents because they make me feel smothered? Am I binge eating as a way to get their attention? Am I binge eating to assert my independence from them?
In theory, if I got to the bottom of my family conflicts and solved them, I could greatly reduce my binge eating. I found this not to be true. I can remember times when my parents came to visit and I truly had a great time, but I still had urges to binge and still binged.

Yes, I had some family conflicts at the time of my binge eating; but I also had them before my bulimia ever developed and before I ever dieted, and to this day, I have ever-changing family issues—nothing major, but I think most families are a bit dysfunctional in one way or another. The conflicts in my family prior to the development of my eating disorder didn't produce urges to binge; and after my recovery, they stopped producing urges to binge. This is because they were never the problem; family problems only became
temporarily
linked to binge eating.

Even if I could have managed to solve all of my family problems in therapy—which would have been unrealistic for any teenager or woman in her early twenties—it wouldn't have taken away my urges to binge. I still feel guilty that I ever blamed binge eating on others, especially my parents and sister, who have given me so much love and support over the years. The high school and college years are characteristically rocky times in the parent-child relationship; this is completely normal as teens assert their independence from their family of origin. For therapists to encourage young women like myself to see inevitable family conflicts as causes of eating disorders is, I believe, highly irresponsible, and it could even lead to permanent damage to family relationships.

2. Dealing with Triggers Was a Monumental Task

Even if dealing with triggers worked every time, which it didn't, it is a monumental task. To deal with triggers, I had to either avoid or learn to cope with all the situations, thoughts, and feelings that preceded binges, which could have been any of an infinite number of thoughts, situations, and feelings. Avoiding or coping with triggers diligently does have the possibility of preventing some urges in bulimics, because, as I've discussed, bulimics are more likely to have urges to binge when they feel bad and want some sort of pleasure, distraction, or numbness. So if a bulimic learns to cope well with all negative feelings, events, and thoughts, she may not crave pleasure or distraction as much, and therefore, her urges to binge may decrease. But there is no guarantee, because once the body and brain are hooked on binge eating, the binge eater will still be driven to do it at times, even if she feels good otherwise.

I never even came close to the ideal of coping well with all of my triggers; I guess I wasn't good at fending off or dealing with negative feelings, thoughts, and events. But was this really only
my
problem? I think it was unrealistic for my therapists to expect me to cope well with everything negative in my life, especially when I was still very young. To deal with every event, feeling, thought, situation, conflict, or stressor that could potentially trigger an urge to binge would be an insurmountable and life-consuming task for anyone, especially a teenager or young adult. Although I did try to deal with the triggers, and I did discover some coping strategies that have served me well in my life (even though they didn't do much to stop binge eating), the enormous chore of dealing with triggers was simply unnecessary for my recovery.

In fact, I believe focusing on triggers gave me more ways to procrastinate about stopping my habit. I found myself saying things like, "When I stop being anxious staying in the house alone, I won't binge when I'm in the house alone," or "When I feel more comfortable in social situations, I'll stop bingeing when I get home from parties," or "When I can become organized and study well before exam time, I'll stop bingeing the night before exams." All of these excuses just served to keep me from taking control of my own behavior, regardless of the situation.

AWARENESS OF TRIGGERS WAS HELPFUL

Once I knew I was no longer a slave to my lower brain's automatic responses, triggers didn't bother me anymore. My lower brain certainly continued generating conditioned responses—the urges to binge—in trigger situations. Those urges, and all the thoughts and feelings that came along with them, were beyond my control. However, I knew my actions were always under my control, regardless of what—if anything—may have triggered my urges.

I did learn something useful from studying triggers. After I stopped binge eating, it was helpful for me to know that some situations were more likely than others to cause urges to binge. I knew that certain foods, feelings, thoughts, and interactions were particularly likely to cause my brain-wiring problem to flare up. There was nothing inherently wrong with those trigger situations or my ability to handle them, but there was something wrong with my lower brain's reaction to them. In the weeks and months after I quit bingeing, I expected my lower brain to act up when I encountered my former triggers, and when it did, I made sure not to let it affect me. As long as I put brain over binge—viewing the urges as simply neurological junk and unrelated to my ability to cope with any given trigger—it was simple not to act on them.

