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  BRAIN OVER BINGE

  Why I Was Bulimic, Why Conventional Therapy Didn't Work, and How I Recovered for Good

  Kathryn Hansen

  Copyright © 2011 by Kathryn Hansen

  Camellia Publishing

  6825 S. 7th St.

  Box 8305

  Phoenix, AZ 85066

  www.camelliapublishing.com

  Printed in the United States of America

  All rights reserved. No part of this book may be reproduced or transmitted in any form by any means, electronic, mechanical, photocopying, recording, or otherwise, without the written prior permission of the publisher.

  ISBN: 978-0-9844817-2-9

  Library of Congress Control Number: 2010911736

  NOTICE OF LIABILITY: This is a personal story of recovery. It is not intended to replace the services of trained health professionals or be a substitute for medical advice. You are advised to consult with your health care professional with regard to matters relating to your health and, in particular, regarding matters that may require diagnosis or medical attention. The author and publisher disclaim any liability arising directly or indirectly from the use of this book.

  This book is for the 19-year-old bulimic who felt hopeless yet swore to conquer her problem one day and then write about it.

  That bulimic was me ten years ago. ...

  So now I dedicate Brain over Binge to my former self and to all those who want to be free of binge eating.

  Contents

  Preface

  A Note to the Reader

  Introduction

  PART I: MY BULIMIA AND RECOVERY

  1 A Typical Day's Binge

  2 A Typical Day of Purging

  3 Choice and Consequences

  4 Introduction to Therapy

  5 My First Binge

  6 Accepting Therapy

  7 Topamax to the Rescue

  8 Some Things Change, Some Remain the Same

  9 A New Book and New Hope

  10 My Two Brains

  11 I Had Control All Along

  12 Resisting the Urge

  13 The End of My Bulimia

  PART II: MY BULIMIA REDEFINED AND RECOVERY EXPLAINED

  14 Investigating the True Story Behind My Bulimia and Recovery

  15 Was I Really Recovered?

  16 Why Did I Binge?

  17 What Caused My First Urges to Binge?

  18 Why Did I Diet and Why Was It Such a Problem for Me?

  19 Why Did I Continue Having Urges to Binge?

  Reason 1: Persistence of Survival Instincts

  20 Why Did I Continue Having Urges to Binge?

  Reason 2: Habit

  21 Why Did I Follow My Urges to Binge?

  22 Why Didn't Therapy Work for Me?

  23 Revisiting Recovery: How Did I Do It?

  24 Brain over Binge, Step 1: View Urges to Binge as Neurological Junk

  25 Brain over Binge, Step 2: Separate the Highest Human Brain from Urges to Binge

  26 Brain over Binge, Step 3: Stop Reacting to Urges to Binge

  27 Brain over Binge, Step 4: Stop Acting on Urges to Binge

  28 Brain over Binge, Step 5: Get Excited

  29 Is Relapse a Possibility?

  30 Where I Am Today

  PART III: THERAPY CONCEPTS REEXAMINED

  31 Normal Eating

  32 Body Image, Weight, and Dieting

  33 Low Self-Esteem

  34 "Coping"

  35 Triggers

  36 Purging

  37 Coexisting Problems

  38 Medication

  39 Prevention

  40 Bridges to Traditional Therapy

  41 Conclusion

  Notes

  Bibliography

  Acknowledgements

  Preface

  "[A]n eating disorder provides solutions to one's problems in life and is not simply about food and weight."1

  In November 2007, two and a half years after I recovered from bulimia, I visited my doctor about some stomach pain. I told him about my past eating disorder, because I thought years of binge eating could have caused some damage to my digestive system. Even though I made it very clear that I had not binged in a long time and was no longer bulimic, he asked me, "Do you think your eating disorder is—" He hesitated, so I finished the sentence for him: "Gone?" Then I answered my own question with a simple "yes."

  "That's great," he said. "So I assume you sought help?"

  "Yes, I did go to therapy, but then I realized it was just a habit and I quit."

  A look of interest, or perhaps doubt, came across his face. "Well," he said, "I'm sure your bulimia was fulfilling some need."

  Fulfilling some need ... the words struck me, and suddenly, I felt as if I were sitting in a therapist's office again.

  I was attempting to write this book at the time but wasn't making much progress. I found new motivation that day. My doctor's comment made me realize that there is a big problem with the way bulimia is viewed, not just among therapists and patients, but throughout society.

  Today, eating disorders are primarily thought to be symptoms of psychological problems like depression, anxiety, low self-esteem, and family conflicts. Eating disorder experts assert that the destructive eating behavior signals an inner emotional crisis, just as fever indicates an underlying infection.2 An affected individual supposedly uses the eating disorder as a coping mechanism to deal with issues and feelings she can't face in her life. In this way, eating disorders are thought to fill an important need or void in the person's life—a need that is much more than physical, which is why it's so common to hear that eating disorders are not about food.

