I agree with Mockingbird; you are doing something that psychologists call "displacement." It's almost like a magical spell: you are symbolically "purging" out painful emotions and memories into another "host" item, such as food. (think of the Bible story where Jesus cast's a man's devils out into pigs, which are then driven over a cliff and killed--a perfect archetype for displacement!). So your issue may not be an ED at all, but perhaps just the graphic visual symbolism of "stirring in" your traumatic "poison" in the process of exorcising it out of yourself. And then, of course, the food "feels" symbolically poisoned, and cannot be eaten (another biblical example (forgive me, I'm on a roll) is when the early disciples argue about whether meat that comes from animals sacrificed to other gods/idols can be eaten by Christians. Their belief is that something "impure" has tainted their food by virtue of the thoughts and beliefs during the preparation of the food. Paul's answer, incidentally, is that the food remains pure and acceptable, and that nothing about the spirits or minds of the preparers renders it unfit).

I've had patients who had similar experiences. One young gifted patient of mine remained alone after group once to ask why she was actually angry at her body for being able to digest and absorb food. This, it turned out, was her symbolic resistance to certain aspects of her trauma; I won't divulge more, but the point is that food became a substitute "scapegoat" for something she hated about her rape.

This is a normal process, but not one that you should passively tolerate, either. Address it with your therapist, and focus on what emotions you're most often "spiking" your food with, and then explore alternate ways to displace them so that your health and diet are not affected, such as molding clay balls while projecting your feelings into them, and then shattering them with hammers, etc.

I like the clay balls idea, that's something I might try myself some time. It's always good to have new ways of offloading some anger. (I'd have a bottle-smashing session in the back yard, except I don't want the local cats injuring themselves on any loose bits of glass!)

I don't know why, but I was recently remembering an old school friend of mine who became anorexic; by the time we were doing our 'A' levels (around age 18) she'd become PAINFULLY thin, her head looked too large for her body. Of course at the time I really didn't understand what was going on, I wish now I'd been more sympathetic.

I never really knew exactly what was going on in her home life, but compared to her brother it was always obvious she was the 'second-class citizen' compared to him. Because she was only a girl she was at the local state comprehensive (with all the other plebs like me :), while her brother got the 'good' education at a private school; as far as I could see he got all the 'cool' Christmas presents like the computer and the driving lessons ......... it seems like the message was always there from a young age that she wasn't 'worth' spending any money on.

Might be going off-topic slightly, but I wonder what happened to her? I hope she did manage to build up a good life of her own.

I wonder about those things too, from my younger days.

Oh, my all-time favorite book on eating/body image issues is Courtney E. Martin's book "Perfect Girls, Starving Daughters." AMAZING book. Sadly, I've parted with my copy with all my notes and underlining.

Bump

This group is eerily in tune with what i secretly need to work on. Thanks for bumping this topic i'm going to give it a good read later

thank you for bumping this, I read most of the comments. I will comment later when i have time to process everything. thank you again

Only because I'm drunk will I admit this, but I am so glad this was bumped. I have food issues. I wish I could never be hungry again because I want to make myself as small as possible. But I eat like a pig, it's what I do and I hate myself. Sometimes I feel in control and I can master my cravings and there is this actual high when I lose weight. I feel almost powerful. I want to be small because people are supposed to be nice and protective of small people, right? Except that's not true, because I was so small, so very small when I was raped.

okay this entire discussion was awsome...a bit much to process all at once. But an amazing discussion....Thanks Matt

I did not eat much after I was raped. I drank, smoked, and took diet pills and ended up in the hospital after a few years of that. I am 5'7" I was like 103 when they admitted me. No one wanted to talk about any of my issures so....all was avoided. Later in life I flipped and became an emotional eater...and got up to 250 and then everyone started telling me how heavy I am...so, I ate more. I have lost some, I have a long way to go, but I also know a lot of my weight issures have been related to either self destructive behavior or that "not wanting to be attractive" issue.

Matt, are you still willing to dive into this again? I know this is from a long time ago, but I think ED's are SO hard to understand for everyone; therapist and client.

Reply #53 is just like me. Just SO like me. I told Gill I was frustrated that after so much time, good work, and improvement that the weight I have hasn't started to just "fall off." If ED's are a mental issue, why doesn't it resolve itself?

