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Thursday, October 18, 2012

What’s the Point? I’ve Already Blown It. Breaking the Cycle of Restrictive & Binge Eating.



What bothered Stacey most was the binging. Sure, the restrictive eating made her feel lightheaded and made it difficult to function. And yes, she was tired—but that was to be expected—it was what she was used to. The preoccupation with her weight, her eating, her food rules—that was all she knew. But then the binges soon followed, along with the need to purge and as this increased in frequency, she began to panic. Which brought her to seek my help.
We began with a behavior chain—a mapping of the sequence of events that Stacey experiences, the link between her thoughts, feelings and actions, which keep her stuck in her disorder. It shows how one link in the chain leads to the next, then the next, to keep the cycle going.

They have no idea how she's suffering.
Her pattern began, like it does for many of you, with deprivation—or simply not eating enough. She often fools herself into thinking that she is having enough—eating regularly, yet consuming insubstantial amounts or very low cal items; or limiting her intake because of not feeling hungry—perhaps because of the large volume of water and coffee she relied on to take the edge off. 

Maybe it seems justified—I mean, she did binge the night before—so it seemed reasonable to her to "get back on track" with her diet mentality. And sometimes even her anxiety makes it challenging to notice her hunger and rely on it. At this point, she simply doesn’t trust her body or herself.

Next, she tends to get quite hungry. Sometimes she actually allows herself to eat enough—knowing she needs the fuel—while other times she overeats. But when she does eat a reasonable amount, she feels so guilty and not entitled to it that she later attempts to restrict.

Patterns can be nice, but not this pattern she's
stuck in.
But once Stacey crosses the line, guess what? She figures “why bother?” and so initially she decides to continue to overeat, thinking she’d already blown it. This leads her to feel disgusted with herself and to lose hope. She continues this cycle for a while until much damage is done—to her intake, to her mood, and to her sense of self-worth. Eventually this leads her, once again, to restricting her intake—to make up for the damage from the day before, to punish herself, to “get on track and take control”.

The scale compounds the problem. Focusing on the number prevents her (and you) from really looking at the problem behaviors. Your weight's climbing? This only increases your panic and impulse behavior to try to seize control--without thinking rationally about what your body truly needs. Your weight’s stable? Perhaps you minimize how damaging your thoughts and behaviors have become, and simply accept them as normal. No, it is not acceptable to spend 90% of your thoughts on food, and eating, and weight. 

And your drop in weight? It may reinforce your unhealthy behaviors, as weight loss can be seen as a positive—even if it is anything but healthy—especially in the manner it is achieved. To me, weighing is generally a lose-lose situation (and I’m not talking about weight) in this situation, before you have learned to trust your body and its ability to self regulate; until you have learned to view your weight as just one variable in the big picture of your health. (So please stop weighing yourself if this applies to you!)

See the problem? In Stacey’s case, as she's eaten less, even with the periodic binging, her weight has been stable. So of course she fears what might happen if she does eat more. In her mind, more food must equal more weight. Yet in reality, there are a couple of explanations for this stable weight despite lower daytime intake. She may be making up the calorie difference when binging (although in her case this did not appear to be happening). 

Or more likely, her metabolic rate decreased to accommodate her low intake. So now she eats less, her body slows the rate at which it burns calories—she feels tired, preoccupied with dieting and sometimes out of control when she overeats—and she fears changing this situation will result in her doubling in size. But this is wrong, wrong, wrong! Because her metabolism will in fact increase again as she normalizes her food intake!



It seems we have a selective memory regarding eating. We focus on the fact that we overate—but we ignore that there was restriction that preceded it; we simply blame ourselves for our "lack of control", or failure to have “willpower”. If we binge and then purge, our memory stays fixed on how much we binged on, so we get annoyed when later on we get hungry and need to eat. How quickly we forget that we have gotten rid of a large part of our food intake, and that feeling hunger makes total sense.

