NO DIETING REQUIRED?
Although my experience with dieting and weight loss preceding the onset of binge eating mirrors the vast majority of bulimia cases, the disorder can occur without an initial diet. Furthermore, in cases of BED, binge eating frequently occurs without any history of dieting. One study found that 55 percent of those with BED reported binge eating prior to going on their first diet, while 45 percent reported that dieting occurred first.123 Without dieting and survival instincts, how do we then explain the onset of binge eating in these cases?
I believe any of the habits I discussed above could develop without dieting as a catalyst. Remember, I developed a habit of pleasure, a habit of excess, or a habit of impulsivity by eating large amounts of food repeatedly. If anyone ate large amounts of food repeatedly—for whatever reason—they could theoretically develop the habit of binge eating; and if they chose to purge afterward, they could develop the habit of bulimia.
There is evidence from animal research that overconsuming foods high in fat and sugar can lead to changes in the opioid receptors in areas of the brain that control food intake.124 Regardless of how the binge eating begins, binge eating on these highly palatable foods can maintain binge eating by enhancing the opioids125 and creating a habit of excess and pleasure.
Those who binge without ever dieting may have been overeaters and binge eaters from childhood, because of learning or because of a genetically strong appetite and attraction to highly palatable food and rewarding experiences. In a person who has had poor eating habits for a lifetime and overindulged in sweet or fattening foods, the body becomes accustomed to those substances. Eventually, the person may need more and more of the highly palatable foods to experience the same pleasure or the same "high."
There is growing evidence that people can become "addicted" to highly palatable foods like refined carbohydrates and saturated fats—or at least people can exhibit behaviors that show similarities to addiction. Indeed, there are many parallels between food craving and drug craving—in the neurochemistry, neuroanatomy, and learning involved.126 There is evidence of tolerance and withdrawal—two of the defining characteristics of addiction—in animal studies.127 Although the addicting nature of highly palatable foods does not excuse binge eating, it does provide an explanation for urges to binge in those who do not diet.
All of this means that—regardless of whether dieting jump-starts binge eating or not—binge eating can still occur, and the binge-created brain-wiring problem can still take hold.
21: Why Did I Follow My Urges to Binge?
I always had control of my actions, yet I succumbed to the drive to binge time after time. Now I can see why. There were five main reasons that I followed my urges to binge.
REASON 1: I THOUGHT MY URGES TO BINGE SIGNALED A REALNEED
My urges to binge were all-consuming. They sometimes made every cell in my body feel it might die if it didn't get large amounts of food—right away. But rationally, I knew that wasn't true. Even when I was drastically underweight at 86 pounds, my urges to binge still did not signal a real need. Yes, I certainly did need to eat, but I didn't need to binge eat. Even though I needed an increase in calories, I didn't need eight bowls of cereal in one sitting.
As I've discussed, the survival drive to binge eat is left over from ancient times, when our ancestors did need to binge because it could be a long time before their next meal. They had to feast to prepare for the next fast. Those of us who live in a society of food abundance will most assuredly have another meal very soon. Therefore, there is never a true need for us to binge. Unfortunately, the survival instincts are not that smart; and when the animal brain senses that it is food-deprived, it will urge most of us to overeat or binge.
My animal brain made me feel that binge eating was a true need only because it was running on an old program of survival. The only true need I had was to eat more, in normal amounts—definitely not to binge. Moreover, when I stopped depriving myself of food, gained a lot of weight, and habit replaced my survival instincts as the driving force of my binge eating, my urges to binge stopped signaling any need at all. My brain was throwing out "neurological junk," so to speak—in the form of automatic urges to binge.
