Psych Doc: Could my behavior signify an eating disorder?

I believe that I have an eating disorder, but I don’t really fit into any of the categories I read about. I binge eat (two pints of ice cream, pizza, chocolate — all in one sitting), but instead of making myself vomit (although if I could, I would), I exercise obsessively to burn the calories. I know this is destructive to my body, but I cannot stop. Some days, I eat like a perfectly normal person and other days my self-restraint is nowhere to be found. I am not overweight per se and never binge in front of people, so everyone thinks I am the most fit person they know. What they don’t know is the daily struggle I go through. It is very depressing and I feel helpless. What can I do?

You describe binge-eating episodes where you consume a large amount of high-calorie food and then follow this with “obsessive” exercising to burn off the calories. You don’t say how often these episodes occur, but if they happen at least twice a week for three months, then yes, indeed, this is a true eating disorder. Actually, this is a classic form of bulimia nervosa.

Psych Doc: Could my behavior signify an eating disorder?

The definition of bulimia nervosa is: Recurrent episodes of binge eating followed by recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting, misuse of laxatives, diuretics, enemas, or other medications, fasting, or excessive exercise. The binge eating and inappropriate compensatory behaviors have to both occur, on average, at least twice a week for three months in order for the full diagnosis to be made. However, milder forms of the disorder, where the binges happen less frequently than twice a week, are very common and also cause a lot of problems.

People with bulimia always binge in secret and can be of normal weight or even slightly underweight. The behavior is associated with a great deal of secrecy, shame, and self-loathing. Although it is more common in females, men can exhibit bulimia nervosa also, and in fact, they appear to be more prone to the “obsessive exercising” forms of the disorder. I once worked with a graduate student whose husband, a young scientist, would have binge eating episodes and then follow the bingeing with self-punitive and grueling 10-mile runs. Later, he began to develop vomiting behavior.

For some people, bulimic behavior is associated with a general tendency towards impulsiveness, and these people may drink or use drugs excessively. For others, especially those who do the self-punitive exercising, there is more of an obsessive, “need-to-be-in-control” attitude. Poor self-esteem and depression are common in people with bulimia nervosa.

You might be wondering about a couple of other things. First, what is the difference between some occasional overeating, and true bingeing episodes? Everyone overindulges from time to time (think Thanksgiving dinner), which means eating too much of the various parts of your meal because it tastes so good and you are enjoying it so much. Often, this happens with an especially tasty or festive meal, when you are in good company, having a good time. You are enjoying what you are eating, even if you know your stomach is getting too full. In contrast, when you are having a binge episode, you are frantic and driven; you are consuming huge quantities of exclusively high-calorie foods, but not from a sense of enjoyment. You are doing this alone, in secret, and you are consumed with self-loathing, as well as a sense of not being able to stop. Typically, people stop the binge episode only when they are in too much physical pain (from stomach distension) to continue eating.

Another thing you might wonder about is: How do you know the difference between a good, healthy, feel-the-burn workout, and some compulsive self-destructive exercising which is being done to an excessive degree? Again, I think it is analogous to what I’ve described with food. Exercise is for health and pleasure, for a feeling of exhilaration and pride in one’s physical self, and a sense of challenge, growth, and fulfillment. In a particularly good, strenuous, push-yourself-to-the-limit workout, you feel strong, proud, and capable. You have discovered wonderful new capacities in yourself and you are on top of the world. In an episode of driven exercising that you are doing after a binge, these feelings are not present. Instead, you feel wretched, guilty, self-punitive, full of a sense of helplessness and self-loathing — determined only to burn off those calories at any cost.

What can you do if you find yourself in this bulimic pattern of behavior? First of all, get help immediately. No one should carry the burden of an eating disorder alone. It continues to amaze and sadden me when I see how much of women’s creativity, autonomy, energy, and self-worth gets drained away by anxiety and preoccupation over food and eating. You can get help from your family physician, mental health professional, and/or a self-help group. The first step is to break the cycle of secrecy, shame and self-loathing about your eating behavior. The second step is to understand your binge episodes and discover a healthier relationship with yourself and food. Some people benefit from learning more about nutrition and how to eat healthy, tasty, nourishing foods in sufficient quantities and frequency. Antidepressants that work on serotonin systems in the brain are also extremely helpful for many people with bulimia, since serotonin is linked to eating behavior.

Finally, I believe that exploring kinder, alternative ways of being with and appreciating your body — through activities like hiking, dance class, yoga or Pilates-based exercises — can also be immensely helpful. This is especially true for women, who are given so many unhealthy messages about their bodies through the media, and through social and cultural pressures.

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