The past few days have been Disaster. For every step forward, it seems there are 12 steps back (not a sobriety reference). I know there are difference between slip-ups and relapses, but I fear this falls under the latter. I've binged-purged 5 of the last 7 days and purged on the other 2.
I had reduced the binge-purge cycle to 2-3 days max during the first weeks of treatment, but as I'm eating more and focusing on weight gain needed to return to outpatient, I'm overwhelmingly triggered. I'm also alone this weekend, which never helps. Excuses aside, I've decided to do some investigation into what exactly causes the descent into the binge-purge cycle. I strongly believe if you can understand the underlying cause, you can work towards preventing the outcome.
In treatment, and over my 9 long years of personal experience, I've nailed down the cause of the binge-purge to several possibilities. I am a firm believer it's a combination of factors that differ by individual and by circumstance. Here's what I've come up with, and an explanation of each.
1. Binge-purge as an addiction.
Addictions are physiological. In other words, once an addiction develops, it involves changes in brain neurotransmitters and chemicals, making it a hard-wired process and super difficult to overcome. In those with bulimia, catecholamine (particularly dopamine) and serotonin concentrations may be lower, predisposing them to compulsions and anxiety. Combined with poor appetite control, and you have a recipe for binge-purge.
I often feel my tie to bulimia is a simple addiction. I binge when I am not hungry. When I have nothing to do. When I feel so inclined to do so, I cannot resist. When I know it's harmful to myself and other, harmful to my treatment, harmful to others, but I cannot NOT binge or purge. They're a packaged deal for me. With binging comes purging. I have never binged and not purged. These days, I rarely eat and not purge.
2. Binge-purge as a physiological response to starvation.
When the body is starved of essential nutrients for a prolonged period of time, it compensates by craving food. Any food. All food. Binging of food. But only in bulimia is the binge phase followed by the inevitable purge. I have also experienced the strong physiological drive to binge. When my body is completely void of nutrients - after an overnight fast, no breakfast, and 12 miles of hard running, I have to eat. I have to. There are no other options. And more often than not, this I have to eat turns into an awful and ugly binge-purge cycle, keeping me alive, but avoiding living.
3. Binge-purge as a response to triggers (HALT and others).
Many therapists or treatment modalities attempt to identify triggers for individuals with anorexia, bulimia, or binge-eating disorder. HALT is an acronynm for the most common triggers identified, common to almost all addictions. Hungry, Angry, Lonely, Tired.
Once triggers are identified, emotional and behavioral responses to these triggers can be adapted to prevent the common response: starvation, binge, or binge-purge. This form of treatment provides the foundation for cognitive behavioral therapy (CBT), a widely used (and successful) treatment for bulimia. I'm not sure how much I buy into this theory. I do agree that triggers can set us off, but I also think the core of binge-purge is rooted much deeper than a simple.. I feel tired.
I believe the binge-purge cycle may be the most destructive, self-deprecating action that characterizes eating disorders. Few things are more demeaning, degrading, embarrassing, than spending a significant amount of time eating in secret and bent over a toilet. Destroyed knuckles, bad skin, red eyes, sore throat, broken stomach, broken soul. None of these come close to outweighing the one-pound weight gain of a binge. None of these come close to addressing underlying issues, fears, and emotions.
I hope I can break out of the current cycle and get on with treatment.
Addictions are physiological. In other words, once an addiction develops, it involves changes in brain neurotransmitters and chemicals, making it a hard-wired process and super difficult to overcome. In those with bulimia, catecholamine (particularly dopamine) and serotonin concentrations may be lower, predisposing them to compulsions and anxiety. Combined with poor appetite control, and you have a recipe for binge-purge.
I often feel my tie to bulimia is a simple addiction. I binge when I am not hungry. When I have nothing to do. When I feel so inclined to do so, I cannot resist. When I know it's harmful to myself and other, harmful to my treatment, harmful to others, but I cannot NOT binge or purge. They're a packaged deal for me. With binging comes purging. I have never binged and not purged. These days, I rarely eat and not purge.
2. Binge-purge as a physiological response to starvation.
When the body is starved of essential nutrients for a prolonged period of time, it compensates by craving food. Any food. All food. Binging of food. But only in bulimia is the binge phase followed by the inevitable purge. I have also experienced the strong physiological drive to binge. When my body is completely void of nutrients - after an overnight fast, no breakfast, and 12 miles of hard running, I have to eat. I have to. There are no other options. And more often than not, this I have to eat turns into an awful and ugly binge-purge cycle, keeping me alive, but avoiding living.
3. Binge-purge as a response to triggers (HALT and others).
Many therapists or treatment modalities attempt to identify triggers for individuals with anorexia, bulimia, or binge-eating disorder. HALT is an acronynm for the most common triggers identified, common to almost all addictions. Hungry, Angry, Lonely, Tired.
Once triggers are identified, emotional and behavioral responses to these triggers can be adapted to prevent the common response: starvation, binge, or binge-purge. This form of treatment provides the foundation for cognitive behavioral therapy (CBT), a widely used (and successful) treatment for bulimia. I'm not sure how much I buy into this theory. I do agree that triggers can set us off, but I also think the core of binge-purge is rooted much deeper than a simple.. I feel tired.
I believe the binge-purge cycle may be the most destructive, self-deprecating action that characterizes eating disorders. Few things are more demeaning, degrading, embarrassing, than spending a significant amount of time eating in secret and bent over a toilet. Destroyed knuckles, bad skin, red eyes, sore throat, broken stomach, broken soul. None of these come close to outweighing the one-pound weight gain of a binge. None of these come close to addressing underlying issues, fears, and emotions.
I hope I can break out of the current cycle and get on with treatment.
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