Authors: Kathryn Hansen
When I dieted, it was as though I was telling my brain that food was scarce. I created a situation of artificial scarcity, but my animal brain didn't know the difference, so it strongly compelled me to eat. Then, when I eventually followed my animal brain's powerful demands, I didn't have to work hard to get what I desired, as our ancestors did. I didn't have to hunt or capture food to satisfy my cravings, because whatever I wanted was easily available.
IT WASN'T JUST ME
For the average adult just trying to drop a few pounds, the survival instincts are merely an annoyance that makes dieting difficult. The casual, adult dieter usually just abandons the diet and starts eating normally again, regaining the weight. Other dieters end up overeating, but not binge eating. The vast majority of diets fail. In fact, 95 percent of all dieters gain their weight back within two years, and 98 percent gain it back within five years.
63
This does not mean that 95-98 percent of dieters lack willpower; it only means that the animal brain is very effective in making sure we don't threaten the body's food supply. Restrictive and fad diets often backfire, or simply don't work, in the majority of cases. I truly hope that this becomes common knowledge and that restrictive and fad diets fall out of favor in society.
The survival instincts are a much bigger problem in fervent dieters and anorexics. Depriving the body of sufficient food for a long time, or trying to maintain a weight that's too low for too long, causes those instincts to kick into high gear; and it's only a matter of time before the brain takes extreme measures. In fact, a full 50 percent of anorexics become binge eaters "when their bodies revolt against their rigid, restrictive diets."
64
Binge eating makes sense in a fervent dieter or anorexic. A binge is compensation for an extreme calorie deficit, and it gives the anorexic or extreme dieter stored nourishment in case she starves herself again.
THE ADOLESCENT BRAIN IS PRIMED FOR BINGE EATING
The problems caused by dieting are, I believe, compounded in young people. Pressure to fit a cultural standard of beauty is highest during the teen years, and it's also during those years that dieting is most likely to cause strong and hard-to-resist urges to binge. This is because, until early adulthood (around the age of 20), the brain is more survival-oriented. The primitive part of the brain that generates survival instincts—namely, the hypothalamus—is ready to function right from birth. "Biologically speaking, if this area was not given top priority, the animal may not survive for long."
65
On the other hand, the higher-functioning, rational human brain—the part that has the ability to override the animal brain—does not completely develop until early adulthood. Studies of the teen brain have found that the frontal lobe—which contains the prefrontal cortex (a vitally important part of the brain for the purposes of this book, discussed extensively in Chapter 23) and controls thought, planning, decision making, goal-directed behavior, and stifling inappropriate responses—is less active in teens than in adults.
Instead, the lower, primitive part of the brain that is responsible for emotional responses and automatic or "gut" reactions has priority in an adolescent. Because of this, the prefrontal cortex—where our civilized selves reside—is often "asleep at the wheel" in an adolescent, because it is one of the last brain structures to fully develop.
66
The prefrontal cortex is the agent of control within the brain and central nervous system,
67
but this agent of control is not yet fully functioning in the teen brain. Furthermore, the survival region of the brain is a "hot area" in adolescents, due to hormones, environment, and learning.
68
This means that adolescents have less perceived control, and perhaps less actual control, of their survival instincts. Biologically speaking, binge eating is a natural result of a young person dieting, which is why the initial development of bulimia is mostly age-specific; it most commonly begins in the teen years.
69
This is the unfortunate impact of society's pressure to be thin on the teenager's underdeveloped prefrontal cortex. Even though dieting is common in our society, it doesn't lead to full-scale binge eating as frequently in adults as it does in younger people—otherwise, we would see much higher rates of bulimia arising in people in their thirties, forties, fifties, and so on. Since adults have a fully developed prefrontal cortex, they can better temper their survival responses.
In other words, if adults have an urge to overeat or binge, they are better equipped to resist it. This does not mean that recovery is only possible after age 20, or that a young person possesses no control over his or her survival instincts. The prefrontal cortex is indeed capable of resisting urges from the animal brain even in young people, or else we couldn't expect appropriate behavior from them. But in a teen, resisting such urges takes much more effort, knowledge, and guidance. The "capacity for volitional control over one's actions is not innate."
70
Instead, it "emerges gradually through development."
71
In modern Western societies, around age 18 is when we are—by law—held responsible for our own actions as adults. This corresponds closely to when our brain development is nearly complete and to when the pathways that connect the frontal lobe to other brain structures become functional.
72
There was nothing wrong with me or my incompletely developed teen brain when I began binge eating, and I don't blame myself for commencing binge eating. After all, my brain anatomy and function didn't provide for much perceived control of my actions at the time of my first binge; however, this does not translate into an excuse for me or any other teens. I believe, with the right information, I could have overcome base drives, even with an underactive prefrontal cortex.