My urges to binge were a type of conditioned need —a term that illustrates well the habit of binge eating. A conditioned need is not a real biological need like the need for food (in normal amounts), water, or shelter; but a need that gets programmed into the brain as if it were a real need. Nearly all habits and addictions could be called conditioned needs. By bingeing enough times, I conditioned my brain and body to need to binge eat, even though I truly didn't need to. My body and brain reset my metabolism to accommodate large amounts of food, so that I began feeling that I needed to binge to feel normal. Sometimes I even felt I needed to binge to survive, even though I knew rationally that I did not. A conditioned need can be illustrated by the following example:
A newborn baby wakes up every night in his first several weeks of life around 3:00 a.m. to feed (drink a bottle or breast-feed). As a newborn, he biologically requires that feeding—eating around-the-clock is a real need. But what happens when the baby grows older and no longer requires that night feeding to survive? The baby of a lucky mother will stop waking up at 3:00 a.m., but many babies continue to wake up at that time long after the feeding is physically necessary.
The baby continues to wake up because the brain has formed a habit—a conditioned need—by repeatedly eating at a certain time every night; and now, even though the baby no longer biologically requires the feeding, the baby's body and brain will still expect it and still demand it. What began as a survival instinct has become a habit. Since newborns' human brains are not developed and they cannot rationalize, the baby in this example does not know that he no longer needs the feeding. His behavior is driven only by the automatic functions in his animal brain; and since his animal brain is programmed to expect a feeding, he cries every night at 3:00 a.m.
It's simple to see how this example relates to my binge eating. Even when I stopped having a legitimate need for more calories, I still experienced the urges. My body and brain still cried for binges, because the parts of my brain that were reacting involuntarily were like the automatic functions of a newborn's brain. And just as a parent cannot reason with an infant to make him stop crying at 3:00 a.m., I could not use reason to make my urges go away.
To complicate matters, I learned—in therapy and self-help books—that even if my urges didn't signal a real physical need, they signaled a real emotional need. This became another reason why I followed my urges to binge. When I believed I was binge eating to satisfy a need for attention, love, comfort, escape, or relief from stress or depression, it became much easier to give in to my urges; it legitimized my actions and gave me an excuse to go ahead and binge.
My urges were certainly good at convincing me I had a real need—physical or emotional. After all, I heard my desires to binge in my own voice, in my head. I didn't hear all the enticing thoughts in a more primitive, caveman-like voice; so I never recognized my urges as something other than me, expressing my own needs, often in a seemingly logical way. This is also explainable in terms of the brain.
The human frontal lobe translates the messages we receive from the animal brain and makes them more complex and nuance-filled,128 or as Trimpey says in Rational Recovery, the animal brain "can't talk, but instead it uses your language to enlist your voluntary muscles to get what it wants."129 The messages from my animal brain telling me I needed to binge were often very appealing to my reasoning, which tricked me into binge eating time and time again.
REASON 2: I TRIED TO FIGHT MY URGES
The second reason why I followed my urges to binge was because I tried—in vain—to fight them. One thing was for sure, I couldn't clench my fists, get angry, and make the urges to binge go away, although it didn't stop me from trying. Since the urges to binge were powered by survival instincts or habit, I certainly couldn't get rid of them by fight
ing.
Fighting with my urges and trying to resist them by sheer will (which is often called "white-knuckling" in therapy and rightly discouraged by therapists) got me past several urges during the course of my bulimia; but it was a frustrating and ultimately futile approach. It was simply too difficult, and sometimes I just wasn't equipped for a fight. Sometimes I didn't have the resources, the strength, or the energy. As I tired of fighting day after day, I inevitably gave in, worn out from the struggle. I often felt that dealing with the guilt, shame, and weight gain that followed binge eating was easier than dealing with fighting the urges.
I didn't know that fighting was simply the wrong tactic because I was powerless to will my urges away. During my therapy, I was introduced to another tactic, supposedly opposite of fighting, called "urge surfing." In summary, urge surfing is trying to ride the wave of an urge. The urge to binge is assumed to swell, peak, and then subside just like a wave; so it's assumed that if you can ride it for long enough, it will go away. On the surface, urge surfing seems similar to what eventually helped me conquer my binge eating, because it involves not acting on urges and not necessarily trying to figure out any deeper meaning behind them.
