Tuesday, October 30, 2012

Restricting causes bingeing

I'm really not sure how I made it this far in this blog without more directly addressing this topic. And, I know I have referred to it in a couple other posts, but this is such a key concept that so many people...patients, family, and providers alike....just don't understand. And, fortunately, it's a very simple concept also.

I recently had another provider give me the most brilliantly phrased psychological assessment of a patient. I was blown away by the providers ability to phrase a summary of the patient's treatment, and the psychological explanation for the patient's bingeing, which I will admit was likely right on. There was just one important variable missing for this provider, and in my experience, for many providers, when it comes to helping patient create behavior change around binge eating behaviors.

What this provider was missing was that the patient was restricting all day long, and bingeing at night. And, this is what most people do, in my experience. Dieters do it, and those with eating disorders do it. They tried to make it as long as possible during the day without eating, but then the physiology of all that catches up at night, and the person ends up overeating. And they think this means they have no control, no willpower, that they are weak; and their provider may think it is some emotional trigger that causes this behavior. But, as long as the person is restricting, that should be assumed to be the "cause" of bingeing or overeating. How we explain it to patients is that we must correct the physiology first, and then we'll have a better sense of what is psychological. So, in this case, we see that most bingeing behaviors are corrected by eating more throughout the day, but of course, there are then psychological factors such as stress or anxiety that result in ongoing overeating; that is when therapy really comes into to address those factors.

But if you miss the fact that someone who is binge eating is also restricting (and in our experience, the vast majority do), a provider, or the patient, can end up looking for psychological explanations, and pursuing those routes, only to result in greater frustration that the behavior continues.

Of course, as I have referenced before, the trick is that many who binge eat don't want to stop restricting. They are afraid of weight gain and don't want to take the risk of that happening by eating more during the day. But, in the end, the "math problem" tends to balance out; the amount of calories consumed by eating more during the day is about the same as, or even less then, the amount eaten as a result of restricting and then bingeing. Eating regularly during the day is also of significantly greater benefit to one's metabolism also, whereas restricting can really only result in decreased metabolism. Your body cannot burn what is not there to burn, so it's only option is to burn less.

So, the main thing I would want binge eaters to understand is that their behavior is NOT the result of low motivation, laziness, weakness, lack of willpower, etc. That is the "easy answer," but in my experience, never the right one. No matter how much our society might say it is true. And, to be clear, restricting is also not a sign of strength or willpower, even if it may feel like it for the moment. Treatment is the sign of strength and willpower. I do not work with a single weak person, that is for sure.

1 comment:

  1. Oh how I wish someone would have told me this 15 years ago. I used to get so extremely frustrated with therapists that would try over and over again to get me to tell them why I binged. They thought that if I was able to stop the binge that I wouldn't purge when in reality I needed to stop the restricting to prevent the binge and would then not have as strong of a need to purge. My therapists always wanted me to come up with some emotional reason for binging and it would make me so mad because the only reason I could come up with was because I was hungry. There was also so much shame surrounding the binge that it was embarrassing to even talk about. I strongly feel that if someone would have addressed my restricting issues earlier in my eating disorder I might not have struggled for so many years.