It wasn't long before I felt completely confident in having treats—a small cookie ... or five; a piece of birthday cake ... or two; a small scoop of ice cream ... or a large fudge sundae; a small order of fries ... or a super-size portion—without it getting out of control. I also felt confident in sometimes saying no to those sugary and fattening foods, knowing that I wouldn't go home later and eat an entire box of cookies. This is because I learned that, regardless of when my urges to binge popped up—whether it was while eating a cookie or a salad—I could easily recognize them and choose not to act.
"LEGALIZING" BINGE FOODS
Traditional therapy and self-help books for binge eaters often recommend learning to eat former binge foods in moderation (the exception is addiction therapy, which recommends complete abstinence from problem foods). "Legalizing" foods is an especially important part of cognitive behavioral therapy. As discussed above, I believe legalizing foods can certainly help the urges to binge subside after binge eating stops, because it deconditions the brain so that the former binge foods no longer create urges to binge.
Legalizing sometimes doesn't appeal to people with eating disorders, because many of them are, ironically, extremely health conscious. That is, their highest human brains are health conscious, while their lower brains are running on programs that are health-sabotaging. They may honestly not want any former binge foods in any amount, because they know that those sugary and fattening foods aren't good for their health. If you are one of these people, don't feel you have to put sugary, fatty, and often chemical-laden food into your body in the name of recovery. Just as it's not necessary to avoid your former binge foods, it's not necessary to eat them, either.
If you decide to avoid all former binge foods, you only have to remember that if and when you do decide to eat a former binge food—which you most likely will at some point in your life—expect that your lower brain may produce an urge to binge. It may automatically fire up some old patterns of neural activity, but as long as you know how to put brain over binge, this shouldn't bother you at all.
MEAL PLANS
Just because I didn't choose to follow a meal plan when I stopped binge eating doesn't mean I don't think they can be useful for others. After a bulimic stops binge eating, if she feels she can't eat normally without the guidance of a meal plan, then by all means, she should use one. There is no special formula for a correct meal plan, as long as it provides adequate nutrition. Individuals can create custom meal plans for themselves by doing some research into healthy diets, or they can consult a nutritionist or dietician to educate them and help them develop a plan that will meet particular needs. Even those without eating disorders use meal plans sometimes to make sure their bodies are properly nourished.
Having said all this, there are some things to keep in mind in order to use a meal plan effectively. First and foremost, it won't make urges to binge go away. Rather, meal plans help people eat normally despite their urges to binge. The urges that will inevitably arise signal only automatic faulty brain activity—not an ineffective meal plan. Of course, the goal is to eventually get off the meal plan and have freedom to eat what and when you want, as long as there's no bingeing.
Conversely, not being on any type of food regimen after binge eating stops might be the preference. The lower brain may react to a meal plan as it would react to a diet—becoming extremely defensive and sending out powerful cravings for more and more food. Also, meal plans can require a lot of advance preparation and thus create unnecessary stress, again devoting too much attention to food and eating when it would be better directed elsewhere. So if meal plans are just not for you, trust yourself and don't worry so much about what and when you eat. It really doesn't matter as long as urges to binge are recognized but not followed.
32: Body Image, Weight, and Dieting
I don't remember ever liking my body. In my mind, there was always something wrong with it; and even now, I don't necessarily like my body—although it's infinitely easier to live in when it's not bloated from all the binge eating. While I was in therapy, I thought I needed to cure my poor body image in order to recover. Yet, everywhere I looked, I saw women who had poor body images, just like me, who supposedly didn't have eating disorders. Just as I thought all my friends, co-workers, and family members with food issues had eating disorders, I believed that everyone I met with a poor body image had a potential eating disorder as well. But they did not. Poor body image is in no way unique to women with eating disorders; poor body image doesn't cause or maintain bulimia; and developing a good body image is not a cure for bulimia.
Body image is predominantly a cultural problem. The majority of women in American society, and many men for that matter, have some hang-ups about their bodies and have some physical features they wish they could change. In fact, the National Eating Disorders Association reported that 80 percent of American women are not satisfied with their bodies.205 In one study, 74.5 percent of women aged 25-45 reported that "their concerns about shape and weight interfered with their happiness."206 However, only a small fraction of American women have eating disorders—about 1 to 3 percent.207
Body image concerns are merely one reason that some people may begin dieting; and for a small percentage—due to many factors, including biology, genetics, and personality—diets become problematic. Dieting and the accompanying brain changes can cause eating disorders, regardless of what sparks the dieting, be that poor body image or another issue.
I'm sure poor body image played into my decision to diet. It is possible, of course, that loving my body as a teenager could have prevented me from dieting in the first place and therefore prevented my bulimia. But once my dieting led to a survival reaction and binge eating, any concerns I had about my looks or weight didn't maintain my habit—the lower brain did that. It didn't matter if I wanted to be thin, fat, tall, short, stocky, muscular, or curvy, I continued having urges to binge.
