HOW BINGES END
After everyday overeating, most people either accept the episode as an indulgence (“naughty but nice”) or have some feelings of guilt (more accurately they feel regret). They may decide to compensate by eating less and perhaps by exercising, but their self-recrimination and compensatory behavior are likely to end there.
The aftermath of binge eating is quite different. Those who binge often report that they experience some immediate, though temporary, positive feelings. For example, they may experience a sense of relief from the psychological and physiological deprivation that preceded it. Feelings of depression or anxiety that triggered the binge may also have dissipated. But these positive effects are soon replaced by feelings of shame, disgust, and guilt.
The fear of weight gain may be so intense that it drives some people to take extreme compensatory measures which, ironically, may encourage yet further episodes of binge eating.
Psychological and Social Aspects
Many people who binge also diet to an extreme degree, or at least attempt to do so, the exception being people with binge eating disorder. Sustained dieting punctuated by episodes of binge eating is the eating pattern seen in bulimia nervosa and those cases of anorexia nervosa in which there are binges. In some cases little or nothing is eaten outside the binges. In binge eating disorder the eating pattern is different. There is a tendency to overeat in general on top of which is superimposed the binge eating. People with binge eating disorder do diet at times: indeed, it is common for them to alternate between periods of successful dieting, which may last for months at a time, and periods of overeating when they also binge. As a result, their body weight may change markedly from month to month and year to year.
is common for people with bulimia nervosa to make the mistake of thinking that their dieting is simply their response to binge eating. While dieting is undoubtedly encouraged by binge eating, especially among those who are highly concerned about their shape and weight, dieting plays an important role in causing binge eating. For example, binge eating is much more likely to occur on days in which the person is dieting.
When tackling a binge eating problem it is therefore crucial to address not only the binge eating but also any contributory dieting.
HOW TO CHANGE: THE VARIOUS OPTIONS
Assuming you have decided to tackle your binge eating problem, what should you do? We considered the main options
In principle, there are four.
Seek professional help. There are many professionals who help people who have binge eating problems. They include psychologists, psychiatrists, general physicians, dietitians, social workers, nurses, and others. Some specialize in the area.
Join a self-help group. Many such groups are excellent, but unfortunately some are not. Some have questionable views on binge eating problems and how they should be tackled. Also, some are focused more on helping people live with their problem than overcoming it. Before committing yourself to a self-help group, find out as much as you can about it. If you do decide to join one, see if it suits you. Remember, you can always leave if the group isn’t right for you.
Use this self-help program. Whether you are male or female, single or married, living alone or with others, you can use this self-help program. You should reject this program only if one of the exclusion criteria mentioned later applies.
Combine professional help and self-help. There are two ways to do this. You can use this program on your own while at the same time receiving therapy of some other sort—therapy directed at, for example, self-esteem or relationships. This is a good plan so long as you have discussed it with your therapist. He or she must be fully informed in case there is a clash between this program and the help being provided.
Your plan should be flexible rather than rigid. It is important that you adjust the times of your meals and snacks to suit your commitments, but do try to establish as regular a pattern as possible. Obviously, the precise times will vary from day to day; for instance, work days are likely to differ from nonwork ones.
When you eat should be dictated by your plan for the day and not by sensations of hunger or urges to eat. Popular articles in the media often tell us to listen to our body’s signals and eat in response to them. This apparently wholesome advice ignores the fact that these signals are often disturbed in those who binge. Erratic eating, especially when it consists of alternating binge eating and dieting, disrupts the normal mechanisms that control hunger and fullness with the result that they are no longer a reliable guide as to when to eat. Later, once you have been eating regularly for some time, normal sensations of hunger and fullness will return—although this may take many months. Once this happens, you can use these sensations to guide your eating, although maintaining a pattern of regular eating should remain a priority.
Try not to leave more than 4 hours between the meals and snacks. Long gaps between episodes of eating create a mounting psychological and physiological pressure to eat that can eventually result in a binge. It is therefore wise to eat at regular intervals, with a 4-hour gap being the maximum. A possible exception to this “4-hour rule” is the morning because this is the time when most people are least likely to binge. If this applies to you, it would be reasonable to omit the midmorning snack as there are unlikely to be any negative effects.
