Friday, May 31, 2013

Name-calling Has Its Place: BED is Now Named as a Distinct Eating Disorder. So what’s in it for you?

What’s in a name?

Perhaps it sounds like an existential question, but if it doesn’t have a name, does it even exist? Labeling Binge Eating Disorder (BED) what it is—a painful struggle living with frequent overeating large amounts of food—makes real the impact on mood, thoughts, energy level, physical wellbeing and hopelessness, to name a few. 
Living with Binge Eating Disorder when it was not yet recognized as a diagnosis, you might not have felt sick enough or eligible to be treated, because it just wasn’t taken seriously enough by those around you. 

Being added as a condition all its own validates this not-uncommon eating disorder whose sufferers live with their secret relationship with food, silently and ashamed.

Like adulterers you may sneak around family members and friends consuming large quantities of food—rarely lean protein or vegetables, I’ll add—but typically those foods and nutrients deemed forbidden. Yes, adulterers, as you carry on a relationship you may fail to acknowledge, cheating only yourself.

You eat quickly, masking the empty packages for fear of the response. “Who finished the cookies?” you dread hearing. You may eat salads or nothing at all in the workplace or with others, then stop at the convenience store or the fast food drive in and eat more than a day’s worth of calories, before even getting home. And then perhaps eat dinner as if nothing had ever happened. There may be a short-lived thrill preceding the binge, but a lingering guilt-filled regret to follow.

I should be mindfully eating? 

Binge eaters rarely taste their food, nor do they enjoy it mindfully—from the accounts of my patients over the past 26 years. They eat cakes and cookies and ice cream, but they don’t consume them with permission—their own permission, that is. They may be quite unaware of what and how much they have eaten. And although there are exceptions, they rarely truly enjoy what they are binging on—although the experience may be quite pleasurable—in the short-term. Friday’s new patient diagnosed with BED would never come in for a follow up—that much was certain—if I dared to suggest he’d have to give up his nightly, longed for ritual of binge eating. Yes, making change takes time—and hard work.

Why oh why do I do this?

You may find yourself eating impulsively, wondering why, even though you know better, you can’t follow through with your intended control over food. 

Let’s start with one basic fact. You are not stupid. It is not for lack of knowledge that you maintain your binge eating pattern, but likely because it meets some needs.  It may temporarily numb you, a drug of choice for some, or may help manage your anxiety. Or it may be triggered by impulsivity, even greater in those who get too hungry and those who struggle with impulse control—like those with ADHD. Now don’t get me wrong. I’m not endorsing binge eating to meet your needs. Rather, hopefully providing some insight so you can begin to move from the place you are stuck.

Binge eating typically, although not always, follows deprivation and food restriction. Ever notice that your binging is worse after dieting or fearing you will be without food? 

Thoughts like “I’ve already blown it so I may as well keep going”, what I call the what the heck effect, adds flames to the fire, contributing to continued overeating. Or you may preplan a binge—a very much-controlled binge, counter to the uncontrolled binges often described.

“What’s your point?”

I just sent a family member a link to a popular press article about a parallel situation- trichotillomania (compulsive hair pulling) is also now added to the new DSM-5, the mental health manual of diagnoses. In response to the link, the trich sufferer responded, “So what’s your point?” So let me clarify for all. The point is, if you are described in these posts, then you deserve to have your condition acknowledged and treated. And that includes getting support from a mental health professional (one who’s trained in CBT, Cognitive Behavioral Therapy). And for BED sufferers, adding a Registered Dietitian who specializes in eating disorders is essential as well.
It takes time to shift your eating pattern and your thoughts, and to find alternative ways to manage things that cause distress, but recovery is possible. 

