Authors: Kathryn Hansen
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: Triggers
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n traditional eating disorder therapy, a trigger is any event, action, feeling, thought, or situation that leads to a binge. It was a primary goal of my therapy to look for patterns in my binge eating to determine triggers, then find ways to cope with those triggers. In theory, if I could identify and eliminate or cope with triggers properly, my desire to binge would go away. Triggers were the stuff of life—common events like an argument with my parents or boyfriend, a night alone with no plans, a less-than-perfect grade on a test, eating dessert, drinking alcohol, missing a meal, having a hard day at work or school, or any of a multitude of feelings, like worthlessness, stress, sadness, or even happiness.
The problem with this approach was that the triggers weren't the problem. The equation of all my binges looked like this:
Trigger —> Urge —> Binge —> Purge
So if I was feeling lonely (trigger), I experienced a desire to binge (urge). Then I followed that urge (binge), and then my true self returned and I felt guilty and fat, so I compensated for the binge (purge). In this example, what caused my binge? Assuredly, it was not the trigger, because loneliness does not cause binge eating. I may have indeed been lonely, but I didn't want companionship—I wanted large amounts of food. Once the urge surfaced, it became the problem in and of itself.
Technically,
nothing can
trigger binge eating, because that completely eliminates free will. That's like saying someone's anger triggered the gun. That's simply not possible. Regardless of anger or any other feeling, someone's voluntary hand muscles have to fire a gun. Likewise, I had to use the voluntary muscles in my hands, mouth, face, and throat to put large amounts of food in my mouth; and nothing could trigger those muscles to work without my consent. So, in therapy, when I said that this or that "triggered my binge," I was squeezing out room for the conscious choice of my highest human brain. The only thing that any situation, feeling, or life event could trigger was an urge to binge. So when I refer to my "triggers" in this chapter (unless I am talking about therapy), I will be talking about what triggered my urges to binge.
There's no denying that the idea of triggers has some validity, because I did have urges to binge more often in some situations and in response to some thoughts, feelings, and events, and less often in others. But those triggers never were the cause of my binge eating, and I think I always sensed that at some level. Prior to my bulimia, those situations, thoughts, feelings, and events hadn't led to binge eating; and today, those same situations, thoughts, feelings, and events don't lead to binge eating. Those "triggers," as it turned out, had become only temporarily, indirectly linked to binge eating.
To explain this, let's take a look at how my triggers worked in my brain.
HOW TRIGGERS WORKED IN MY BRAIN
As my habit developed, I essentially created my own triggers by bingeing in certain situations over and over again. At the beginning of my binge eating, I didn't have any specific triggers except hunger and the presence of highly palatable foods. I had urges to binge when I was food-deprived and had access to large amounts of sugary and fattening foods. Those first binges were instinct-driven—opportunity presented itself, I couldn't resist my urges, and I gave in to my lower brain's demands. There was not much rhyme or reason to it; however, my first binges did not occur in a vacuum.
I was, of course, in the midst of life—with all its problems, stressors, relationships, emotions, joy, and pain. Every time I followed an urge to binge, my brain learned an association between the binge and whatever else was going on in my life. At first, triggers remained primarily about food—I had urges to binge when I hadn't eaten enough for lunch, after I left a party where I'd denied myself dessert, or when I slipped on my restrictive eating plan and ate something sugary or fattening. But eventually, my triggers expanded to include events, thoughts, situations, people, and feelings surrounding my binges that didn't have much to do with food.
This didn't mean I was ill-equipped to handle certain aspects of my life, it only meant I'd conditioned associations, or patterns, in my brain. For example, from the start of my bulimia, I binged alone because I saw binge eating as a shameful act. This taught my lower brain that being alone was associated with binge eating, and it began responding automatically with an urge whenever I had some time to myself.
The brain "craves" patterns and looks for them endlessly.
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The brain associates significant patterns with meaning, and attaches appropriate responses.
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I believe triggers are nothing more than "stimulus-response patterns" in the lower brain. A stimulus is any outside event or inner feeling that causes a response—an automatic reaction. All of us have many stimulus-response patterns, some instinctual and some learned. For instance, if a woman is walking alone at night down a dark alley (stimulus), she may automatically feel fear and become hyperalert (response). When a driver sees a red light (stimulus), his brain automatically prompts his foot to press the brake (response). When someone hears a loud noise across the room (stimulus), she will automatically flinch (response). When someone thinks about a happy memory from childhood (stimulus), he will automatically feel positive feelings (response). Everyone has stimulus-response patterns attached to many situations in their lives, whether they are aware of it or not.
Once a stimulus-response pattern is conditioned in the lower brain, the stimulus automatically triggers the response, beyond conscious control. When the stimulus is encountered, neurons fire automatically down familiar pathways, and the brain generates the response. Much of the time, such responses are sensible and sometimes even vital to one's existence—like pressing the brake or becoming hyperalert in a dark alley. Other times, the responses aren't vital, but they cause no harm—like flinching at the sound of a loud noise or feeling nostalgic when recalling memories. However, sometimes the lower brain attaches inappropriate and even dangerous responses to stimuli. This was the case with my binge eating.
By repeatedly binge eating in certain situations, I created stimulus-response patterns that were not healthy—in which a normal daily event or stressor caused an inappropriate response: an urge to binge. I followed urges to binge when I was alone in my house at night, when I was in my car driving home from a party, after a stressful day at school or work, when I was bored, when I had eaten a little too much at a meal, when I didn't have enough at a meal, when I was feeling sad, lonely, rejected, or anxious ... the list could go on and on. As my lower brain remembered where, when, and how I had binged, it easily became conditioned to maintain the patterns.
