Brain Over Binge (30 page)

39
: Prevention

I
often think of things that may have kept me from developing bulimia in the first place, and there is only one thing that would have prevented it: avoidance of dieting. If I could have somehow avoided dieting, I could have avoided an eating disorder. So what would have prevented me, and what will prevent other young women from dieting?

Restrictive dieting is serious and potentially dangerous, especially in young people, but I don't believe the dangers are clearly communicated. Dieting is praised in our culture, and the aim to prevent it in young people isn't strong enough. I often see advertisements to discourage kids from taking drugs, which are sometimes terrifying in nature. I've seen billboards showing a ghastly figure of a drug addict; I've heard a radio commercial featuring an addict talking about all the horrible consequences he faced as a result of his drug use. Police go to high schools and put on chilling presentations about the risks of drinking and driving. None of this is done in regard to dieting.

Since eating disorders are viewed as diseases, like diabetes or lupus, plenty of groups—like the National Eating Disorders Association—raise
awareness
about them, just as the American Cancer Society raises awareness about cancer. It's fine to raise awareness about eating disorders, but that's not a preventive measure. That only promotes the idea that eating disorders are illnesses that inexplicably happen to people, when in fact nearly all cases of anorexia and bulimia, and a large number of cases of BED, would never occur without the initial diet, just like a drug addiction would never occur without that first hit.

There are susceptibilities to eating disorders just like there are susceptibilities to drug addictions, but the first diet, like the first hit of a drug, is not inevitable based on those susceptibilities. It's a choice, and one that can be prevented. When parents tell their kids not to smoke, they say, "Don't smoke" and possibly inform them of the horrible consequences of smoking. They don't say,
Smoking is a disease you should be aware of.
I'm not suggesting that scare tactics are the most effective way to prevent restrictive dieting, smoking, drinking and driving, or drug abuse; but there have to be measures to discourage all of these behaviors in young people. Restrictive dieting should not be excluded from the list of detrimental behaviors, and it should definitely not be praised.

PREVENTION CAN BE COMPLEX

I realize that "don't diet" is a more complicated message than "don't smoke" because smoking is clearly definable and dieting is not so clear-cut. Cutting back on junk foods and cutting down excessive portions is not truly "dieting;" it's learning to eat healthier. But even healthy improvements can have the effect of throwing the body from homeostasis and triggering survival instincts. In other words, the diet doesn't necessarily have to be restrictive to cause problems. Adolescents in a situation where they need to make changes to become healthier should be educated about survival instincts and why their bodies initially protest even healthy changes in eating habits. They should also be encouraged that soon, if they stick to it, healthy changes will become habitual and effortless.

Discouraging dieting is also a tough issue in that it could send the wrong message; that is, it could encourage teens to eat excessively in the name of "not dieting." Furthermore, harping on adolescents' eating habits to ensure they don't diet could run the risk of making them overthink their eating and lose touch with their natural hunger and fullness cues. Because of these issues and more, I'm not claiming there is an easy answer to dieting prevention, but I do think there are three things that may have helped me avoid dieting in the first place. I'm not blaming any of these factors for my own choices, but I believe that the following changes may have helped me choose to keep eating naturally.

Less Emphasis on Weight in the Family

Too many young women are raised by mothers and sometimes fathers obsessed with their weight, talking about their diets and workout plans, talking about how fattening certain foods are, lamenting about parts of their bodies they consider fat. I don't need to share exact details about my own family's issues surrounding weight while I was growing up to admit that there were definitely issues. There were comments—nothing too outrageous or out of the ordinary—that led me to believe that any excess weight was not preferable, and not just for health reasons, but for personal worth. I personally believe weight and food should be discussed in a family in the context of health, not in the context of appearance. I think positive role models, both in and out of the family, could do much good in dieting prevention.

More Preparation for Weight Changes During Puberty

Because my background involved believing that weight gain was bad, puberty was more worrisome than it should have been. Now, with perspective, I know that the natural weight gain I experienced in puberty would not have kept up indefinitely. My body would have leveled off at a natural weight—a woman's weight, not a child's—and it would not have escalated to me being overweight. Back then, I needed to know that the extra weight in puberty was healthy, normal, and beneficial, not only for my future childbearing years, but in the present for athletics and strength. I wish I would have welcomed the change. I sometimes see skinny little girls like I was and hope they are prepared for weight gain later in life. Since being thin is praised so much, I think skinny girls risk fighting the change or lamenting the loss of their girlish bodies even more than others do.