How do you change and move from being a binge eater? Five areas tend to need to be addressed. You’ll need to:

  1. Eat enough calories throughout the day. Guidance from an RD can be quite helpful here.
  2. Watch your eating pattern to avoid long periods without eating. Excessive hunger leads to excessive intake. Think about a pendulum; swinging to one extreme results in an equal swing in the opposite direction. We are looking to be swinging in a much more narrow range!
  3. Move toward mindful eating. Start by separating eating from distractions, such as TV, reading, computer, driving, phone use. Keep food in the kitchen or dining room only. And try to use your senses when eating. Yes, you deserve to experience and taste what you eat.
  4. Once you are preventing excessive hunger and mindfully eating, it’s time to reintroduce foods you view as ‘forbidden’. Remember that if you are listening to your hunger and eating when you need the fuel, you are no worse off for choosing something you really enjoy eating—be it ice cream or chocolate chip cookies. But keep in mind that while you’re working on liberalizing your ‘forbidden’ foods, work on…
  5. Distinguishing physical hunger from emotional eating triggers, such as stress, reward, depression, anxiety, the need for self-punishment.

Now that it is a recognized condition, it’s my hope that MDs will no longer direct their overweight patients for lap band or gastric bypass surgery, never inquiring about or addressing the underlying problem behaviors. Perhaps the medical community will also begin to distinguish those who are overweight yet healthy—yes, they do co-exist—from those that are struggling with their thoughts and behaviors.

What I like most about this new diagnosis it that it puts the focus on your behavior, not your body weight. Now let’s hope that the medical community begins to ask the questions to open discussion about eating behaviors so that you and others can get the support and direction you need to recover.

Check out these older posts on binge eating and related themes:

Many more posts on the subject can be found by clicking on the relevant labels on the right of the blog.
I'd love to hear from you! Thanks for reading.

Sunday, May 19, 2013

The difference between you and me.

“How presumptuous”, you must be thinking, “to group all of your readers into one lump sum, overgeneralizing between us and you.”

Well, unless you are a member of my exclusive club, the one-in-750-in-the-US-living-with-Multiple Sclerosis, then I think you'll agree. As I'm sitting here awaiting the chemotherapy treatment to infuse into my veins, I'm painfully aware that I live with a chronic disease, a potentially debilitating one at that. But for now, I'm fortunately unaffected by this progressive neurological condition. 

Perhaps, like you, I'm on borrowed time. Borrowed time? Yes, because neither of us can predict just when the impact our conditions will hit us the worst. Or when the damage from our situation will lead to a fatal consequence.

A depressing shift in perspective from me? Not really. In fact, my intent is to show you just how fortunate you are. And to demonstrate that change is, in fact, in your hands.

I live with a healthy dose of denial. (Ok, so we really may not be all too different from each other.) That said, my denial allows me not to dwell on the ‘what ifs’. What if my condition progresses? What if a symptom hits me suddenly, like temporary blindness or double vision, my presenting symptom? And what if I become unable to work? Or walk? Or cycle and hike? Or leaves me unable to be present and functional? 

In spite of my denial, which I find quite beneficial, I am not denying my need for treatment. The stats are quite unimpressive—treatments don't cure MS, just like meds don't cure an eating disorder. But they might prevent my situation from progressing. Or they might not. MS is an unpredictable disease. And boy do I dislike uncertainty. But doing nothing ensures that nothing good can happen. 

Hmm, maybe I ought to change the title of this post to read "What you and I have in common"?

But here's where we differ. Besides the fact that you might be living with an eating disorder—bulimia, anorexia, binge eating disorder—or you might feel ruled by your rules (compelling you to deny yourself enough food or the pleasure of food)—the differences between us are vast.

Here's the biggest: You can do something to reverse your eating disorder or your disordered eating. You can use the tools of CBT or DBT or FBT to move you along. You can potentially utilize your resources—your friends, your family, a higher level of care, if needed. No, it won't be easy and it's not a quick fix. But these are strategies that can turn your condition around.

You can decide it's time to move on, to prevent your rules from ruling you, and eat enough to nourish your brain to soften those unhealthy voices. You can remove the triggers which result in purging and learn to move on after a slip from less than perfect eating and disordered behavior.

There's evidence that people recover, fully recover, from bulimia, binge eating disorder and anorexia, and that normal eating is a real possibility. Yes, you can take an active role in reversing your condition and prevent your eating disorder or disordered eating from robbing you of the life you so deserve.

I have no such option. Sure, I can choose to focus on the positives from living with such a condition as MS, but let's be real. Living constantly aware that any part of my brain or nerve pathway can be damaged and stop working is hardly something to see the positives in. 