Resist the temptation to compensate for the planned meals and snacks. There is no need to compensate for the planned meals and snacks, even if they are a new addition to your usual way of eating, as their introduction will reduce your frequency of binge eating, and therefore your calorie intake. Remember, this is true even if you vomit or take laxatives or diuretics immediately afterwards because none of these methods gets rid of anything like all the calories from the food that you have eaten.
Some people are tempted to eat very little in their meals or snacks for fear of gaining weight. This is not wise since it will increase the risk of binge eating by creating physiological and psychological pressures to eat
Introducing a pattern of regular eating has little, if any, effect on body weight.
WHAT TO EAT
it does not matter exactly what you eat in your meals and snacks so long as you eat enough. If you would like guidance on what to eat, the best advice is to consume a broad range of foods and average-sized portions. The size of an average portion can be determined from the eating habits of friends and relatives, from recipes, and from the labels on packaged meals. If someone is helping you follow the program, you might want to ask his or her advice on what is a reasonable amount to eat. The critical point is that it does not matter what you eat so long as you do not vomit or take laxatives or diuretics afterwards to compensate and so long as you eat enough
Initially, this pattern of eating may create feelings of fullness. This is particularly likely if you are not used to eating without vomiting or taking laxatives or diuretics. The feelings of fullness almost invariably subside within an hour or so, and moreover, within a few weeks you will be less prone to have them. They are best dealt with by avoiding wearing tight clothes at mealtimes and by engaging in distracting activities for an hour or two afterwards
Your planned pattern of eating should take priority over other activities. Do your best not to let other commitments take priority over your planned meals and snacks. At times, of course, your plan will need to be adjusted to accommodate important engagements. For example, if you know that your evening meal will have to be late, say at 10:00 P.M., then a sensible plan would be to move the evening snack earlier to midway between the midafternoon snack and the 10:00 P.M. evening meal.
If things go wrong, try to get back on track immediately. It is especially important to avoid writing off the remainder of a day because there was a problem earlier on. This “all-or-nothing” way of responding just makes matters worse. Always try to get back on track as soon as you can.
If your eating is very chaotic, you may not be able to introduce this eating pattern in one go. If this description applies to you, introduce the pattern in steps, starting with the part of the day that is least chaotic, which is usually the morning. So, begin by introducing breakfast and lunch (and possibly a midmorning snack) according to the guidelines above. Then, over the next few weeks, progressively introduce the other meals and snacks until the full pattern is in place.
DEALING WITH SETBACKS
It is common for people who have stopped binge eating to hope that they will never binge again. While this hope is understandable, it is neither helpful nor realistic. You should regard your eating problem as your Achilles’ heel. You will still be prone to react this way at times of difficulty. Just as some people react to stress by becoming depressed or irritable, or by drinking too much, so people who have had an eating problem are liable to start eating differently.
To minimize the chances of relapsing, it is essential not to mislabel any lapse (or setback) as a relapse because doing so is likely to affect your behavior. If you think you are having a lapse, you are likely to take active steps to get back on track, whereas if you regard yourself as having relapsed, you may well give up and as a result matters will get worse.
There are three aspects to dealing with a lapse:
- Spot the problem early. This is important. The “head in the sand” approach only makes matters worse. If your binge eating has returned or become more frequent, you should act, and act as soon as you can. If you think there is a problem, it is best to assume that this is the case and take steps to do something about it. If you think you might be having a setback, almost certainly you are.
- Do the right thing. Reinstitute the program in this book. Restart monitoring and weekly weighing; force yourself to eat at regular intervals; and engage in whatever other elements of the program that seem relevant. Be your own therapist.
And do your utmost to resist the temptation to cut back on your eating as this will only make you more prone to binge. And remember to review your progress every few days.
- Identify and address the trigger of the setback. You need to think what has led to the setback. It may be obvious or it may not. Think long and hard about this. Once you have identified the likely trigger, address it.
With this three-pronged approach, you will find that you can nip most lapses in the bud, well before they get a hold. But if you are not succeeding, seriously consider seeking professional help.