During that period, every time I encountered a trigger—such as eating at a restaurant with my parents—without binge eating, I taught my brain something new: that I no longer binged in response to that trigger. Without knowing it at the time, I was breaking all of my old stimulus-response patterns by not following my urges to binge. In behavioral psychology, this process is called "extinction": the gradual disappearance of a conditioned response to the stimulus.
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The most famous—and, in fact, the first—example of stimulus-response patterns and extinction was observed in the dogs of Ivan Pavlov.
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Pavlov conditioned the dogs to expect food after the sound of a bell, and a stimulus-response pattern soon formed. The dogs began salivating whenever they heard that bell, prior to the food arriving. The bell was the stimulus, which produced the response of salivation. However, if Pavlov stopped providing food after the sound of the bell, the dogs gradually ceased salivating when they heard the bell. In other words, if Pavlov took away the reward (the food), the stimulus (the bell) stopped evoking the response (salivation). It was the same with my binge eating. When I took away my lower brain's reward (the binge), all stimuli (triggers) stopped evoking the response (the urges to binge).

After I had encountered an urge-producing trigger a few times without providing my brain its reward, I noticed that the urges to binge faded in response to that trigger. Soon, I could have arguments with family or my husband without binge eating popping into my mind; I could feel depressed, anxious, or lonely, and my lower brain would not generate even the slightest urge to binge. The lower functions of my brain were like the child in the toy store—once he learns that tantrums won't get him what he wants, he will stop throwing them.

GETTING EXCITED ABOUT FACING TRIGGERS

Once I began seeing my urges to binge as the real problem, and I truly felt the power of my highest human brain over them, I found that I actually liked facing my old trigger situations. I found it empowering to know that my lower brain was going to act up, then feel it do so, all the while knowing I was not going to take it seriously. I got excited about overcoming my trigger situations—not by always coping well, but by simply not binge eating—and my excitement not only made me feel good, but I believe it solidified the changes in my brain. Since no situation was inherently dangerous, I no longer had to fear certain "triggering" people, places, foods, feelings, or situations, because I knew that nothing I encountered could make me binge. The situations I faced weren't always easy, but that's just life.

36
: Purging

A
purge is a compensatory behavior—meaning it compensates for, or makes up for, something. That something is a binge. Take away the binge, and the purge serves no purpose. When I stopped binge eating, it followed that I simultaneously stopped purging. Why would I go through the misery of spending hours and hours exercising if I didn't binge eat? It simply wouldn't be necessary.

Purging was not a part of a disease I had; and in fact, purging was in no way a sign of psychological impairment. Although it was an unhealthy behavior, my purging began as a semi-rational attempt to undo the damage of each binge. Looking back at the beginning stages of my bulimia, when my survival instincts drove me to binge, reaffirms that there were two brain mechanisms at work: the survival instincts that produced those overwhelming urges to binge; and my true self. My true self was temporarily engulfed by urge after urge to binge; but once each binge was done, I returned to my senses and attempted to make up for what I had done.

In my case, my purging behaviors—overexercising and limiting food intake following a binge—weren't quite as dangerous or extreme as those of some other bulimics, because I physically couldn't make myself throw up (although if I could have at the time, I certainly would have). But even throwing up or abusing laxatives is not a sign of disease—it is the bulimic's attempt to take control back after a binge.

Until I knew what was going on in my lower brain, my true self felt powerless during each and every binge—as if it could see what was going on but could do nothing to stop it. So, I resorted to damage control. Once the binge was over and my true self returned, I felt I had to do something to compensate for my disgusting, gluttonous behavior—so I purged. Purging was never a good decision, but it was a rational decision made in times of desperation.

In therapy, I learned that purging, like bingeing, was a symbolic act that signaled a deeper emotional need or psychological problem. I learned that purging could be a form of self-punishment, a symbolic way of cleansing myself of unwanted feelings, an expression of anger, or a form of stress release. It was none of these things. It was a rash, yet understandable attempt to get rid of the massive amounts of food I knew I shouldn't have eaten.

PURGING BECAME HABITUAL TOO

Even though purging started as my own conscious—if bad—decision, it, too, became automatic and habitual as my bulimia progressed. This is because any behavior that is repeated enough gets relegated to the lower brain centers; then habit takes over. Purging became part of my whole binge-created brain-wiring problem, such that, after I binged, my brain automatically triggered an urge to purge. If I tried not to overexercise the day after I binged, I experienced strong urges to do so. I would get anxious and feel extreme guilt until I broke down and went to the gym. Even though overexercising was difficult and on some days excruciating, the feelings I had when I didn't purge were worse. I can imagine that the urges to purge are only amplified in those who practice self-induced vomiting, because the relief from guilt is so immediate.

