Authors: Kathryn Hansen
During the first several weeks of college, I broke vow after vow to stop binge eating. I also broke my promise to never return to therapy.
6
: Accepting Therapy
I
began therapy only four weeks after starting college, on the insistence of my new cross-country coach. During a practice in September 1999, as the team was about to begin running, my coach asked me to follow him. He led me to the office of a sports psychologist, telling me that I was too thin (at 94 pounds) and needed to get some help for my problem. I didn't feel I could argue with my new coach as I could with my parents.
My parents saw that I indeed ate—not enough to support my high activity level, but decent amounts of food nonetheless—and they knew that I was naturally very thin. It seemed I could convince them that being super skinny wasn't such a huge problem for me as it would be for someone else with a lower activity level, slower metabolism, or genetically larger body shape. I couldn't convince my coach of any of this. He probably thought that I rarely ate—a conclusion most people who saw me at the time would understandably draw. I felt like I had no choice but to follow him to the psychologist's office. But it wasn't only that—it occurred to me that maybe he was right, maybe I did need professional help. I certainly wasn't having any luck stopping binge eating on my own.
Maybe therapy is exactly what I need,
I thought as I walked behind my coach.
Maybe the therapist I saw when I was sixteen was right all along and I do have a disorder that I can't control. Maybe I am somehow defective, flawed, or diseased.
So, over a year after I'd walked out of my first therapist's office, I stepped into another one. This time, unlike the first time, I was willing to listen. I was willing to do what it took to stop my binge eating, because I felt out of control.
Over the course of a few meetings with the sports psychologist, he diagnosed my condition. Officially, I met the diagnostic criteria for
anorexia, binge eating-purging type,
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which is used when bulimic behavior (binge eating or purging) exists in an underweight person. As I put on more weight from binge eating in the next few months, my diagnosis shifted to
bulimia, nonpurging type.
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In the diagnostic criteria for bulimia,
nonpurging type
means that the bulimic uses diet, exercise, and/or other compensatory behaviors but does not regularly engage in self-induced vomiting, misuse of laxatives, diuretics, or enemas.
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Based on my symptoms, the psychologist recommended that I see the campus nutritionist and a campus therapist with experience treating eating disorders. I was hesitant, but I made the appointments, and by October 1999, my days of therapy and recovery had officially begun.
THE THEORY THAT EATING IS NOT THE PROBLEM
What I heard in my first appointment with my new therapist, Jim, was very similar to what my first therapist had told me: my eating disorder was not my fault, and it was not about food and weight. I was told that binge eating was only a symptom of deeper problems in my life that I needed to uncover—problems like low self-esteem, depression, anxiety, and family and social life issues. Jim said I was using food to cope with feelings. He said my eating disorder was an illness that had hidden benefits for me, which explained why I was unable to stop. He said my binge eating was fulfilling some of my emotional needs, and I needed to learn to meet those needs in other, noneating ways.
Although I do not believe this explanation today, at the time I felt slightly relieved to hear my eating explained in this manner. It felt good to learn that my binge eating wasn't my fault, but was instead a sign of illness. It felt better to think of myself as a victim of a psychological problem than as simply a gluttonous individual. It felt better to think that my binge eating was a complex disorder rather than a sign of my stupidity and lack of control.
Even though all this made me feel less culpable, it still didn't feel right to me. Intrinsically, I knew my eating problems
were
indeed about food and weight, as I always had. I thought back to how I'd first begun dieting after my tonsillectomy, merely to lose a few pounds. I thought about how this habit had gotten out of control, making me crave food more than anything. I thought about my first binge—eating eight bowls of cereal before school—which I knew was only a consequence of depriving myself for so long. I hadn't thought my eating problems were complicated then, so why did they seem so complicated now?
Despite my doubts, I decided to go forward with treatment. The first goal of my treatment, directed by my nutritionist, Debbie, was to get on a meal plan to regulate my eating. Even though I was already eating meals and snacks at regular intervals, they weren't substantial enough to sustain all of my exercise, so Debbie created a dietary plan with me to make sure I met my daily caloric needs. She said if I ate filling meals, it should take away some of my desire to binge.
I did my best to follow the meal plan, even though I felt the meals were too big; however, that didn't take away my desire to binge eat. Simply adding more calories to my diet and incorporating a variety of foods—including binge foods—didn't solve the problem. If anything, the plentiful meal plan made it worse because I had to keep more food in my dorm room. Now I allowed myself access to some of my binge foods on a daily basis, which only served as a temptation that I wasn't able to deal with.
Maybe eating more food would have helped me years before, by preventing me from ever binge eating in the first place; but now it seemed to be too late. I knew that simple hunger wasn't the problem anymore, because my urges to binge were just as likely to come when I was full. But if hunger no longer drove my binge eating, I didn't know what did.
Debbie wasn't at all surprised that the meal plan didn't put a stop to my bingeing. She told me I was doing this for psychological reasons, not purely physical ones. She said that wanting to eat after I was physically satisfied was a sign of emotional hunger and that I needed to work on those emotional issues with my therapist, Jim.
I saw Jim twice a week during my first semester of college. We talked about my past and what could have led to the development of my problem, but we also talked extensively about what could be driving my binge eating in the present. During this semester, I also began reading self-help books for binge eaters/bulimics and numerous materials pertaining to eating disorders.