There is a lot of talk about AN, Bulemia, etc., but much less about the binging. I know that after the rape, no one took care of me. Not a soul. My mom would harp on me about my weight. Even when she bought good food for the house, she'd say, "Idk why I buy the healthy foods. You just eat that AND the other stuff." I couldn't win. And she never bought things that I enjoyed. She always bought foods for her. Very simple requests of preference she could have indulged me in, she didn't. So when I'd go to my friends house, and they had that stuff, I'd over-do it there because I didn't know when I'd get it again. It got to be a constant pattern of thinking ahead, and hording food almost so she wouldn't see what I had eaten and couldn't yell at me.

Even this last weekend, when I was out of town at a funeral, my brother approached me with a current list of his blood pressure reading and didn't know how to interpret them. I told him (as a nurse) he needed to see a doctor to get it under control. So my father looks at me and says, "When have you been for a check up lately? I really worry about you and diabetes." I love my father dearly. 100% with my heart, but in front of my 7 brothers and sisters was not the time to point out his diabetic worries related to my obesity.

You can stop purging. You can scale back the exercise. But when it comes to binging, how do you control that? I have to say I don't think I binge. I think I eat whatever I want, which happens to be not good food (face it, fatty foods are yummy), because I indulge in myself. What is the solution? A permanent diet? "A life change?" as people LOVE to say when they decide they are just going to scale back...

There's not a lot of patience out there for people who over eat, but there's a hell of a lot more for people who are anorexic or bulemic. They are "sick." We're just "gross, with no self-control." Many times I wish I were Anorexic. It would be understood so much more. I don't want the nasty teeth or corroded esophagus that goes with it, as well as it would be really hard to hide. I've thought about it way more than I'd like to admit.

If the the only way to handle it is to truly just diet, than I am up shit's creek.

GREAT bump, btw.

I don't think dieting really works anyway. Think of any ten random people you've known for years. Now think of their body types from five-ten years ago. Is there much change? Rarely. Much of our body type is genetic. I've tried and tried to do the "hardcore exercise" thing, and I just stay mostly the same. Dieting is usually premised on a media fantasy that such transformation IS possible if we try hard enough. Most changes in diet improve us by 10-20 pounds, contrary to the TV advertising promises of 50 pounds, etc.

The biggest problem I see with most bingeing is the emotional component of it. People shame themselves when they have pie, or feel defeated when they have a burger. The shame, more than the biology, has been the under-appreciated real harm of our food choices. The medical risks of most diets can be mitigated by enjoying foods sparingly, rather than omitting them altogether, and adding healthy ancillaries like fish oil, flax oil, alpha lipoic acid, and fiber, and getting sufficient sleep. (I recently tested high for blood pressure, which was both a result of my poor diet--fajitas!--and insufficient sleep. I'm taking very high doses of fish oil now, and sleeping better. It's already helped.)

(Fish oil, especially high doses of EPA and DHA, help maintain hormones, reduce storage of sugars as adipose, improve insulin sensitivity, improve mood/depression, reduce anxiety, and help antidepressants work better. I take well more than a gram of combined EPA/DHA daily. Flax oil is heart healthy, provides energy without a spike and insulin crash. Alpha lipoic acid is one of the best antioxidants you can buy, and improves insulin sensitivity. 200-250mg of ALA about 20 minutes before eating will help tremendously.)

I'm not a nutritionist, but I do keep up with research about nutirition, especially as it pertains to emotional health. Bingeing that becomes medically dangerous is a whole other issue, and isn't the same as "pleasurable eating" that results in snarky family comments. I happen to like Mary Pipher's book "Hunger Pains." It's an easy-to-read book about the emotions of eating, and the best I've ever found on the topic.

How do you treat over eating? I know I've heard somewhere that therapies like reward systems work with anorexia and bulemia, but what about the binging? It sounds like a process you have to white-knuckle and that can only work for so long. Plus when you are busy, it's so much easier to grab something that is unhealthy and lots of it. How do you work around all those environmental factors? There just doesn't seem to be a lot of support for over-eating. When you deal with purging, I kind of akin it to quitting smoking or something. Finding a temporary distractor to get through the impulse and maybe a different coping mechanism. But over eating requires you to recognize and have the willpower to stop in the middle of an act that has a fine line where you may be dealing with a healthy habit that can turn into unhealthy simply by over indulging. I know it's a bigger problem for me than just liking cake. I think over eating and binging seems like it would be harder to treat than some other ED's. An addiction you can still partake in... only in moderation.