Knowledge of Ineffectiveness of Restrictive Dieting

When I started dieting after my tonsillectomy, my parents recognized it soon enough. However, their main message, it seemed, was to try to convince me there was nothing to worry about, that I was thin and didn't need to lose any weight. I remember asking to buy a diet book in Walmart one day and my mom telling me that I was skinny and didn't need to diet. I'm not saying theirs was the wrong approach, and it was certainly well-meaning; but it wasn't effective. Telling me not to worry about my weight when I'd clearly watched it go up in recent years wasn't going to quell my concerns. The message I got was,
You are still skinny, so stop worrying about it.
From this message, I took away,
You better watch out, because if you don't cut back on calories, you won't be skinny anymore.

I think a little validation of my feelings might have helped, as in,
Yes, you have gained weight in high school; yes, it's normal; yes, it's healthy; and yes, it's going to stop.
I also needed to know that it was normal for a girl my age to become concerned with appearance, based on biological drives (see Chapter 18), and that these concerns would only be transitory. More importantly, I needed to know that restrictive dieting wasn't the answer and would only make things worse. I needed to know that—regardless of how I felt about my body—I had to avoid restrictive dieting to avoid dangerous consequences; just like I learned that—regardless of how much I wanted to fit in—I had to avoid smoking to avoid dangerous consequences.

I also needed to understand and appreciate that eating is for health, not weight. I'm not saying I shouldn't have changed any of my eating habits at the time, I simply should not have turned to "dieting." There would have been nothing wrong with me cutting back on soda and some other unhealthy foods in my diet in the name of health, all the while being aware of my survival instincts. But I did not do this. I cut back on my food purely in the name of weight loss.

Once my weight loss escalated, I believe the slide into bulimia could have still been prevented. My parents, in wanting to help me overcome my problem—anorexia—sought information about eating disorders and attended a support group. There, they received the wrong information. They were told I had a disease, that I couldn't truly control my behavior, that they had to be unconditionally supportive, that they couldn't question me or bring up my eating unless I brought it up. In short, they were told they had to keep their mouths shut and let me find my own way, offering support only if I requested it.

This advice, I think, made them afraid to mention my restrictive eating or confront me about the dangers of dieting. I think when a kid is engaged in harmful eating behavior, it needs to be treated just as firmly as someone on drugs or smoking. In smoking or drug use, it would be unheard of to tell a teen,
It's not your fault you smoke or do drugs
or
You have a disease you can't control.
In smoking or drug use, unconditional support and an unquestioning attitude toward the destructive behavior is not a typical course of action; and I don't think it should be a typical course of action for friends, family, coaches, and teachers of those with eating disorders, either.

I think it would have been helpful for others to take a more direct approach with me. My teachers, coaches, and people I looked up to had every right to question me and criticize my destructive actions, but they didn't. Some approached my parents delicately but never earnestly confronted me. There was only one person who ever told it like it was, and that was an old coach of mine—one known and loved for her honest approach. When my weight loss first became noticeable, I remember going to dinner one night with a few friends and teammates. One of them—I'll call her Mary—had a stomach problem at the time and noticeable weight loss as well. Mary and I didn't order any food; she had a good excuse, I didn't. Our former coach saw us at the table and came to talk to us. She noticed we weren't eating anything and said, "You don't have that stupid anorexia nonsense, do you?"

Some would call this comment uninformed and insensitive. Looking back, I don't think it was. Maybe true anorexia is not stupid, because once the starvation habit is firmly in place, it's much harder to see the problem and to change it, but restrictive dieting
is
stupid. It's stupid like smoking is stupid; it's stupid like shooting heroin is stupid; it's stupid like getting drunk every night is stupid. And it's stupid because it simply doesn't work for weight control in the long run. This lone comment from my old coach didn't make me stop, but perhaps the message that dieting doesn't work and is dangerous—from a variety of sources prior to beginning dieting and after it escalated—could have helped me avoid it.

40
: Bridges to Traditional Therapy

T
he primary message of this book is that in order to recover from bulimia or BED, one has to
stop binge eating.
It may seem overly simplistic, but it is the truth, even from the perspective of traditional therapy. All paths to complete recovery inevitably involve quitting binge eating, regardless of how long that takes. Since quitting binge eating changes the brain, it follows that all paths to recovery ultimately lead to desirable brain changes.

Traditional therapy can work for some people, by ceasing binge eating and preventing it from ever coming back. In these cases, the brain is already undergoing or has already undergone the necessary changes. My mission in this book is not to take away what is already working or has already worked for other people. Like I've said, some binge eaters indeed recover using traditional therapy. So I'm just trying to offer an alternative for when therapy isn't working, isn't resonating, isn't effective, and isn't possible or desired.

I don't think my ideas are altogether antithetical to those of traditional therapy. On the contrary, in some ways, my "brain over binge" approach might be compatible with each major therapeutic approach, as discussed below.