Stacey has a long way to go. But here’s what she is working on. Rather than blaming herself for her seeming inability to take control, she's working on acknowledging that restricting keeps her stuck in the vicious cycle. And now she is beginning to liberalize her daytime intake, to prevent this unhealthy chain of events from continuing.

She further needs to join the “Clean Slate Club”. Yes, that's the Clean Slate, not clean plate, club. Overate? Binged? What's done is done. Trying to compensate with restricting will ensure you (and she) stay stuck—and that needs to change.  Starting with a clean slate mentality can help. It is more damaging to keep going on the destructive eating path, than to stop now and lessen your losses. It is worse to purge then to sit with the discomfort of overeating. And it is senseless to begin again with restricting, because it is quite clear where that will lead.

A typical breakfast prepared and eaten on my vacation:
fruit, yogurt, honey, baguette and butter and pastries. 
Perhaps you identify with Stacey—who is actually a composite of several patients I have seen this week.  Or maybe you haven't (yet) experienced the rebound binging—and purging—that may result from continued restrictive eating. It is not too late to change, to prevent the potential rebound overeating that deprivation can cause.

Why not start to break the cycle now?






14 comments:

  1. All I can say is a huge, heartfelt THANK YOU Lori for this excellent...as usual...post. Timely for me personally as well. I am in the midst of what your composite patient is going through. While I know returning to the restrictive route is highly "wrong"...I do know that when I tried, for one calendar year to go back to "normal" eating, I ballooned from 32 kilos (5'2")to nearly 60 kilos within the first seven months..I was devastated and convinced that my metabolism had given up on me...for life. I returned to running and restriction, for I could not bear the "new weight/new me". Initially, I had every good intention of nourishing myself in a healthy manner, but with my menses returning for only the last two months of that "healthy eating" calendar year, and no plummet in the weight crescendo..I returned..somewhat grudgingly to restriction. My question is this...Is it possible to have destroyed, irrevocably, one's metabolic system after years of anorexia (9+ years for me), or does age have something to do with it? I am 52 and believe me, a life of eating only veggies and lean protein is not always a thrilling prospect, but I begin to ask myself whether I indeed have a "choice" in this matter. My body seems to have "adapted" to a 400 calorie daily intake, and this just seems WRONG. Yes, I am obsessed with gourmet recipes, websites and revues and would like to what life is like outside the food bubble.

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    1. If you are 60 kilos and 5'2 you have just recently gotten to a healthy weight. It sounds as though your body is doing exactly as it should. Please don't assume that you have to restrict. I suggest that you continue listening to your body and focus on learning more about body image. It sounds as though you are too harsh on yourself and see a different person than is really there.

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    2. It's not what you want to hear, but Anonymous may very well be correct. You are in the range of normal and it's possible that this is truly a healthy place to be. Without exploring your history, it is difficult to say. Sometimes people say "well I used to be able to maintain such and such a weight" but they fail to acknowledge that that weight was maintained with unhealthy behaviors or physical and psychological consequences. You need to ask yourself whether the price you pay for lowering your weight is worth it. If it simply requires more mindful eating, and your weight settles down, tat's another story!
      Hope this helps.

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    3. Thanks so much for your reply...and that of Anonymous...but my 60 kilo point was, unfortunately, the "high" point..or should I say "breaking point" in my recovery, for I have actually gone back..alas way too far back down "the slippery slope". I am back to wearing the clothes I realize I SHOULD have thrown away in recovery, but there was something that snapped when the numbers went higher than my numbers were when I ate normally (that wondrous period when I did not think about calories/safe foods/time of day to determine food intake..in short, when I didn't THINK about food in such an obsessed manner).

      I realize too that I over-research...seeking out that solution to arriving at normal leptin levels so that I may once again enjoy fine cuisine without fretting/stressing/obsessing over it. I've read that leptin levels can return to normal, although there is a period where the weight may "go over" what had previously been maintained without restriction, IF sufficient caloric intake is received (Gwyneth Olwyn's blog)...Is this true? While I truly desire recovery, know I need to gain at this point, must I accept numbers which, for me, are unacceptably high or above "normal" on a permanent basis? I think that if I thought the "overshooting" of a healthy were a temporary, albeit necessary phase of recovery I would be more inclined and dedicated to the difficult work involved in true recovery. Any thoughts?