Around the end of my sophomore year of college (about four years before I recovered), I more or less gave up on the idea of having a perfect body. I tried to accept my body for what it was; however, this was extremely difficult as the pounds piled on due to my binge eating. Often, it seemed like all the self-affirmation in the world wouldn't have been enough to convince me to like my body while I was ruining it with bulimia. And even when I did have a decent body image and felt OK with my weight, I still had urges to binge, and I still binged. No amount of acceptance or love of my body could reverse my habit.
After I stopped binge eating for good, I learned that—as far as recovery goes—it simply wasn't necessary for me to be able to stand in front of the mirror and like what I saw. In fact, it's not even necessary for me to like my body in order to have a full life. Sure, feeling confident in my appearance can be beneficial in some ways; but the body is ever aging and changing, good looks are at best fleeting, and it doesn't make much sense to get hung up on those things when there are so many more important things in life.
After I recovered, I found that I had no desire to diet or lose weight; nearly all of my harmful thoughts concerning body weight and diet went away. It seems that any weight concerns I'd had were amplified as long as I was binge eating. It took about five or six months after I stopped for my body to level off at a normal weight for me, which is about 120 pounds. Now if I gain a little weight—which I certainly have done with three pregnancies—that's fine; and if I lose a little weight—which I have done trying to keep up with my small children—that's fine too, as long as I still feel healthy.
I find it ironic that my weight is basically the same now as it was when I started dieting in high school. That's such a testament to the inefficacy and harmful nature of dieting. Instead of leaving my body alone and maintaining my healthy weight, I lost 30 pounds by dieting, gained over 50 by binge eating, and then lost about 20 after recovery. This was a total of 100 pounds of unnecessary weight fluctuation—all to land me back at the same weight where I'd begun. I hope my story can motivate some youn
g people to stop restrictive dieting, because it simply doesn't work in the long run.
GIVING UP DIETING
I know now that it's simply not worth it to obsess about food and weight. Maybe that's wisdom that comes with age, or maybe it's because I've seen how much trouble dieting caused my body and brain. Some might say that my new attitudes about food and weight are the real cure for my bulimia; however, this would be inaccurate. Throughout most of my years of binge eating (aside from the first year), I truly wanted to eat healthy, exercise moderately, and let my body settle to its natural weight; but binge eating got in the way. Even when I completely gave up dieting during those years, it did nothing to get rid of the urges programmed into my brain.
Some might say that my new beliefs and attitudes about food and weight—if not the cure for my bulimia itself—are what prevent me from relapsing. This would also be untrue. Regardless of my eating and exercise habits or body image, I will never relapse, because, as I've said, relapse is a choice. No negative thoughts about my body and no abnormal thoughts about food could ever take me there. The only cause of binge eating is an urge to binge, and since I will always know how to deal with urges, I will never binge again.
Even though giving up dieting isn't a cure or a means of relapse prevention, it did have one big advantage. I believe that avoiding dieting helped my urges to binge disappear quickly and stay gone. Remember that my urges to binge originally started because of survival instincts. I shouldn't have followed those survival drives and binged, but I also shouldn't have ignored them, as I often tried to do while dieting restrictively in high school. My survival instincts were trying to tell me something: my diet had upset the balance in my body and brain.
Before I started dieting, my body and brain had became accustomed to a certain amount of food and had maintained a state of equilibrium, or homeostasis. Dieting upset that equilibrium, sending my body and brain reeling for more food; especially so because I was young and my survival instincts were strong. During my junior and senior years of high school, I had a real physiological need for more food. Yet I disregarded what my body and brain were telling me—that is, until my lower brain completely took over and I binged. Of course, I should have heeded the warnings beforehand and eaten more in normal quantities. This wouldn't have magically made my urges to binge disappear; however, if I had eaten adequately and ignored all urges to binge, those urges would have eventually gone away.
After I finally stopped my bingeing, what would have happened if I had gone right back to restrictive eating? Would my urges have still gone away? I don't think so—at least not so easily, quickly, and completely. This is because at the time of my recovery, my binge eating was purely a conditioned need—in no way was it a real one, because I was eating an adequate diet. Of course, there is never a real need for binge eating, but urges to binge can signal a real need for more food in normal quantities. I believe I was able to get rid of my urges to meet my conditioned need fairly easily and quickly because doing so did not jeopardize my health.
Adjusting to a lack of binge eating was a healthy change, and my body and brain soon welcomed it and turned off my cravings for it. However, if I had gone right back to restrictive dieting, my urges to binge might have continued as a signal that my body had a true need—a need for more calories in my diet. And if I hadn't heeded these warnings, my urges to binge probably wouldn't have extinguished so fast.
To explain this, I'll go back to the example of the newborn baby who wakes up every night at 3:00 a.m., screaming for food. The baby will adjust just fine if the middle-of-the-night feeding is stopped when he is several months old, perhaps between six months and one year, because the feeding is only a conditioned need at that point and no longer truly needed for survival. The baby may initially resist the change, but the resistance won't last long. This is because the lack of a night feeding will not risk his health; in fact, it will be better for his health because he will be establishing a healthier sleep pattern.