In fairness, living with MS has had its benefits. It has made me much more sensitive to the fact that many individuals who look just fine—and act fine, even—may be harboring a condition that zaps them of their energy and steals their ability to life a full life. Living with MS reminds me that I can never look at someone and assume that they are just fine, when they may be living with a disability like MS or an eating disorder or disordered thoughts. Or depression. Or OCD…

Like those of you living with an eating disorder, we share a genetic predisposition to have the diseases we have—and we are not to blame! And our conditions might have been triggered by something in the environment. Stressing about it may only worsen our fate—high stress and anxiety—while not the cause of either of our conditions—may be obstacles to recovery and wellbeing. 
Based on statistics, I'd have mentally checked out of treatment, believing that chronic disability was my fate. But it's not. Not for me and not for you. 

You can live with some denial to get you through the days, but you still need to take your medicine—your food, your nourishment. And we need to put one food in front of the other and follow the recommendations of those in the know—our treatment team members—for without that commitment we fulfill a self-fulfilling prophecy that recovery can't happen. A positive outlook, and the belief that we can beat the statistics is essential to moving forward and making the most of what we’ve been dealt.

Personally, I cannot simply eat or take a medication to cure my MS. But you can certainly do just that. You can help your brain function fully, by eating enough, all the while improving your quality of life.
You can shift your thinking and ultimately your actions, and make change happen. I am at the mercy of MS research to be successful and find a cure for Multiple Sclerosis.

Neither of us is at fault for our conditions. But you are at fault if you take a back-seat approach to management of your eating disorder. Passively showing up for appointments fails to support recovery and well-being. Yet acting to change your course makes all the difference.

So as you move through the day, ask yourself if you are changing what's in your hands to change to move toward recovery. And if you answer no, then it's time to make a plan for moving forward. Not on Monday, nor on January first, but today.

I'm feeling disconnected and groggy right now. The Benadryl pretreatment has hit with a bang. I know no hunger, for now, and my thinking is compromised. My heart rate is slower than usual, and I have little control over much of anything—thank goodness for spellcheck. I'd be at risk if I dared to check out of here and attempt to drive my car or to exercise. I am compromised. Right now, you and I are truly quite similar. But my state is transitive. Yours can go either way, depending upon your actions.

Do not have pity for me, for I am fortunate enough to function 100% and I am living my life to the fullest. Have compassion for yourself, and may this post inspire you to get your butt in gear and turn your situation around.

Saturday, May 11, 2013

Do you believe recovery just isn’t possible, at least, not for you?

Lessons from ICED 2013

I see 30-40 individuals suffering from anorexia, bulimia, binge eating disorder and disordered eating each week. Men and women, preteens through age 70+.  So short breaks and vacations are, of course, quite refreshing.

But last week’s Academy for Eating Disorders Conference, the International Conference on Eating Disorders (ICED) offered anything but relaxation.

Stimulating, inspiring, fascinating and hopeful—even these words do little justice to the conference presentations. I became pumped, and felt validated that the progress I see with my patients is not random. I was sparked by the incredible research demonstrating the progress in the understanding of eating disorders and their treatment. It only confirmed my belief that there’s reason for you, too, to know that recovery is possible.

Let me tell you about a session I was most excited about—Lisa Dawson, a PhD candidate’s research presentation entitled Recovery From Chronic Anorexia Nervosa: The Tipping Point for Change. You don’t have long-standing anorexia? Don’t stop reading. The lessons from this psychologist’s research are inspiring for all.

Dawson decided to select those individuals who recovered from anorexia—and I mean truly recovered—because by looking at this population we can figure out what elements are critical for recovery in anyone living with an eating disorder. They had to be free of anorexia for 7+ years, in an objectively normal weight range, and free of eating disorder behaviors. “You mean such people really exist?” you’re thinking? You bet. And she identified the common elements that contributed to their movement toward and their ultimate full recovery, based on extensive interviews with the participants. Here are some key points she identifies:

There are 4 stages to recovery, which individuals move through in one direction, and for differing amounts of time:
  1. unready/unable to change
  2. the tipping point of change
  3. active pursuit of recovery
  4. reflection and rehabilitation

In the first stage, people feel like they didn’t know why they were doing what they were doing (wrt ED behaviors) but felt they just couldn’t stop. They internalized the eating disorder and they perceived treatment as unhelpful. They felt misunderstood and lacked insight. In summary, recovery seemed impossible; they didn’t feel like anything they did made a difference for recovery, they had low motivation and had a sense of helplessness and hopelessness.