However, I found the urge surfing technique to be a lot like fighting. In thinking that I was "riding the wave," I was then trying to endure the wave. I was trying desperately to stay afloat until the wave subsided. Since I didn't know the wave was just neurological junk, I viewed it as a worthy opponent, as a surfer might view a mighty swell. I was trying to survive it, trying not to get swept under, because I believed the wave had the capability of washing me out to sea (i.e., to the refrigerator, pantry, or nearest fast-food restaurant) at any moment. I believed it could control me, move me, toss me about. If I made it through one urge in this manner, I was usually pretty exhausted; so when another urge came along, I often couldn't muster the strength to ride that one as well.
In the end, the thinking skill I used to stop acting on urges was, in fact, much different. I stopped seeing the urges as a powerful adversary capable of altering my course or washing me out to sea. I stopped trying to desperately stay above water, because I learned that I didn't even have to enter the water. In separating myself from my urges, I was learning to watch the waves from the shore. I could watch each one rise and fall, without getting all caught up in it and without becoming exhausted and weary. Even if another urge to binge came shortly after the first, I felt I could handle it, because I knew the wave wasn't capable of affecting me. Maybe it seems like a subtle difference, but for me it made all the difference.
REASON 3: BINGE EATING QUELLED MY URGES TO BINGE
Although I list this as the third reason why I followed my urges, it was the most significant. The primary reason I followed my urges to binge was to make the urges go away. Urges often made me anxious, depressed, and desperate; that is, until I binged. Then all of those feelings suddenly melted away, and I felt tremendous—albeit temporary—relief. That relief was reason enough to give in to the urge. Each time I binged, I quickly put to rest the question that haunted me every day: Will I be able to resist binge eating today?
The relief I felt when I finally gave in and binged was not relief from emotional pain or sadness; it was relief from that nagging urge. The neurons that fired to create my urges to binge fired tenaciously until I binged. Then those neurons finally came to rest, and it was as if my brain was saying, Ahh, my job is done. Even though I knew the relief I felt during and after binges wouldn't last long, bingeing seemed worth it just to stop my incessant thoughts and feelings about food.
I felt I needed to binge just to quiet my brain. I felt I couldn't focus on school, work, relationships, family, or even mundane daily tasks while experiencing a desire to binge. I often binged to shut off those urges so I could focus on other, important things I had to do; it seemed worth it if only to get some peace, even though I knew I'd regret it and have to deal with the guilt and health consequences later. Bingeing was like hitting a reset button in my brain. It temporarily stopped my urges, but it started the cycle all over again.
REASON 4: BINGE EATING FELT GOOD
Even to people who do not binge, eating is physically pleasurable and can provide comfort. Most people enjoy eating and derive some level of emotional contentment from it. Even normal eaters use food in celebration, in mourning, in gifts of gratitude, and in cultural expression. It's fine for food to have meaning in our lives. Furthermore, even normal amounts of food, especially sweets and fats, can alter brain chemistry, leading to improved moods and anxiety relief.
In the same way as normal eating, binge eating provided me with physical pleasure and often emotional comfort or distraction. Even though my binge eating episodes were often frantic, impulsive, and unsettling, it was still enjoyable to eat large amounts of foods that tasted good. Stuffing myself with sugar and fat often put me in a trance-like state in which I sometimes forgot about my other problems.
Brain Chemicals and Good Feelings
As previously mentioned, eating increases feel-good brain chemicals, which was a factor in forming my habit. Eating sugar increases opioids, which create analgesia—a decreased sensitivity to pain and stress130 —and dopamine,131 which is involved in reward and pleasure.132 Furthermore, eating sugar and carbohydrates boosts serotonin, which affects mood133 and "produces a feeling of relaxed calmness."134 This explains why—with the amount of sugar I ate during binges—I often entered a near-dream-like state. These biochemical effects were temporarily highly gratifying and gave me another incentive to binge, in addition to the instant relief from craving.