FEELINGS AND THE BRAIN
I certainly didn't know what was going on in my brain when my first urges to binge appeared; and without that information, I felt that I didn't have much power to resist them. As much as I tried to tame my appetite, it got stronger and stronger until I finally gave in to a powerful urge on that March morning of my senior year. Then, after I gave in, another group of feelings surfaced. My feelings surrounding my first binge (and all my other binges, for that matter)—like the sense of being out of control, excitement and pleasure, and guilty feelings afterward—are easily explainable in terms of the brain.
As I began pouring that first bowl of sweet cereal that would begin my first binge, I felt out of control. This was due to the fact that I let my animal brain take over immediately before and during the binge. Temporarily, my human brain, which was capable of free choice even then, was absent. I surrendered to a lesser, more primitive part of myself; and my true self temporarily felt powerless to stop the binge eating.
Even though I felt out of control as I ate bite after bite, it temporarily felt so right to binge. It was a great relief to finally give in to my desires for food, and even though I would have never admitted it at the time, I felt great excitement and pleasure. That was also easily explainable in terms of the animal brain, which not only generates survival drives, but intense feelings and emotions.
73
When I binged, I gave the animal brain what it wanted; and it rejoiced, leading to those pleasurable and exciting feelings. Eating, and especially eating highly palatable/sugary foods, releases "feelgood" chemicals in the brain.
One of these feel-good neurochemicals is the opioids, which have been shown to have a large role in mediating binge eating.
74
Eating causes opioids to be released in the hypothalamus,
75
which is highly rewarding. Regardless of the biochemical cause of those pleasurable feelings during my first binge, they were all too fleeting. When my true self, residing in my human brain, returned after the binge, I felt terrible and ashamed. The parts of my brain that had driven the binge settled down, and my true self began to feel the effects of what I'd done.
Had I known what was going in my brain then, I would have realized that I wasn't crazy, but a normal teenager who happened to be caught up in a divided-brain crisis. Instead, in therapy, years removed from my first binge, I struggled to come up with many theoretical causes of my first binge. I hypothesized many reasons for it: I was feeling pressure about going away to college, so I binged to comfort myself; I was seeking guilty pleasure in food because I denied myself many other pleasures in life; I was feeling inadequate in a relationship, so I binged to make myself fat and unattractive to avoid intimacy; I binged out of anger at my parents for always being on my case about eating.
The theories I came up with in therapy were endless, but none of them rang true to me. It seems to me now that, on some level, I always knew what my first binge was about—food and my body's lack of it. The experience of bingeing for the first time was certainly unsettling, but I felt it was not complicated. I knew I had binged because of strong cravings that I hadn't been capable of resisting. I was angry and ashamed at what I had done, but at that time, I believed there was nothing more to it.
After I recovered, I came full circle. Just as I did when I was a senior in high school, I realized my motives for my first binge weren't complex. My needs were physical. I simply needed food, and lots of it, to make up for my dieting; so my healthy and powerful animal brain drove me to overeat, in a world of food abundance—a world where my parents' pantry was stocked with boxes of sweet cereal. Nothing was wrong with me or my brain. This simple information finally gave me a true explanation for my first binge, one that made sense to me.
18
: Why Did I Diet and Why Was It Such a Problem for Me?
M
y first urges to binge were not a symptom of anything more than dieting, but was my dieting a symptom of something more? Was my dieting a signal of some sort of illness or emotional problem, as my therapists said? What caused me to diet in the first place? Then, what made me take my diet too far?
My therapists believed that my dieting
and
my binge eating were both part of a much bigger problem, that they were both symptoms of a disorder or illness, which I was somehow using to cope with my life. Although I initially resisted that idea, I came to believe that my dieting played not just a physical part in the commencement of my binge eating, but a symbolic part. In therapy, I learned that depriving myself of food for so long was symbolic of depriving myself of something emotional—like enjoyment, pleasure, love, or freedom. I also learned that dieting was a symbolic way I attempted to gain control of my life.
The idea that dieting was part of a bigger problem within me seemed to make sense because, after all, others I knew dieted without a problem or did not diet at all. I came to believe that my restrictive diet in high school was another sign that something was wrong. However, after my recovery, I saw clearly that this was simply not true. My diet was not a sign of disease or a result of emotional problems. It was a choice—a choice that brought serious consequences. There were certainly some factors that led me to that choice, and there were also factors that made the consequences more likely. I don't believe there is anyone or anything specific to blame, but here I will do my best to speculate on a combination of reasons why I dieted and why I took that diet too far.