Over time, they realized that their eating disorder wasn’t helping them. Those who recovered also started to experience feeling understood. They were able to externalize the eating disorder and over time gained insight into their condition. They became more worn out by their eating disorder as well. Motivation increased. They started to feel that they had the power to change their situation, that they could impact their curse.

More value was placed on life outside their eating disorder. They learned skills to help them cope as they let go of their eating disorder behaviors.

Self-discovery, self-acceptance, and learning to love oneself were components of the maintenance stage.

It was a long, and slow process. But it happened.

So here’s an email I received this week from a patient of mine who, in spite of living with anorexia for more than 25 years, is now in recovery. The timing couldn't have been more fitting for this post:

"I've been continuing to do well with food.  I know I was upset at my last apt with life in general, but that did not affect my eating.  To date, I still have not purged or restricted or exercised.   Can you believe it? And... I don't want to forget to tell you so I'll share now, re: exercise...  I have been taking walks after dinner with either one of the girls or my husband or all (not every night, but several) and it didn't dawn on me til yesterday that I can go on these walks and I haven't:

  • thought about how many calories I'm burning
  • gone at fast pace to burn more calories
  • obsessed over having to walk each and every night/same time/same pace/same path 
Instead, I:
  • go on a walk if I feel like it
  • enjoy whatever pace I seem to be going at, without thoughts of burning calories
  • actually enjoy being present with the people I'm walking with!!! 
I do not fret if I can't make a walk.  I do not keep track of how many nights I've walked. I do not feel it's necessary if I've eaten a larger dinner. The obsession is not there!  Where did it go? I don't feel it, all I feel is the happiness that I'm going on a walk with a very loved family member where we can chat and talk and laugh. 
Huh? When did this happen?! Although it may not seem big, it really didn't hit me until yesterday that these walks are not the same walks as in the past. Not one bit. I am totally present and I completely enjoy them. And I continue to eat. Normally. I think I now know what normal is. At least, my normal. And I never, ever thought I would find "normal". And "normal" to me means:
I can eat when I'm hungry, know when I'm full, eat what I want in moderation... and because of this, I have not gained 30 lbs in 5 days as previously thought. I have gained weight.  I am working on accepting the feelings that accompany this. I think I'm in a better place to work on this. Nobody likes to gain weight, that's pretty much reality. But... I'm healthy.   
I put myself, my body, through hell. Can you imagine deliberately depriving your own body of nutrients it needs to stay alive? Can you imagine the destruction throwing up food causes? Or ingesting a plethora of pills to help further the weight loss process? How good is THAT for your body?! Oh my God, I sit and think how the hell am I still alive!!!  This has been going on for decades!  
I am at a really low point - sad, lost, confused, lost, angry, lost...  I feel like everything is out of control in my life.  Where did I turn for all those years to gain control over something when everything else felt so out of control? Ed. But what is happening now? Everything feels so out of control, yet the ONLY thing that feels IN control is my decision to eat well. Isn't this the complete opposite? What is going on here?  
So, the point of this email is to tell you that I have the strength to continue fighting this and I will succeed.  You are not going to see me relapse. Everything about this eating disorder is finally beginning to make sense. I have so much more to share but I'll save that for our next meeting. 
Lori, boy I can't begin to tell you how everything you've taught me is now landing in place and making sense and how in the world do I thank you for that?I was so, so sick.You saved my life.I still have work to do, I'm a work in progress, but slowly I'm regaining inner strength - which is just what I need to move forward. 
Thank you, thank you, thank you..."

I share this, with her permission, because while recovery is challenging, to say the least, it happens. And what I hear from her and from others confirms what Lisa Dawson shared in her study—that belief that you can recover, that change is in your hands, is essential for recovery. And that working with providers who get it and help you feel understood, and provide hope that full recovery is possible, can make all the difference.

Your thoughts?