Secondary Benefits
Following my urges to binge gave me what I'll label "secondary benefits." Just as the act of binge eating became a habit, the secondary benefits—the biochemical and emotional payoffs—became habit-forming as well. The good feelings I had when I was eating without inhibition; the rush I felt when I took the first bite of a binge; the emotional numbness I felt immediately afterward—all of these benefits became part of the habit, and my body and brain craved those feelings time and time again. My body and brain came to rely on the secondary benefits of binge eating, and those benefits became more reasons for me to follow my urges.
We are all pleasure-seeking creatures, and many of the worst habits involve tempting and pleasurable substances like alcohol, nicotine, drugs, and food (See Chapter 20). The act of consuming the substances and the feelings the substances induce become reinforcing. There is nothing wrong with getting pleasure or emotional relief from food in moderation. The problem, for me, was that it wasn't in moderation. Not only that, but pleasure and emotional relief weren't truly what I was in search of when I binged. I knew full well that the secondary benefits weren't worth the terrible cost of my bulimia, that binge eating truly didn't help me get relief from any of my problems in the long run and only made them worse.
Once the habit was in motion and my brain and body were conditioned to binge, whatever comfort I may have received from binge eating only became fuel for the fire—more reasons my brain generated to get me to binge eat. Eating will help you get to sleep, I heard inside my head. You've had a hard day and need to relax. Eating will bring you relief from your worries. You deserve some guilty pleasure. Eating will make you stop feeling lonely. Those were automatic thoughts, disguised as "logical" reasons for binge eating, and those thoughts served as great excuses for my behavior.
Secondary benefits did become a major focus of my therapy. In therapy, I learned that, because binge eating brought me some measure of emotional comfort and pleasure, a deep-rooted inner need for emotional comfort and pleasure was therefore causing my binge eating. I learned that, because eating brought me temporary relief from problems, the problems themselves or my inability to handle them effectively was therefore causing my binge eating. So my therapists told me I needed to learn new ways to find comfort, pleasure, emotional fulfillment, and relief from my problems in order to stop binge eating. In other words, I needed to find substi
tutes for binge eating—other ways to get the secondary benefits of binge eating without actually binge eating.
The therapists' theory, although it seemed to make some sense when I was first introduced to it, was ineffective in practice. When an urge to binge hit, I found it extremely difficult to choose any substitute behavior. I came up with lists of things I could do to get the secondary benefits—take a relaxing bath, go for a long walk, watch a favorite TV show, listen to music, go for a drive—but I found that there were simply no substitutes for binge eating.
The problem was, I wasn't seeking the secondary benefits when I binged. I was seeking the food. Nothing could take the place of food, nothing. If I were seeking relief only from anxiety when I binged, then anti-anxiety medication, a relaxing bath, or some yoga would have done the trick. If I were seeking relief only from loneliness, a friend or boyfriend would have cured me. If I were seeking only mood improvement, then antidepressants, a long walk, or some uplifting music would have taken away my urges to binge. If I were seeking only tranquil sleep, then a sleeping pill or relaxation techniques could have easily taken the place of binge eating. If I were seeking only numbness from emotions, then zoning out in front of the TV or having a few drinks would have been enough. But none of these "substitutes" gave me what my brain truly wanted—food, and lots of it.
It is easy to illustrate why this was the case if I go back to the example of the baby. The baby cries at 3:00 a.m. because he has a conditioned need—not a real biological need—for a feeding. Along with that night feeding, the baby gets many secondary benefits, including closeness to his mother, comfort, security, and the pleasure of sucking. In other words, the feeding is not all about the food. However, food (in the form of formula or breast milk) is the only thing that will truly satisfy the baby, because food is his brain's top priority at 3:00 a.m.—the primary reason he woke up and cried. If the mother were to offer merely comfort and security by holding or rocking the baby, or perhaps giving him a pacifier, she would leave him unfulfilled and probably even more frustrated and upset. Sure, the secondary benefits that go along with the food are nice for the baby, but when the baby's brain is urging him to eat, the secondary benefits alone do nothing to satisfy.
Brain Over Binge Page 15