Let's take a look at how this played out in real life.
In the first month of my freshman year of college, about six months after I began binge eating, my parents came to visit my sister and me, and we all met at a restaurant for dinner. I was still trying to restrict my food intake between binges and still trying (in vain) to maintain my low weight. I had binged the day before, but I hadn't been able to exercise too much that day because of their visit. So I felt I shouldn't eat very much for dinner. I ordered a low-calorie sandwich and ate only half of it.
When I stopped eating, I couldn't help but see disapproving looks on my parents' faces—whether they were real or imagined. Corey ate only a meager portion of her own dinner, yet my parents didn't seem to notice that. At the time, my sister was cutting calories, increasing her exercise, and losing some weight—as the majority of young women attempt to do at one time or another (see Chapter 18). Given that Corey and I had a similar upbringing, this wasn't surprising; and luckily, her very different personality traits spared her from serious consequences. Nevertheless, at the time, seeing her limit her food intake only served to remind me of my lack of willpower. That meal, like most family meals while I had an eating disorder, had an underlying tension about the food. I didn't feel full after I'd finished half of my sandwich, and I struggled internally to keep myself from eating more of it, while my sister's scanty eating seemed, to me, to take no effort at all.
As I sat there staring at the other half of my sandwich, a familiar urge to binge arose. I stopped paying much attention to the conversation and began wishing I could leave the restaurant to get more food. I tried to talk myself out of it and fight off my cravings, but when I finally was alone again, I gave in and binged.
My urge to binge was a response to my undereating, but this experience taught my brain several stimulus-response patterns. My lower brain learned an association between binge eating and going to dinner with my parents, watching my sister eat small portions, feeling uneasy in conversation with my family, feeling resentful of others' eating habits, and, of course, not eating enough at a meal. The next time I encountered any of these situations or feelings, my brain was more likely to send out urges to binge.
THE LOWER BRAIN REMEMBERS WHAT GETS RESULTS
The lower brain remembers stimulus-response patterns because the brain is opportunistic; it quickly seizes on whatever gets it the desired results. In behavioral psychology, it's called the "law of effect": behavior followed by consequences that are satisfying to the organism will be repeated, and behavior followed by unpleasant consequences will be discouraged.
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The binge eater's lower brain is like a little boy who throws a tantrum in a toy store because he wants a toy. If his mother gives in and buys him the toy, this only ensures that the next time the boy and his mother are in a toy store, he will be more likely to repeat the tantrum. Why? Because the tantrum was effective—it got him exactly what he wanted. Or, put another way, the behavior was positively reinforced. The little boy's brain will now remember that whenever he enters a toy store (stimulus), he should throw a tantrum (response), and he will get the desired result. When the response gets the desired result, the brain is more likely to repeat the response when the stimulus is encountered again.
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It was the same with my lower brain. When it got what it wanted—a binge, and all the rewarding biochemical changes that came along with it—it remembered the events leading up to the binge and it learned to repeat the same tactics. It remembered what urges were successful and what urges weren't; and since an urge was successful after dinner with my parents, then dinner with my parents became a powerful stimulus that—more often than not—produced an urge to binge. The more times I followed that urge and repeated this pattern, the more cemented in my brain that association became.
Anyone with an addiction has to deal with stimulus-response patterns. For example, it's common to hear smokers say they can't have a beer without having a cigarette; and while there is nothing about a beer that physically requires a cigarette, there is a often a strong pattern of association in the smoker's brain between the two, because he has repeatedly smoked and drank simultaneously. Because the stimulus-response pattern is so strong, his brain will automatically send strong urges to smoke whenever he is drinking. If he even dares to try to drink without having a cigarette, his lower brain will throw a tantrum. It will kick and scream until it gets what it wants; and if the smoker keeps giving in, the tantrum will repeat indefinitely.
Trigger situations for my binge eating grew more numerous over time, which only makes sense in light of the brain. As I binged more and more in many different situations, I created more and more stimulus-response patterns. In addition to growing more numerous over time, my triggers also grew more generalized over time, so that the stimulus didn't have to be specific to produce an urge to binge. When the habit was firmly entrenched in my brain, anything that even resembled the stimulus produced a response—again, this was my lower brain being opportunistic. To illustrate this, I'll return to the example of eating in a restaurant with my parents. Once this was established as a stimulus-response pattern, I found that similar situations generated the same response. Soon, I had urges to binge not only after going to a restaurant with my parents, but after eating at home with my parents, after eating at a restaurant with friends, and after eating in any type of social situation.
Again, my lower brain was like the tantrum-throwing little boy. When the boy realizes the tantrum works in a toy store, he may try it in a grocery store, a fast-food restaurant, at home. If the tantrum works in any of these similar places, those places will become additional stimuli that automatically produce the response: a tantrum. Likewise, when my brain effectively got me to binge in a situation similar to the original stimulus, that similar situation also produced an urge to binge.
WHY BINGES ARE OFTEN LINKED TO STRESSORS
Most bulimics report that their triggers are primarily negative events, thoughts, and feelings. In other words, bulimics often say that their binge eating "is preceded by situations they perceive as stressful,"
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and that's certainly what I reported to my therapists. Although this has some validity (which I will discuss soon), I believe reporting bias is a factor as well. When I was in therapy and searching for my triggers, I was seeking out only negative triggers, because that's what I thought I was supposed to do. Traditional therapy teaches that negative thoughts, feelings, and events cause binge eating, so that's what I focused on. If I had analyzed the binge after eating at a restaurant with my family, I would have blamed the binge on the tension of the meal, on watching my sister eat, on my parents' disapproval of my eating habits, or on another negative feeling.