Those nutritional facts are really interesting and helpful. It seems like they'd be more beneficial once the main problem is under control.

If I am honest...I really hate the way I handled being forced to eat later on in life. That memory of shame, frustration and loss of control meant that when I wanted control back I moved to binge eating.

I equate binge eating to control...which is odd. I can mindlessly over eat (have been doing recently) and that feels out of control so I start restricting to try and pull it back. Like the the last couple of days I've been having one meal a day. Yet when I purposefully binge, it feels like control. I'm making a decision.

Actually, I just remembered some things. At 5/6 I was being forced to eat. By eleven I was being told to stop eating so much even though I was perfectly healthy weight and size. My mum started to put strict restrictions on my food..smaller meals AND no snacks between meals. Then my nan had to look after us for a while and she is a feeder. Massive meals, multiple courses..and we'd been taught to finish it all. So I put on a couple of stone that year.

Then mum gets us back and starts her restriction diet again. By which point I am begin regularly abused. I need to control something so I rebel against the food regime and secretly binge.

My dad was bulimic during my later teens and now I am not sure if he is just anorexic or if he has anorexia nervosa..its hard to tell he just says his meds make him have no appetite yet he's always complaining about tiredness and migraines. I can't help but compare...him not eating anything makes me feel like this big massive pig. I so want to have his control/lack of appetite...

I never got diagnosed with an ed because I never stick at it long enough. I flit between all my methods of self destruction until I find one that suits the mood im in. I feel out of control which is why most of the time I feel 'myself' when I am restricting. But..and it's a happy but :) ...I've started to get days where having a healthy food schedule feels like I am being myself. And that is really weird!

For me, the treatment of binging vs overeating is that I could imagine cbt working with binging. There is a definite and conscious thought process to when I binge or purge.

Over eating..starts as a real hunger and I can't distinguish the emotional hunger from the actual hunger. So I'll just tell myself I am having a hungry day but then the next day I can't seem to satisfy myself even when my stomach hurts from so much food. It's so unconscious.. I can literally imagine that it is me stuffing a feeling. I think over eating, for me, will go away in line with my rape therapy progression.

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Can I ask..I have food intolerance and I know that eating certain foods will make me really ill even if I use my medication. Yet I still do it..difficult as it is to admit I like the punishment element of it. It's like I get this 'i don't deserve to be well' rhetoric going on in my head. Does that fit in with the food issues/eating disorder or is that more a self harm thing??

Boy, you're going to let me off the hook easily, are you? One of the TOP controversies in medical mental health today is the best way to treat bingeing. Every profession sees it through the lens of their own training, so eating-disorder people see it as something to treat with ED methods, and physicians tend to see it as a purely medical condition, and want to treat it as they would also treat obesity. Each side thinks the other has gone about it backwards.

One expert on it is Dr. B. Timothy Walsh, who chaired the DSM-IV working group on eating disorders (so far, bingeing is not its own diagnosis; it's only a sub-category). Dr. Walsh promotes cognitive-behavioral therapy as his preferred choice, and he says the data supports it the most. He also advises clinicians to eventually add in interpersonal therapy for depression and behavioral weight-loss methods as CBT progresses.

CBT, as pretty much anyone here who's ever been in therapy knows, is aimed at exposing the "false beliefs" we have about a topic, exploring how we arrived at them, and beginning to replace them with more useful ones. Trouble is, a lot of psychiatric medications result in weight gain as a side-effect, which may reinforce the faulty beliefs about food and body that the person already holds. If I believe negative things about myself and my appetite, and then medication causes me to gain weight, I might not see that as a medical effect...Instead, I'll see it as proof that my beliefs are true! (some meds, like Wellbutrin, can cause weight loss, though).