  I believe that the widespread view of bulimia as a complicated problem that helps victims fill some sort of emotional need is a shaky hypothesis at best; and in practice, it can be downright harmful to people suffering daily with incessant urges to binge and purge.

  A bulimic typically seeks therapy because she can't seem to stop eating large quantities of food. But in therapy, she learns that food really isn't the problem—the problem is her personality, her inability to cope with life, her childhood, and/or her relationships. In short, she learns that she is psychologically unwell. No one tells her exactly how to stop the behavior she so desperately wants to stop. There are no specific directions, no pinpoint cure. No one tells her that she has the power to stop binge eating anytime she chooses. Instead, she learns she doesn't have much control over her own behavior—that is, until she addresses the underlying emotional issues.

  So the bulimic sets out on a path of self-discovery, hoping to find some answers to why she binges, hoping that if she makes some changes in her life, heals past hurts, or builds new relationships, the incredible urges to binge and purge will go away. She learns to deal with depression, reduce anxiety, and build healthy self-esteem. She works on her nutrition, battles her perfectionism, and learns to cope with the events and feelings that supposedly trigger her binge eating episodes. She tries to figure out what purpose the bulimia serves in her life. But all the while, she continues to binge and purge.

  This was my story for six years. After an initial reluctance, I embraced therapy. I embraced the view that my bulimia was about something more than food; I embraced the idea that I was using my eating disorder to cope; I embraced the idea that I was ill, that I needed professional help to get well, that I needed to get to the root of my problem before I could quit. I did everything I was supposed to do in therapy, and when it didn't work, I tried different therapists, slightly different approaches. But all this had the same result: I remained bulimic.

  I don't blame my therapists because, after all, they were only trying to help me and they were always sensitive and supportive. Therapy simply didn't empower me to stop binge
eating, and there are many like me who have had the same experience. Although there is a wide range of recovery rates in the available literature, current therapies for binge eaters do not come close to curing everyone. There is no consensus on exact recovery rates because of problems in research, including a limited number of studies, study design flaws, differing definitions of eating disorders and recovery, different treatment types, and patient withdrawal from studies.3 However, bulimia recovery rates are not encouraging, and "we still have much to learn about providing truly effective treatments for eating disorders."4

  One study showed that, after treatment, 50 percent of bulimics maintained bulimic behavior with episodic remissions and 20 percent remained symptomatic.5 Another showed that, three years after treatment for bulimia, one-third of women binged every day, one-third binged less than once a month, and one-third fell somewhere in between.6 Even the treatment considered most effective for bulimia—cognitive behavioral therapy—eliminates binge eating and purging in only 30 to 50 percent of cases.7

  These statistics show that although therapy does help some bulimics, it does not help them all. Therefore, alternatives are needed. After talking to my doctor that November day, I felt a strong desire to provide an alternative. I realized the view of bulimia as a coping mechanism is so pervasive in our society that it is generally accepted as fact, even by those outside of the therapy community, like my medical doctor. I decided that a new voice was urgently needed—a voice to challenge this orthodoxy and reach those who are not being helped by this view of bulimia. I also want to give hope to those who are not currently seeking therapy, because about nine out of ten people do not receive treatment for their eating disorder.8

  Fulfilling some need... I thought about those words over and over, trying to understand why my doctor's simple and innocent comment kept lingering in my mind. I reflected on my experience in therapy and how the experts led me to believe that by binge eating, I was using food to cope with my problems, stuff down emotions, or fulfill a more complex psychological need.

  Then I thought about the way I changed once I'd decided to view my eating disorder differently: by dismissing the belief that I ate for deeper, more profound reasons and, in turn, completely changing how I approached my problem. I'd discovered another path to recovery, a simple and quick way to stop my bulimia—without therapy. I have completely stopped bingeing, and I have had no desire to do so in years. I believe that I am at zero risk for relapse, even during stressful times in my life. My bulimia is over.

  When I was consumed with my struggle with bulimia, I vowed that if I ever found a way out, I would write a book to help others find their way too. Sometimes I still can't believe that I've now written this book, because for a long time, recovery seemed so elusive. But my recovery is real and permanent; and now I want to share my story with others so they can end their own struggle. I want to share my alternative approach, in hope that I can be a voice of change, a voice for those who are frustrated with therapy or who simply can't afford it, a voice that helps many escape the daily torment of bulimia.

  When you are caught up in bingeing and purging or starving, you don't grow and you miss moments you'll never get back. I lost valuable years to my eating disorder, and I don't want anyone else to do the same. I am here to tell you it's possible to end your eating disorder right now and get on with your life.

  Maybe traditional eating disorder treatment hasn't helped you thus far. Maybe self-help books you've read, while inspiring, haven't truly empowered you to stop your binge eating. Maybe you've tried many paths to recovery that only led to dead ends. Maybe you've realized, like me, that it may take a lifetime to transform into the person you want to be; but you are quickly grasping that you can't wait a lifetime to stop your bulimia.