A BRIDGE TO PSYCHODYNAMIC THERAPY

With this form of therapy, it is most difficult to build a bridge; yet I see two ways in which psychodynamic therapy and brain over binge could be used together.

First, I have been told by a few critics that my basic argument is simply to "stop the behavior first, then work on underlying issues." Actually, this is not what I'm saying, because this still contains the potentially harmful idea that the eating disorder and the other problems are intimately related, and solving the other problems is necessary for full recovery and relapse prevention. I believe that once the BED or bulimia is stopped, any personal improvements made are only quality of life improvements, unrelated to recovery.

Even though "stop the behavior first, then work on underlying issues" is not the message of this book, I do believe that it
is
the most useful order of events when psychodynamic therapy is employed. Psychodynamic therapy could be presented in conjunction with brain over binge, such that the bingeing could stop first, then the emotional changes could occur afterward. This would avoid binge eaters getting the message that they can stop only once they resolve this or that issue or become whole or happy.

Stopping the habit first would have the added advantage of weeding out any problems that are actually results of the bulimia, meaning that lots of time and money wouldn't have to be wasted in therapy talking about side effects that would just go away when the habit disappears. Also, there is no reason that a patient can't solve emotional problems or underlying issues while she simultaneously stops the binge eating—as long as the two endeavors are kept separate.

Secondly, psychodynamic therapy could be used as "readiness" therapy. Recall my belief that the first step in recovery is wanting to recover. This book is intended for people who fully realize they have a problem and want to recover from it—or, at least, part of them wants to recover. However, I'm sure there are binge eaters out there who do not feel any pull toward recovery, who are complacent in their behavior, who don't have any desire to give it up. Without the will for recovery, the separation between the self and the binge-created brain-wiring problem is irrelevant; being driven by the lower brain will remain the status quo.

The highest human brain has to be on board with recovery, even though the lower brain will resist. Psychodynamic therapy could then be used to help find a spark of the true self who wants to recover. I'm not talking about "finding the true self" in the sense of becoming fulfilled and developing a cohesive identity prior to stopping binge eating, because this could put off recovery for a very long time. I'm talking about using psychodynamic therapy as a way to catch a glimpse of the highest human brain that does not want to be run down by the lower brain any longer.

In summary, a patient doesn't have to transform in psychodynamic therapy in order to recover, but she can use it to transform afterward—if a transformation is desired—just like anyone, with or without bulimia, could use this type of therapy. Alternately, psychodynamic therapy could be the vehicle that helps a patient find the part of herself that wants to recover.

BRIDGE TO COGNITIVE BEHAVIORAL THERAPY

Cognitive behavioral therapy is the easiest to build a bridge toward, because on the surface it doesn't seem that much different from the brain over binge approach. The ultimate goal in CBT is to substitute healthy behaviors for binge eating. In substituting healthy behaviors for unhealthy ones, CBT activates executive systems (the prefrontal cortex) and can develop new neural pathways that support substitute behaviors.
248
Isn't this similar to what I've been talking about?

Ideally, it could be. If the bulimic goes for a walk, takes a warm bath, sews, or does another fulfilling or distracting activity every time the urge to binge hits, then yes, the neural pathways that support those new behaviors would become strong and the pathways that support binge eating would weaken. However, CBT—at least for me—made it so that I could
rarely
substitute one of those positive behaviors. I had lists upon lists of things to do instead of binge, but actually doing the things on those lists was overwhelming.

It was so difficult because of the value CBT placed on my urges. My urges to binge were supposedly the result of something significant, like a stressor, a trigger, or an emotion I supposedly couldn't cope with. I gave the urges attention and emotional significance in trying to decipher them, which only made them more powerful. Furthermore, I thought that substituting a healthy coping skill or distracting activity was supposed to take away or significantly lessen my desire to binge, which, of course, it didn't.

I couldn't resist my urges as long as they had any measure of value—physical or emotional. It was only when I learned to view them as neurological junk that I was able to resist.

When I did stop acting on my urges, I didn't necessarily substitute positive activities for them, mainly because that's what I tried to do in vain for many years and I wanted to do something different. That said, I
could have
substituted specific, positive behaviors. This is where the bridge to CBT lies. If you are using CBT, you may find that a change of perspective regarding your urges allows you to easily choose alternate activities over binges. Once you stop giving your urges attention and attaching meaning to them, you will have the power to assert your will and substitute any positive behavior you want.

