When the most exciting part of your day is planning that perfect binge

I’ve been sitting on this blog for several weeks, but I decided to finally post it. My instinct is not to talk about bingeing (b/ping in general, but particularly the bingeing aspect), because to me it’s the most shameful part of my eating disorder. I know I’m not alone in this though, and I hope that the more I address it the less ashamed people will feel about confronting this behavior.

The article “Investigating the Reinforcing Value of Binge Anticipation” talks about binge eating in terms of alleviating negative emotions. A person apparently binge eats in the context of these emotions and through negative reinforcement the binge eating behavior alleviates this negative affect. When I first read this, I kind of disagreed. In the worst of my eating disorder, I binged/purged in the context of any emotion. I sought to numb myself completely but I was also physically starving, so I relied on the constant b/ping behavior to distract from the never-ending hunger. I was either severely restricting or bingeing on large quantities of food and then purging until completely empty (or well, as empty as was possible for me). That was in the worst of my disorder though. When I’m not as physically starving, I do notice the urge to binge is related more to negative emotions and anxiety.

I also noticed right away that the article focused no attention on the role of purging, which makes me wonder if their generalizations apply more to individuals who binge eat without purging, rather than those with bulimia or anorexia- b/p type. For me (and I’m sure others), bingeing is always paired with purging, and purging almost always follows true binges, not regular eating. This is why I usually refer to the entire behavior as “binge/purging” or “b/ping,” because those two behaviors are always linked for me.

That said, the article then goes on to talk about the unique role of binge anticipation, which is rarely, if ever, discussed in the literature. Ah, binge planning… so many memories of scrambling to write down all the foods I was craving in the moment and hoping they’d be the same foods I craved hours later when I actually got the chance to binge. Clearly for most people, bingeing directly following negative emotions is not always possible. You may be at school, at work, or simply unable to obtain the food necessary for the binge until a later time. This is where binge anticipation comes into play. Researchers hypothesized that often this binge anticipation phase may serve the same purpose as the binge itself, in terms of alleviating negative affect. This may explain why so often I’d be in heaven while planning my perfect binge only to be sadly disappointed when the actual binge failed to live up to expectation (or when the streneous purging part ruined it all).

The article talks about a recent pilot study that examined the brain activation of women with bulimia using an MRI scanner. The experimenters used a mood induction technique to place the subjects in a negative mood. They then measured the subjects’ brain activity when they were asked to plan a binge versus when they were asked to pick out furniture for a fictional apartment. They found a large drop in amygdala activation when the women were planning a binge, but almost no change in amygdala activation when picking out furniture. The pattern of amygdala-related change observed when the subjects were planning a binge has been associated with a decrease in negative affect. They also noticed an increase in activation of the caudate, which may indicate positive reinforcement and “appetitive reward.” In other words, this data suggests that the decrease in negative emotion that has been long associated with bingeing happens (also? instead?) during the binge planning stage. Another study they mention involving the anticipation and actual consumption of a milkshake suggest that this reduction in negative affect is solely associated with the planning, and not the eating itself. However, I think there are too many variables not accounted for to make this conclusion, including the role of purging and level of physical hunger before the binge.

The authors go on to suggest more mood induction, ecological momentary assessment (i.e., rating moods in the moment using some kind of mobile device), and longitudinal brain imaging studies of binge anticipation. I would add that studies should be done with a variety of diagnoses that involve bingeing (binge-eating disorder, bulimia, and anorexia- b/p type).

So the answer is simple then? Just do all the fun planning and skip out on the actual binge (and purge). Negative emotions sill reduced! Problem solved! Haha, right. Up next, how to actually apply these brainy findings to real life…
Advertisements

No easy answer: Anorexia and the right to die

A few people have asked about my opinion of this case in New Jersey where a judge ruled that a 29 year-old woman cannot be force-fed against her wishes; instead she will receive palliative care. Honestly, I have no simple opinion on this matter. It’s way too murky for me to say one way or another whether or not this is the best choice. I would love to be the optimist who says, “Anyone is capable of recovery, this woman included,” but do I really believe that? I’ll admit my overall opinion of recovery has shifted over the past several months. I used to think that everyone had a kind of a pre-destined “recovery potential” that dictated the maximum level of recovery they could ever achieve given the best case scenario. I now see things a little less black-and-white. I used to think this was about as good as it would ever get for me, and now I think differently. I believe I’m capable of more, and I hope to get there one day.