  Granted, we all want to become something greater than we are. We want to live with grace, love ourselves, and pursue our dreams unhindered. But that may not be possible for you right now. Maybe you can't even think about flourishing in other parts of your life until you conquer the most pressing issue—the thing that's holding you back: your destructive eating habits.

  I hope my personal story of recovery can give some people who are plagued with bulimia the courage to expect a cure, and I hope my practical advice will give many bulimics their lives back. I hope I can change some people's attitudes about what bulimia is all about—people like my doctor and my therapists who believe that bulimia fulfills some need. If I can change one person's mind, give one person hope, or save one person's life, I will have done enough.

  A Note to the Reader

  For the sake of simplicity, throughout this book, I use the term therapy or treatment to refer to the collective treatment I received for my eating disorder, and I use my therapists to refer to the collective professionals who treated me over the years. During my college years, I saw three mental health counselors, two psychologists, three nutritionists, a psychiatrist, and a medical doctor about my bulimia. I was also an avid reader of anything pertaining to eating disorders. I got much advice from eating disorder experts by reading informational and self-help books and from resources on the Internet. Naturally, I don't remember exactly where I learned each specific item of information; so when I say, for example, "my therapist told me ..." or "this is what I learned in therapy," it's possible that the advice quoted could actually have come from a self-help book or another expert source. When I do mention specific therapists' names, I have given fictitious ones.

  Introduction

  The stories I've read of bulimia recovery are of two types. My story is neither of the two.

  The first is what I call the "butterfly tale." It goes something like this: The bulimic—the caterpillar of the story—is not happy, her relationships are not fulfilling, she tends toward depression and negative thinking, she lacks true direction and purpose in her life, she holds on to hurt from her past, and she doesn't like herself. She binges and purges, supposedly to deal with her pain, but that only makes her more miserable.

  Then she enters the recovery process—the cocoon—and there, she works to resolve issues from her past, learns how to cope with everyday problems and major stressors, learns how to manage feelings and emotions, and finds peace within herself.

  The recovery process is not comfortable: it is hard work, and the transformation inside the cocoon can take an extremely long time. But when the bulimic is finally ready, she emerges as a fundamentally changed person—the butterfly of the story. She has become happy and fulfilled. She is in touch with her feelings and involved in satisfying relationships. She is at peace with her past and is able to live joyfully in the present; her ambitions for the future are quickly becoming reality. As a result of her transformation, she no longer needs to hold on to her eating disorder. She can fly away.

  The second type of recovery tale is what I'll call the "tamed house pet story," and it goes something like this: The bulimic—the untamed animal of the story—lives a destructive and dangerous life. She binges and purges, and in so doing, she finds herself isolated, struggling through every day, and never safe from her bulimia.

  Then she enters the recovery arena and begins the arduous process of taming her disordered eating behavior. After much training, practice, attention, and patience from therapists and support networks, she learns to reduce her binge eating and purging. She may even stop these behaviors—for the most part—after a long and difficult recovery process.

  This type of recovered bulimic is like a wild animal who is taken into a home, trained diligently and painstakingly, given much attention and care, and learns to live a new and better life. However, even though the house pet learns to behave correctly most of the time, it still retains its untamed instincts at some level, and the owners may never be fully confident with the house pet in all situations.

  In this type of recovery, an occasional binge is excused, just as occasional inappropriate behavior is expected from a tamed house pet. The bulimic falters every now and then, but she gets back on tr
ack afterward. Her relapses are welcomed as learning experiences or as signals that something else in her life needs attention. When they occur, the bulimic seeks support, tries to address what she believes to be the underlying emotional causes of the binge, and learns some new coping skills so as to avoid binges in the future.

  This type of recovery eventually becomes fairly secure; however, the recovered bulimic can never get too comfortable. She has to take it "one day at a time." Just as the owner of a tamed house pet has to keep it away from, or train it to deal with, anyone or anything that could trigger its past behaviors, the former bulimic has to either avoid, or ensure she copes well with, things that could send her back to binge eating and purging. She has to be on guard against feelings and life events that could allow her untamed ways—her binge eating and purging—to return. These events and feelings are termed "triggers" in the eating disorder community. The recovered bulimic has to continue to deal with issues from her past, ensure that her emotional needs are met, and make sure she eats the right type and quantity of foods to avoid triggering a relapse.

  The improved quality of life of the "tamed house pet" former bulimic is, undeniably, a vast improvement over the daily torment of bingeing and purging, just as the pet animal is unquestionably better off than when it was living on its own. But remaining free of bulimic behaviors is certainly not effortless—it takes constant maintenance.

  When I was in the depths of bulimia, none of these stories made sense to me. Butterfly tales of triumph are commendable and inspiring, and no doubt very real; but in six years of trying, I found I could not relate to the idea of a long journey into a rich and full life while struggling daily with my incessant urges to binge. My failure to transform myself into a butterfly wasn't for lack of effort. Sure, I wanted to become happy and fulfilled; but that was not happening for me, especially while I continued to eat thousands of calories at a time and while I was exercising to exhaustion to try to undo the damage to my body.