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  2. I use to weigh myself about 75 times a day, crazy when I think about it now. I still weigh myself everyday, sometimes a few times a day. I was weighing myself less than that, but my T started weighing me again so I started weighing me. If she's going to weigh me, I'm going to weigh me.

    I consider myself lucky, for lack of a better word, that in my 20 yrs of "restricting," I've never fallen into the binge mode.

    ReplyDelete
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    1. I'd say it's not so "lucky" to have spent 20 years restricting. Perhaps seeing the negative impact of rebound binge eating might have helped drive more change away from restriction. In any case, perhaps you can find other motivators to shift away from restricting and obsessive weighing.

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  3. I appreciate this article. I am somewhat stuck in this right now. While I do not binge, I tend to restrict. I weight restored a little over a year ago and then lost a little bit of the weight. I now weigh more on far fewer calories. Getting myself to eat more to spark the metabolism is a challenging process. I know I need to do it, but it is scary. From your experience how long does it take to see the metabolism pick back up?

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    1. Metabolic rate begins to increase with increased intake and continues until you are at a healthy target weight. Evidence for this is increased heart rate, body temp, hunger, to name a few. get some support to help you move forward--sounds like you are almost there, but staying short of where you truly need to be wrt intake will only keep you stuck.

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  4. Lori, thank you, I found as usual a great write up. This topic is something that is effecting me now. The one thing Im not clear on is the term "binging". I believe I asked you before, but not sure.

    I do enjoy your blogs and read them. Hope all is well with you

    Thank you

    Steve B

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    1. Good question! Binging is generally eating large amounts of food in a sitting--either large quantities of a single item or of multiple foods--beyond a comfortable level of fullness. Eating typically continues in spite of physical fullness, often compulsively, and often until one feels numb or disconnected.
      Hope that helps!

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  5. Stacy might as well have my name as she describes me in freakishly accurate terms. Once a strictly restrictive anorexic I have moved and turned into "Stacy" ... my biggest nightmare come true. While at a healthier weight I do not feel any freer around food. The idea of not restricting after a binge/purge episode is an outrageous one for the eating disorder as I am sure you are aware but then, the e.d.'s aren't exactly known for their sane rational ability.
    You pointed out that Stacy would sometimes fool herself into believing that she was eating enough when she really wasn't. This is a point my dietitian has been trying to make for a long time and I haven't heard it. Reading about it from a third person perspective made it possible for me to hear that unless I do trust my team with the amount of food I need to eat (trusting someone with this is not easy) I simply shall not move forward in recovery. Thank you for pointing that out. It was really helpful!

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    1. Glad this was of value! Thanks for reading and sharing.

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  6. Hi Lori, I've really appreciated your posts over the past year or so that I've been reading. Your posts have revolutionized my thinking about eating such as helping me to stop when I'm full, not deprive myself of the foods I love and to eat mindfully without having the pressure of now or never.

    There is one thing I'm not understanding about the approach presented here. How does a person who legitimately needs to lose weight actually create a deficit in calories so that her weight goes down all while maintaining your helpful techniques such as those stated above? I'm just not clear on that.

    I am at a weight much higher than what is typical for me, but even using the techniques above, my weight keeps staying them same and never goes down. Of course, it could just be me not doing a good enough job in following your techniques, but I'm really unclear how to actually lose weight.

    Any insight you could offer would be appreciated! Thanks!

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  7. Assuming that in fact you have comfortably maintained a lower weight without unhealthy behaviors, than you may just need some fine tuning. For instance, check out the post on titration: http://dropitandeat.blogspot.com/2010/08/size-matters-but-not-how-you-think.html which addresses how to figure out just how much you need to eat. Also, consider your activity level. If you are eating well and your activity has room for adjustment, that may make the difference. But I am not talking about getting obsessive with exercise!
    Hope this helps.

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