THE TEMPTATION TO DIET IN ADOLESCENTS
The first reason I began dieting is the most clear-cut: my age simply put me at risk. I do not fault myself for choosing to diet as a teenager. In hindsight, I wish I had not made that choice, but given the fact that many of my peers were dieting, it wasn't surprising that I, too, began restricting my food intake.
Dieting is a cultural problem among young girls and women, and especially teenagers, because our society glamorizes thinness and praises those who lose weight. One study found that two out of three high-school-age females try to lose weight.
76
In fact, teenagers in all cultures attempt to meet their cultures' standards of beauty. This is not just a result of peer pressure; it is the result of a biological drive. Young women are biologically predisposed to want to do what it takes to be beautiful in their given culture.
Humans have an innate tendency to begin working on "mating display"
77
when hormonal changes occur during puberty, meaning humans begin to pay attention to their attractiveness to the opposite sex—whether they are aware of it or not. For young women, this involves paying more attention to their physical appearance; they have worked on improving their appearance throughout recorded history and across a variety of cultures.
78
This biological drive isn't dangerous; and it's advantageous for the survival of our species, except, I believe, in cultures where the standard of beauty is unrealistic, as in the United States, where the standard of beauty is a body that's too thin.
I wish I would have rejected our cultural standards and left my body alone, but I can't change that now. Dieting seemed like a good idea at the time, and I had no idea dieting was going to cause biological havoc in my body and brain. Furthermore, I didn't have much internal defense against the temptation to diet, because of some risk factors from my upbringing and some of my personality traits.
NURTURE AND NATURE
The other factors that swayed me to choose dieting and take that diet too far were rooted in nurture and nature. I know some life events led me to believe thin was preferable and weight loss was a worthy accomplishment; I know my family didn't always have healthy attitudes toward weight; and I know my background in athletics made me place a high value on extreme fitness. In addition, some aspects of my personality—especially perfectionism and low self-esteem—put me at risk for dissatisfaction with my body and thus the commencement of dieting.
Once I began dieting, my low self-esteem and perfectionism made things worse. I probably liked feeling successful at weight loss because my low self-esteem made me feel like a failure in other areas of my life; I probably continued dieting long past when others would have stopped—because my perfectionism drove me to do so. Also, there could have been some biological and genetic factors at play. Maybe weight loss simply came faster and easier to me because of my metabolism; or maybe I enjoyed weight loss more than others—possibly because of brain chemical differences.
My point in listing all of these hypothetical risk factors is to say that, of course, there was something different about me that made me choose to diet and made that diet problematic, just as there is something different about everyone who develops an eating disorder after a period of dieting. However, I cannot speculate too much because research has yet to fully explain the etiology of eating disorders. Today, we can't yet say definitively what developmental, social, and biological factors predispose someone to bulimia or anorexia, although the factors are presumed to be complex and interactive.
79
There is evidence that eating disorders are heritable
80
and that there are some genetically based temperament and personality traits that make one vulnerable to develop bulimia in adolescence,
81
but there is not yet a reliable way to predict who will develop an eating disorder and who will not. So yes, I was probably more susceptible for one reason or another to overly restrictive dieting—and thus to anorexia, binge eating, and bulimia—than my friends who dieted and didn't develop eating disorders; but stating exactly why I developed an eating disorder while someone else didn't would be impossible.
IRRELEVANCE TO RECOVERY
Whatever was "different" about me did not mean I was diseased, and whatever made me susceptible to an eating disorder didn't matter when it came to recovery. The risk factors from my upbringing and my inborn nature did
not
make my eating disorder inevitable. The factors I have mentioned, along with others, only made me more susceptible to choose to diet and choose to take that diet too far, which, in turn, triggered my survival instincts and led to my urges to binge and then to bulimia.
The simple fact is, if I never had dieted, I never would have developed strong cravings for food, I never would have binged, and I never would have developed bulimia. Whatever risk factors I may have had for developing an eating disorder meant nothing until I began to diet. Even with a perfectionist personality, low-self esteem, and all my other faults, I was OK before I began restricting my food intake.
It is possible that addressing low self-esteem, perfectionism, and other hypothetical risk factors a long time ago could have prevented me from ever dieting in the first place and, therefore, prevented my eating disorder. But whatever the causes of my problematic diet, those causes didn't matter once I got caught up in the cycle of bingeing and purging. It was too late to go back and try to fix whatever factors had caused my dieting, as I tried to do in therapy. Even if I could have somehow solved all of those factors, it wouldn't have turned off my urges to binge.