In the OCD study I have repeatedly discussed, the majority of Schwartz's patients were able to engage in alternative activities—such as gardening—instead of acting on OCD urges. He found that his patients' ability to perform those substitute behaviors was related to the value they placed on their urges. In fact, the "key predictor" of whether his therapy would help an OCD patient was "whether he learns to recognize that a pathological urge to perform a compulsive behavior reflects a faulty brain message—in other words, to Revalue it."
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Revaluing was the step where he taught his patients to "quickly recogniz[e] the disturbing thoughts as senseless, as false, as errant brain signals not even worth the gray matter they rode in on, let alone worth acting on."
250
The more detached the patients were from their urges, the less significance they placed on them, the greater their ability to focus their attention on an alternate activity.
251

Based on my premise that the urge to binge is the only true cause of binge eating, if the bulimic learns to view the urge differently—as simply junk from the lower brain—it doesn't have to cause binge eating. If CBT added this simple concept to the vast array of cognitive and behavioral techniques it endorses, then I believe those techniques could become doable for many. Separation and detachment from the urge can make doing any number of alternate activities possible—even if it's simply something distracting like surfing the Internet, doing a crossword puzzle, or listening to music. In other words, brain over binge could give patients the willpower they need to use CBT-recommended techniques and therefore make CBT a more effective therapy. It's a subtle change in the approach, but it could make a world of difference for many.

CBT is also useful in changing cognitive distortions regarding weight and body shape. If a woman is determined to diet restrictively when she stops binge eating, then her urges to binge probably won't go away quickly or at all. CBT could help her give up the desire to deprive herself, by helping her think healthier thoughts about food and weight or by providing nutritional counseling. This is useful to women (and men)—with or without a history of an eating disorder—who place an unhealthy value on their weight and appearance. Furthermore, CBT can help correct thoughts that lead to depression, anxiety, perfectionism, or negative feelings—again, useful for anyone with or without an eating disorder who suffers from those problems. As long as recovery doesn't hinge on solving any coexisting problems, CBT is useful in solving a wide variety of them.

BRIDGE TO ADDICTION THERAPY

If you believe you are addicted to certain foods—especially sugar and white flour—then you are probably right. But we don't actually experience a true loss of control when we eat those foods. Like I've said, the loss of control in binge eating is only a perceived loss of control, not a biologically based loss of control.
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What we don't have control over is the surfacing of our urges to binge. If the lower brain is conditioned to binge on certain problematic foods—like sugary ones—then even one bite of something sugary will automatically produce an urge to binge. It's these urges to binge that we have no control over, not the actual binge eating.

Knowing this, a binge eater could use the addiction model in this way. She could avoid all problematic foods for a while if she wants, knowing she will probably crave them and knowing she can detach herself from these cravings. Then she could gradually introduce them in moderate amounts—that is, if she wants them to be a part of her normal diet. When reintroducing the foods, she should set a limit and stick to it; but she should know that the brain will send urges to eat much more than the set limit. For example, if a limit of four cookies is set, eating those four cookies will probably set her lower brain aflame with desire for the whole box. But if, using her highest human brain, she remains separate and detached from this automatic brain reaction and assigns it no value, she should be able to refrain from reacting to the urges and acting on them.

Once normal amounts of problematic foods are eaten many times, the old binge eating habit will subside and eating moderate portions will be become normal and effortless. Or, if she doesn't want to eat any amounts of former problematic foods—perhaps for health reasons—there is no pressing reason to, as long as she knows how to deal with her urges to binge when she inevitably eats those problematic foods someday. It seems unrealistic to expect that anyone will never eat even a bit of sugar for the rest of their life, so it's vital to be prepared for when we do eat a problem food. Prepared only means being aware of the brain and dismissing any faulty messages it may send.

Overeaters Anonymous

Overeaters Anonymous applies the addiction model to eating disorders, although not all OA groups advocate complete abstinence from problem foods. All groups do advocate a plan of eating but maintain no specific requirements for that personal plan.
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Since OA is the most popular group using the addition model, I will attempt here to build a bridge between OA and the brain over binge model using the first three of the 12 steps of OA:

Step 1:
We admitted we were powerless over food—that our lives had become unmanageable.

Step 2:
We came to believe that a Power greater than ourselves could restore us to sanity.

Step 3:
We made a decision to turn our will and our lives over to the care of God
as we understood Him.

The rest of the 12 steps involve admitting wrongdoings and shortcomings, making amends with others, and ultimately, having a spiritual awakening and carrying the message to others—worthy life goals that don't have much to do with recovery from the actual eating disorder. In looking at the first three steps, I realized that I could reword them to describe my own recovery:

Step 1:
I admitted that I was powerless against the surfacing of my urges to binge in my lower brain and that I had stopped managing my own life.

Step 2:
I came to believe that I had great power within myself—my highest human brain—and that I could use that power to restore myself to sanity.