THERAPY'S ANSWERS
One of the first techniques I learned in therapy was journaling for self-analysis. In my journal, I was supposed to self-monitor by exploring my thoughts, feelings, and moods to determine which ones led to binge eating. I looked for patterns in my bingeing: At what time of day did I binge the most? What thoughts preceded my binge eating episodes? What feelings did I have in the moments before binge eating? What situations and interactions preceded binges? My therapist explained that if I knew my triggers—the feelings, thoughts, or situations that led me to binge—I could learn other ways to deal with them.
Now each binge became an event to analyze and a problem to solve. After a binge, I tried to figure out the emotional reason why I had binged. I asked myself:
Did I binge today to soothe an emotional upset? To relieve stress? To avoid a problem? Did I binge to escape a feeling? Was I feeling particularly bad about myself in the moments before the first bite? What happened today that could have driven me to the refrigerator? What need was I trying to fulfill?
I often came up with compelling reasons for my binge eating, but I always thought of these reasons
after
a binge. Before a binge, all I knew was that I desperately wanted to eat. I learned this was normal. My therapist said it would take me a very long time to figure out, in the midst of an urge, why I wanted to binge, and even longer to learn to substitute positive behaviors. Furthermore, I learned it wasn't realistic to expect myself to resist urges to binge. Instead, my therapist said I should try to prevent those urges to binge from surfacing in the first place.
Now, that caught my attention, because all I really wanted was to be free of my nonsensical and intrusive urges. They seemed to come so automatically, and I couldn't reason with them. No matter how much I tried to fight my desire to binge or to distract myself from it, it wouldn't go away until I finally gave in. My abnormal need to eat massive amounts of food was ruining my life, so I wanted to believe that working on therapy goals could prevent those urges.
My therapist said that all of the information I was gathering through self-monitoring would eventually help me prevent the urges to binge. Even if I couldn't decipher why I had binged until afterward, there was a lesson to be learned from each binge. Once I figured out what thoughts, feelings, emotions, moods, stressors, and situations triggered my urges, I could address each of them, either with Jim or through journaling. I would then need to learn ways to cope with my triggers in my everyday life. The key to preventing urges to binge, as I understood it, was to deal with triggers before they led to the urge to binge, because once the urge arose, it was usually too late.
I began to think about and record very specific situations that seemed to occur before bingeing. For instance, I discovered that being stressed about an upcoming exam often preceded a binge; therefore, I labeled "academic stress" as a trigger. I learned ways to avoid academic stress by studying in advance and better organizing my notes; I also learned ways to cope with such stress by doing deep-breathing exercises and taking frequent breaks from studying. Feeling lonely, too, often preceded binge eating, so I labeled "loneliness" as a trigger. I developed a plan to deal with loneliness, which included calling friends, going for walks, going shopping, and writing letters or e-mails.
This effort turned into a monumental task for me. I discovered countless triggers. My urges to binge appeared in so many different situations and I found them to be associated with so many different feelings and thoughts and stressors that it was difficult to narrow down the true issues. My urges to binge surfaced when I was sad, but sometimes when I was otherwise happy. My urges arose when I was lonely, but often when I was with friends or family. My urges came up when I was angry, but also frequently when I was calm. My urges appeared when I was stressed, but sometimes when I didn't have much anxiety at all. My urges surfaced when I was hungry, full, or somewhere in between; and when I was feeling fat, thin, or just right. My urges came when I was feeling hopeless or hopeful; cynical or faithful; invisible or important. Even though there were some distinguishable patterns, there was also inconsistency and unpredictability.
It didn't really seem possible for me to tackle every potentially triggering thought or feeling, but I certainly tried. I wrote countless journal entries in which I recorded the trigger I was encountering, then detailed a plan of action to deal with that trigger. In theory, all this made some sense to me, but in the end, it wasn't practical, efficient, or effective in my recovery from bulimia. Although it was certainly worthwhile to deal with negative thoughts/feelings and problems, that usually didn't prevent my urges to binge. Further, it seemed that if I successfully dealt with one triggering thought or feeling, another would be sure to follow. As it turned out, dealing with all the triggers required more vigilance and time than I had while trying to maintain a good grade point average and compete on the cross-country team.
Again, my therapist was not overly concerned. I learned it would take patience, practice, and hard work to get in touch with my triggering feelings and cope with them. Moreover, coping with triggers wasn't the only plan of action; there was a bigger picture to consider, my therapist said: considering the deep-rooted causes of my eating disorder.
Jim told me that people who are generally fulfilled in their lives—emotionally, physically, mentally, and spiritually—don't seek fulfillment in eating disorders or other addictions. I learned that my eating disorder was symbolic of a lack of fulfillment or unhappiness in one or many aspects of my life. I also learned that my eating disorder signaled a lack of true identity, direction, and self-love; it symbolized hidden pain from the past that needed to be worked through and resolved. In addition, I learned my eating disorder was a symptom of long-standing problems with depression, anxiety, and perfectionism.
In sum, I learned that my eating disorder was an outward manifestation of complex and deep-rooted inner turmoil. That turmoil was the true cause, but the disorder was maintained on a day-to-day basis by triggers. So, in order to recover, I would need to address both.
I didn't learn all of this in one day, or even in my first year of therapy, but this is how I came to understand my eating disorder as the professionals explained it to me. I didn't take all of this as hard fact, and I internally questioned much of what I was told and what I read. In fact, during the first year of college, I held on to the idea that I could indeed "snap out of it" and start acting responsibly, which is why after each binge, I promised myself that it was the last time. I saved the wrappers of countless "last binge" foods, only to replace each one a few days later with another food wrapper. Sometime during the beginning of my sophomore year, I stopped saving the last wrappers and resigned myself to the fact that each binge probably wouldn't be my last; recovery would be a long process.