Purging became linked to binge eating because my brain developed one of those stimulus-response patterns that I discussed in the previous chapter. Just as triggers produced urges to binge, binges became triggers that produced urges to purge. Bingeing and purging became physically linked in my brain, so that binge eating became the stimulus and the urge to purge became the response. When I took away the stimulus (binge eating), I by and large stopped having the response (the urge to purge). Since I never binged, the neural pathways that produce urges to purge never got a chance to fire. It was as if I'd put up a roadblock in my brain, so that the stimulus-response pattern never got set in motion.

However, I noticed that it was possible for my brain to generate a desire to purge even if I had not binged. Two situations sometimes brought this about.

1. The Urge to Purge from Simple Overeating

This was the situation where I was most likely to experience an urge to purge. If I ate a big meal or felt a bit too full, the feeling of fullness sometimes triggered a response similar to the response binge eating triggered. I found myself thinking,
I can just work out for a long time tomorrow to burn it off.

The problem was, since fullness was part of the old stimulus of binge eating, my lower brain acted as if I had actually binged whenever I felt a bit too full. For a short while after I quit binge eating, I just had to live with this. I ignored the automatic messages telling me that I needed to overexercise simply because I ate a little too much, and soon, fullness stopped producing urges to purge.

2. The Urge to Purge When I Ate Former Binge Foods

No food can cause purging; but certain foods—especially those I used to binge on—sometimes created urges to purge just as they sometimes created urges to binge. Even though I ate the former binge foods in normal quantities, my lower brain sometimes reacted nonetheless. It was reacting to the quality and type of food that I ate—sugary and fattening—and not necessarily the quantity.

For example, I used to binge on entire bags of potato chips; so if I ate a normal portion of potato chips, I sometimes had automatic thoughts telling me that I needed to work out more to make up for eating the chips. This doesn't mean chips were a problem or that I needed to eliminate them; it only meant that my lower brain had learned to associate eating chips with purging. Since I didn't act on my urges to purge, they soon went away.

DEALING WITH URGES TO PURGE

I dealt with urges to purge the same way I dealt with urges to binge. I recognized the urge as neurological junk—a remnant of my old habit—separated my highest human brain from the urge, didn't react emotionally to it, and, of course, didn't act on it. I remained aware of situations that could give rise to urges to purge, but I didn't need to avoid them or learn to cope well with them. I just knew that I didn't have to do what my lower brain was urging me to do. I could veto any eating disorder-related urge, whether it was to binge, to spend many hours in the gym, or to restrict my food intake after simple overeating. The neural connections that once produced my urges to purge simply faded away with lack of use; and now I can eat a big meal without any desire to compensate for it, and I can feel normal after exercising for only twenty minutes.

PURGING WITHOUT BINGE EATING

Before I end this chapter, there is one more issue to address. There are some with eating disorders who do not binge, but they nevertheless purge after normal meals or even after eating a very small amount. It is common for anyone who self-induces vomiting or abuses laxatives to consider herself "bulimic," but this is actually a misuse of the term. Bulimics—by definition—binge eat. When someone is purging regular meals or small amounts of food, she is engaging in a severe and dangerous form of restrictive dieting. Some have suggested that a new eating disorder—purging disorder—be added as a distinct classification.
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Purging without binge eating can be more complicated than bulimia or BED, I believe, for the same reasons that anorexia can be more complicated. If the woman sets out to lose weight, and that's what she is doing by purging, then she will have less motivation to quit. The purging may be ego-syntonic—in line with what her true self wants. Making it more difficult is the fact that purging can become addicting, so that any amount of food can trigger an urge to get rid of it. Furthermore, purging can lead to severe gastrointestinal problems, which can make keeping down any food painful and the urges to purge harder to resist.

Once the purging habit forms, the urges to purge are the only true cause of purging; however, the woman may have a hard time separating herself from those urges if she sees them as her true intention. Like I've stated previously, the first step in both traditional therapy and in my opinion is wanting to recover. Certainly, the advice I've given for resisting urges to binge and purge could apply to someone with purging disorder, but only once recovery is desired and the woman can see the urges as an unwanted intrusion in her life. The same holds for anorexia: once the woman can see the desire to starve as something apart from her highest self, only then can she overcome the problem.