However, if the baby were to stop receiving the middle-of-the-night feeding during his first several weeks of life, when night feedings are indeed necessary for survival, he certainly wouldn't stop waking up and crying. Instead, he would try desperately to get his real need met. If he cried long and hard enough for many nights on end, he might finally give up, as his brain accepted that his need was not going to be met and any further attempt would be futile. His metabolism would slow down to conserve energy, and his biological functions would begin adjusting to cope with deprivation; but the baby would certainly suffer grave health consequences from this abuse.
Likewise, if I'd had a legitimate need for more food after I stopped binge eating, my urges to binge would not have gone away so easily. And if I'd stubbornly disregarded the physiological need for more food over a long period of time, my body and brain might have learned to cope with deprivation, just like the deprived baby in my example and just like the bodies of long-term anorexics. But, had I done this, I, too, would have suffered grave health consequences.
If I dieted restrictively today, my survival instincts could potentially kick back into high gear and urge me to binge. That is doubtful, though, because of my age and the fact that my survival instincts aren't as strong as they were years ago. I will illustrate this with two experiences I've had with restrictive eating since I recovered, both of which proved that my lower brain isn't the same as it was when I was a teenager.
During two separate eight-month periods when I was breast-feeding each of my two babies, I had to eliminate many foods from my diet. I found that both babies reacted to my breast milk with painful gastrointestinal symptoms when I ate certain allergenic food groups—mainly dairy and wheat. So, for the first eight months of each of their lives, I had to avoid eating dairy and wheat; for my son, my diet had to be even more limited. Eliminating dairy and wheat cut out countless food possibilities, and I did lose weight during both periods of restrictive eating. Despite that, I never had an urge to binge.
I certainly wanted the foods that I was eliminating from my diet, but I made sure to eat enough calories to maintain good nutrition for myself and the quality of my breast milk. I did not become obsessed with food as I had when I'd dieted in high school, and I didn't have strong cravings. Both of these periods of restrictive eating came at very stressful times—in both cases, I was sleep-deprived and trying to take care of a colicky baby who didn't sleep much. And the second time around, I was responsible for a colicky baby and a toddler. It seems that if emotional problems and stress have a tendency to cause relapse, as my therapists said, these two periods of my life would have been risky. However, I didn't consider binge eating even once.
I believe this was so for two main reasons. First, I wasn't actually trying to lose weight; and second, restrictive eating doesn't cause as many problems in adults as it does in young people. I was 25 when I had my first child and 26 when I had my second, so my survival instincts were simply not as strong as they were when I was 16, making my restrictive eating not such a big deal. The point of this story is that I really don't have to worry about my lower brain sending out urges to binge, even if I need to diet for one reason or another and even if I go through stressful times.
CAN IMPROVEMENT IN EATING HABITS LEAD TO BINGE EATING?
In the case of my teenage self, my survival instincts signaled a legitimate need for more food in my diet because I was not eating nearly enough to nourish my active body. However, some people may develop survival-instinct-driven urges to binge when, in fact, their "diet" is not a true diet at all, just an intentional switch to healthier eating habits. Many reading this book could be in that situation.
What if—when a woman started binge eating—she was simply looking to drop a few pounds to feel better? What if she changed her eating habits and activity level to become healthier? This book, unlike many eating disorder books, is not against all weight loss. There are many people for whom weight loss would enhance the quality of life. If you are someone whose diet is
meant to be a healthy change in your life and it in no way jeopardizes your health, there is no reason to abandon it. Please keep in mind, though, that when I say "diet" in this context, I mean changes to your food intake to make it healthier and less excessive. I do not mean calorie counting, avoiding entire food groups, or gimmicky diet plans. It has been proven time and again that restrictive and fad diets don't work in the long term.208
Even though weight loss can be beneficial, the body and lower brain may still react as if a diet is a threat to the dieter's survival. Because new eating habits upset the balance—or homeostasis—that the body and lower brain are accustomed to, the dieter may experience strong cravings, many thoughts of food, and urges to binge. As long as the dieter stays detached from these thoughts, feelings, and urges, they do not have to affect food choices.
Anyone—with or without a history of an eating disorder—who chooses to diet for health reasons should be aware of the role their survival instincts will play. Acting on survival instincts by binge eating or simply overeating will, at best, sabotage the diet and, at worst, lead to the habit of binge eating. But being aware of the survival instincts and knowing how to deal with urges to binge allows the dieter to go forth with the weight loss plan, without worrying that binge eating will hamper progress. Urges should disappear quickly as healthier, less-excessive eating habits become the norm.
33: Low Self-Esteem
Just as I didn't have to improve my body image to be free of binge eating, I didn't have to improve my self-esteem, either. As far back as I can remember, I've never had the greatest self-esteem. As a child, I didn't have too much confidence, I often doubted and underestimated my abilities in sports and academics, and I didn't usually feel confident in my ability to socialize and make friends. Achievements and compliments from others could boost my feelings of self-worth for a little while, but my esteem never seemed very strong from within. My low self-esteem didn't hold me back too much, however, and it often served as a source of self-motivation for me. It was as though I always had to prove to myself that I could accomplish things. It wasn't until I entered therapy that I viewed my low self-esteem as a big problem, even a hypothetical cause of my eating disorder.
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