Some of my closest friends have severe eating disorders and I can’t imagine myself ever giving the “okay” for them to give in and settle for palliative care at such a young age. Part of this has to do with knowing the profound effect that malnutrition has on the brain. It’s pretty much impossible not to be intensely depressed when you’re starving. However, I’ve watched people I love make dramatic transformations through re-feeding– not just physical transformations but mental and cognitive transformations as well. I’ve also experienced this myself. When you’re drastically underweight and malnourished, simple food will have a much bigger impact on your mood and thinking than any antidepressant will (and actually, most antidepressants probably won’t work at all when your body is that compromised).

On the flip side, anorexia is an illness not unlike many physical diseases that, when determined to be terminal, have led to approved physician-assisted suicide. Have I ever felt defeated enough by my illness to wish death upon myself? Absolutely, more times than I can count throughout the course of  my eating disorder. However, I honestly don’t think any judge would have granted me permission to die (or to give up on treatment) had I asked for it at the time. As sick as I was at times, I had never done such irreversible damage to my body that it would have seemed warranted. Obviously I don’t know the details of this woman’s case, but I’m guessing her body has deteriorated to a degree that they believe she has little chance of ever making a full physical recovery. Re-feeding can be extremely dangerous when a person has gotten to such a grave physical state, so much that many hospitals won’t admit patients who are below a certain BMI. The places that can treat patients with single-digit BMIs or serious medical complications is very limited. For all I know, this woman may have exhausted all her options and is now just looking for any kind of relief– relief that only palliative care may be able to give her (I also can’t help but note that the article states she suffers from binge/purge type anorexia, which, at least in my experience, is like double the horror).

It’s depressing for me to even be writing about this. I’ve watched more than a few people die from this illness. Some of those people had clear wishes to die and others died very unexpectedly. I worry about my current friends and acquaintances with eating disorders every single day. I hate that this illness takes so many lives, whatever the circumstance, and I wish everyone could be as lucky as I’ve been to experience such a life-changing shift in perspective on the prospects of recovery.

Using the past to your advantage: When comparisons may actually be helpful

I was reminded by Facebook that eight years ago today I was sitting at the tiny wooden hallway tables of good old  “4 Center” at New York State Psychiatric Institute writing a sitcom about life on a mixed diagnosis psych unit. Sadly but not surprisingly, that sitcom never got off the ground– I wasn’t exactly known for finishing the things I started back then.

pi-pic

Aside from bringing back both hilarious and horrific memories, it also reminded me just how different my life is now. Eight years ago, despite being 24 years old, I still had not graduated from college; I was too busy being dragged from one treatment center to another in hopes of making any dent at all in my eating disorder.

Recently I’ve experienced a spike in some super frustrating behaviors. Of course things are nowhere near as bad as they once were, and often I would consider this kind of thinking dangerous (i.e., “Things used to be way worse so things must be fine the way they are now” –> no reason to change or progress further in recovery). However, sometimes I think it truly can be worthwhile to compare the past to the present, even just to ease your mind that not everything is coming crashing down around you.

So, while the actual behavior (e.g., binge/purging) may be the same, the frequency, duration, intensity, and/or circumstances may be completely different. I know for me there are certain aspects of the behavior that have not been a “thing” for me in years– like regularly purging in public restrooms, stealing food, or using the scale and other devices to obsessively (in the moment) monitor my purging “effectiveness.” I no longer wake up and b/p first thing in the morning and continue straight through the day into night. I no longer walk around with scary looking eyes due to all the blood vessels I’d break from purging so excessively. I no longer drive my roommates away by my weird and intrusive habits (it kinda helps that my roommates are now both cats, but still).

So no, things are not perfect now, and I wish they were better, but at least I can look back and remember how far I’ve come. Failed psych ward sitcom writer without a college degree to… accomplished research analyst with a master’s degree (x2, eventually) and an exciting new life plan, with two roommate cats who haven’t kicked me out yet. Yay, total failure this is not!

 

You don’t have to participate.

The past few days have been rough on the social media landscape. I normally try to stay out of political discussions on the internet (or anywhere, really), but there were a few instances these past few days when I felt I could not not say something. In those instances, I was choosing to participate in what I knew had the potential to be triggering territory. I felt it was worth it, and I was fully prepared for people to disagree, agree, or completely ignore what I had to say. Of course the beauty of the internet is that you can stand up and walk away when you want to get out of an upsetting or unpleasant situation. Sometimes it’s hard to do this– or even know that you can– in real day-to-day life.