Interestingly, interpersonal therapy is entirely relationship-based, and follows the same premise I use(d) in treatment of rape trauma: the individual must recover in a way that develops social support from others. Many people with bingeing disorders that I ever treated had a pattern of worsening that followed their loss of support from family, such as relocation, trauma, divorce, etc. They had not connected the two until therapy, when they realized that their eating patterns varied with their social connectedness.

the largest study on bingeing disorder (Archives of General Psychiatry) measured the effects of CBT versus interpersonal therapy in 162 patients. Both therapies worked, and 25% lost significant weight too. Notice the mindset of this study: weight loss was an "...also" effect, not the CHIEF goal. The study sought to reduce mental health problems associated with bingeing (depression, anxiety, shame). Other researchers don;t like that, and think weight itself ought to be the primary concern. So it depends: do you think the chief concern is weight issues only, or emotional health such as depression and anxiety? Some patients are trying something new entirely: surgery. Laproscopic stomach banding is easily the MOST effective approach (drug surgery yields only about 5% long-term success for weight loss), and most hospitals now require a patient to also participate in pre/post mental health counseling and weekly support groups. Such surgeries have been risky in the past, but are becoming more common and safe today. What hasn't yet been studies is whether this method not only reduces weight and bingeing (it does), but also reduces depression and negative self-talk about food and body issues (anecdotally, women say "yes" but there hasn't been a controlled study on it yet).


Also, my spell-check still hasn't learned that "bingeing" is correct. It keeps trying to fix it to "binging."

I had two sisters have that laproscopic surgery. It helped alot right after, they could only eat small amounts at time otherwise they would throw up and have a miserable stomachache.. so one lost 140 one lost 130. Its been over 7 years for one sister since her surgery, 5 or the other....and both have learned how to eat...to bypass the nasty side effects. Each of them has gained 100 lbs back. They both had that pre and post op psych evals...Matt they do the post op evaluation so close to the surgery their answers are skewed..because it hurt too much too over eat. And the pre-op one was ' a joke'...they had to answer 100 questions, the psychologist 'scored' their responses and passed them through. They both could use weekly counseling , but instead my one sister's doc just recommended hypnosis. Oh and the second one was 'not a candidate' for hypnosis... apparently she wouldn't/couldn't get hypnotized..which I didn't even think was possible.

I lost 70 lbs at 24years old because I was afraid of the medical issues most of my family had because of their weight. I lost it cutting only the AMOUNTS of food I ate, NOT the types of food. I lost 30 in a little over 4 months. I felt comfortable enough to begin exercising so I started an easy 1/2 hour cardio tape (Sweatin to the Oldies with Richard Simmons...don't knock it til you try it. After a while you start looking forward to making fun of him:) I did that and kept up my same eating and lost the last 40 in 6 months. I kept it off for 6 years until I got pregnant with my first child (after 6 years of fertility treatments ---which was the catalyst I needed to try to lose weight because the meds were going to make me gain)
Once I found out I was pregnant I gained 6 lbs in one WEEk! Gaining 60 overall ....yep I was one of 'those' pregnant women. I ended up losing it all again after my second child was born..but let me warn you..it's LOTS harder to lose weight after having kids. I got pregnant with my 3rd unexpectedly 6 years after my second and I gaine the 'respectable' amount of weight (25 lbs) and lost the baby weight the same was. I wasn't until I started working through this in therapy that I've seen my weight creep steadily up and quitting smoking last year seemed to boost it quite fast. I know how to fix it..but frankly , like anything you have to want to...NO reallly realllllly want to. Enough to make the effort.

As a side note, my family has been in part of what they call a 'fat study' at the State University. Doctors approached both my parents because of their weights and the large number of children they had that were overweight. All but me participated..you couldn't be pregnant or nursing for the tests. They tested my mom, dad, all but 3 of their children and 10 grandchildren. They were looking to find a genetic reason for the weight problems. I'm not sure of the exact results but in a nutshell they concluded that there was an overwhelming lifestyle factor, and slight insulin factor in the older (over 50) category. So no we weren't 'destined' to have weight problems...we were taught our eating habits and while we were all thin when we were young because of our activity level at home(working and playing outside everyday) we could offset the effect of unhealthy eating, once we were out on our own we didn't have to do what we didn't want to do.

Some of us have learned how to cook healthier and managed to get or keep our weight under control...but the majority hasn't. So if you want to know if there is sucha a thing as a 'fat gene' the evidence so far says no. But insulin sensitivity is a factor and that is 'easily ' remedied by significantly reducing carbohydrates and refined sugar in our diets. Uh, they're telling this to a family who would give up all meat and vegi's to keep their bread and fruit..(which has lots of natural sugars)... so...
Dev , even when you know how and know what you need to do and what foods to eat and what foods to limit..its not easy (and can I just say the fry-bread at the retreat is breaking like 10 hearthealthy eating guidelines:)