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The Diet/Binge/Purge Cycles
Let’s start by defining compulsive eating as
any eating out of relation to physiological hunger and satiation.
This means that anytime one eats for reasons other than hunger
or bringing hunger to satiation, we say that eating was compulsive
in nature. Which is to say we all eat compulsively at times
(i.e. for reasons other than physiological hunger).
People with eating problems, however, eat compulsively
consistently and feel terrible shame about both the behavior
and the effects of the behavior (perceived or real) on their
body size. In fact, each compulsive eating episode tends to
be accompanied by a great deal of shame, as shown in the cycles
below. Indeed it could be said that shame is the main ingredient
that turns a "normal" experience of compulsive eating into
a repetitive anguished pattern.
In my work with people with eating disorders,
I listen to them carefully as they describe their eating in
detail to me. Below is a common pattern I have distilled from
underneath the many stories I have heard.
Image "Diet/Purge and Binge Cycle"
- please click here
As you see above, the binge (or perceived binge)
is initially triggered by an event or thought that may also
be associated to an earlier less conscious experience. The
earlier experience may have included a great deal of shame.
That experience is then transferred to feelings of body shame,
and self-critical thoughts. At this point the person reaches
for food to help salve the pain.
The shaming thoughts are then redirected onto
the eating behavior, which puts the eating in a paradoxical
role. While it is soothing the person, it also acts as a scapegoat
for the bad feelings that triggered the binge to begin with.
The eating behavior, and the soothing it brings, then becomes
the enemy. The person then believes “I feel bad because I
am eating” rather than “ I felt bad and so I ate”, because
they no longer remember what made them reach for the food
in the first place.
The person then has to keep eating because they
still feel bad, and so they start to feel bad because they
can’t stop eating. The binge is experienced as out of control
self-destructive behavior. The eating must continue or the
original shameful feelings (now forgotten) will return. Eventually
the experience of being over full will force the eating to
stop. When the shame returns, the person may seek out the
redemption of a diet, "purification" fast, or purge. By this
time the original trigger is completely obliterated by the
drama of the binge and purge or diet. But whatever one tries
to do to deny hunger, hunger will return. If it is ignored,
it will return with a vengeance, and this extreme state of
hunger will trigger a perfectly normal and healthy reaction…a
binge. But the person may have difficulty distinguishing between
a binge triggered by waiting too long to eat, and a binge
triggered by emotions that have nothing to do with physiological
hunger – because the behavior is identical. Confusing this
healthy binge with a compulsive binge, the person will try
to further resist his/her hunger, only to ultimately meet
defeat (except for cases of anorexia). The diet, the purging,
the fasting must end because the person must continue to survive,
only now the view their survival instincts as harmful and
shameful, and this begins the binge cycle again.
Example:
JL: What do you think made you go for the Oreos
at 2PM yesterday?
Pt: Well, as you know, that's when I get home from my job,
and then I have an hour to get to class. I always binge then.
I have trouble with transitions.
JL: Yes that seems to be a hard time of the day. Can you remember
what made it so hard yesterday?
Pt: I'm just stupid...it's stupid, that's all. I used to see
Joey during my break when we lived together…but that was so
long ago and so that can't still be it.
JL: So you feel ashamed about still missing Joey? You should
be over it by now?
Pt: I never get over anything. I'm so clingy and needy- no
wonder he left me.
JL: So remembering that you used to see Joey then reminds
you of the shame you feel for still needing him?
Pt: It makes me sick to think about it.
JL: Is that why you reached for the Oreos, do you think? Because
of that sick feeling?
Pt: Yes, but they just make me feel sicker! It doesn't make
sense!
JL: Well it kind of makes sense if you wanted to forget the
sick feeling about Joey, that you might cover it with a sick
feeling about eating, which maybe doesn't feel as shameful.
Pt: But it does! I'm nothing but a big fat cow! All I do is
stuff cookies to get fatter. Ugh! **********************************************************
Here we see the shame originally associated with her clinging
now reattaching to the relatively familiar and socially endorsed
arena of her body. From feeling isolated and humiliated by
her neediness, she now joins the throngs of women who think
they're too fat. This feeling, as bad as it is, is clearly
more tolerable.
Pt: I had a huge binge last night.
JL: Were you hungry?
Pt: I was starving, but I couldn’t stop eating. I was putting
away food like I would never eat again – I just shoveled it
in. It was disgusting.
JL: That is a normal way to eat when you are starving. How
did you end up getting so hungry?
Pt: No. You didn’t see it – there was nothing normal. I mean,
I ate straight from the container – I didn’t even bother to
heat it up.
JL: You must have been terribly hungry. How did that happen?
Pt: Well, I had had such an awful binge the night before that
I decided I could go the next day without any food. I’ve done
it many times before. But I was such a weakling.
JL: I don’t agree. There’s nothing “weak” or “bad” about feeding
yourself when you are hungry. We would do better to explore
this idea that you have to starve yourself any time you have
what looks to you like a compulsive eating episode. Some of
these “binges” may be perfectly normal reactions to abnormal
deprivation. In order to work through the actual compulsive
eating episodes, we must first be able to distinguish them
from binges that are in response to deprivation. The only
way to be sure is to ask yourself if you are physically hungry
first. If the answer is yes, then please, enjoy your food.
This approach goes against so many socially
imposed beliefs that it is sometimes difficult to follow.
However, most realize that it makes sense, once they are more
in tuned with their patterns of hunger and satiation. There
are even people in OA groups that are now defining abstinence
in terms of only eating with hunger and satiation, which is
a much more natural definition of abstaining from compulsive
eating, in my opinion, than sticking to a low calorie food
plan. According to the World Health Organization, an adult
female requires 2,000-2,500 calories per day (depending on
degree of activity). Less than that is, by definition, substandard,
and your body will fight hard to get and keep those calories.
Most restrictive food plans (as they are often called now
that dieting has gotten a bad rep) attempt to keep your caloric
intake below these basic requirements, and so, are bound to
rebound eventually. The dieter then blames him/herself and
feels ashamed, fueling the die/binge cycles to continue.
For more on how I work with eating problems
see: Therapy
for eating problems
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About the Author: Judy Lightstone - MA,, MS, LMFT
Licensed Marriage and Family Therapist; specializing in eating
disorders and dissociation - has been providing psychotherapy
for the past 21 years and training professional therapists
for the past 19 years. In her Berkeley private practice, she
currently specializes in treating eating disorders, trauma
survivors, and working with couples and families. Patients
describe her as gentle and compassionate in a strong way,
tempered by an easy sense of humor. She helps you become more
conscious, and offers support and advocacy as you learn to
live with greater awareness of yourself and the world. She
stays clear and focused so you can better access your inner
strength and wisdom. For more information visit Judy's website
www.psychotherapist.org
or call (510) 704-0940 in Berkeley, CA.
© by Judy Lightstone, 2000
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