Recently my workplace launched a “Maintain Don’t Gain” weight loss initiative. Okay, so I guess it’s technically a “weight maintenance” initiative, but let’s face it, the message is that you should be highly conscious of this single number that’s supposed to define your success or failure in the game. I’ve never been a fan of any type of workplace weight competition, but until recently I thought it was all my problem and I just had to suck it up and stop being so sensitive. I realize the committee who put this thing together has nothing but the best of intentions, and I appreciate their interest in our well-being. I just happen to disagree that these types of activities actually foster wellness. There are going to be scales placed around the office for us to use as we please, aside from the official weigh-ins with someone called a “Wellness Champion” (not sure who that is, or how they got that title). At the end of six weeks, anyone who maintains or loses weight wins some kind of prize.

I was telling my dietitian about this and we had to laugh because for the first time in well… ever, I’m actually making a conscious effort to gain a small amount of weight. I’m no joke trying to get to a healthier BMI now that I’m taking this “become a therapist” thing seriously. And then along comes this initiative telling me to “maintain not gain!” Cool. I also can’t wait to be even more self-conscious about people seeing me eat now that we’re all supposed to be like, dieting. I know if I can get through these crazy six weeks and still reach my goals, which seem completely out of line with the work initiative’s goals, then that will be some kind of a miracle. I guess I won’t be getting that prize, but oh well.

Now obviously, participation in this initiative is voluntary. No one is forcing anyone onto a scale or blurting out their stats for all to laugh at. As you may have guessed, I will definitely not be participating. I have no problem with other people participating, I just hope everyone realizes that the option not to participate is there. I know I’m probably far more negatively affected than most by things like this, but I also doubt I’m all alone. I’m not just talking about people with past or current eating disorders. This may not be a healthy activity for others for various reasons. Also, for someone already at risk, a competition like this could act as a breeding ground for an emerging eating disorder.

I hope this initiative serves all those who choose to participate, and I also hope those who don’t feel they’d be best served by it exercise their right not to participate. Simple as that. 🙂

 

Therapy for the therapist (and everyone else too)

Tonight I saw a new therapist for the first time– someone who miraculously takes my insurance. I pay just a small co-pay for each visit; it’s kind of amazing. Of course I’ve only seen her once, but I think I’m really going to like her. Our first session together was different from most if not all other “first sessions” I’ve had with therapists before. We didn’t do a long detailed assessment where I felt pressure to spit out my entire life story in a span of 50 minutes. We didn’t launch right into “How are we going to fix your eating disorder/depression/anxiety?” She just let me talk about what brought me back to therapy.

It’s been over two years since I’ve been in regular one-on-one therapy. My decision to go back was largely motivated by my recent plan to apply to MFT programs and finally pursue my own dream of becoming a therapist myself. Most programs require that you be in some kind of personal therapy for at least a portion of your time in the program. Even if they didn’t require it, most agree that it’s the smart thing to do. I guess I wanted to get a head start seeing as I’m already experiencing such a wide array of feelings since making the decision to go back to school.

Nearly 12 years ago during one of my inpatient stays for my eating disorder, a fellow patient’s father came up to me during one of the weekly “Multi-family” groups and started making conversation. When he asked me what I wanted to do with my life, I said I ultimately hoped to become a therapist. When I said this he (no joke) started cracking up laughing. “A THERAPIST?!? But you’re… here. In a mental ward. How IRONIC!” um, no not really? It was weird to me that this was apparently the first time he had heard of someone with “mental issues” bad enough to be on a “mental ward” going into the helping profession. Hello nearly every person I know who has pursued this path?

This man had a strange way of saying things, but it was far from the last time I heard someone allude to the assumed distinction between “the therapist” and “the patient” as if they could never be one and the same. It makes me sad that therapy in general is still stigmatized at all. Going to therapy does not make you crazy, mentally ill, or broken. A couple weeks ago I was out with some people from work and we somehow ended up on the topic of therapy. The resulting conversation uncovered that most of us have been or are currently in “therapy.” And guess what? We’re all accomplished, intelligent, hardworking individuals. Kind of amazing.