So..... what about anorexia then?

Updated March 31 2019

After reading and writing a lot about reward seeking behavior, I want to return to the topic of anorexia but want to review my experience as a starting point.

My experience with what I believe was anorexia but which was never formally diagnosed because I never sought treatment came along in the late 1950's long before much was known about it. I started with bulimia in ninth grade and then went through a phase (late high school/early college) where I became dreadfully thin.  I did not like how I looked in that phase.

By my senior year in college, I had regained enough weight through eating more than I was purging and I conscientiously would make a point of eating breakfast and lunch while resorting to binging in the evening or on weekends.  I remember trying very hard to quit in my freshman year and that lasted for about two weeks followed by infrequent episodes until the end of that first semester.  Then all hell broke loose in my life and bulimia became entrenched.  I've talked about this in another post. 

From that point on, I maintained a fairly steady weight although too low according to my PCP and went through periods of fluctuation -- heavier binging/purging followed by more controlled episodes, meaning less frequent episodes.   I shared this information with no one.  My BMI was constant until I began long distance running and volunteering and changed my life.  I slowly gained weight and held it for about twenty years and then gained more over the past fifteen years.  With the weight came stamina, fewer bouts with bronchitis until that totally disappeared, and a marvelously strong body.

So although I did lose a lot of weight, I cannot really identify with the concept of anorexia but I've watched my family member wrestle with it and bulimia since she, too, was fifteen. Only anorexia is much more of a factor for her.  In fact, I often wonder what might have happened to me had I not had the habit of bulimia first.  Would I have starved to death?  Was it inevitable?  Why was my path different from my daughter's?  Does it have something to do with the area of the brain involved in reward-seeking behaviors?  

Both of us have a very strong will and both of us have a strong will to live.  The will to live has brought my daughter back from the brink each time.  It has been her choice to get into treatment admittedly with thanks to the existence of Title 36 here and the creation of an incredible team that worked (and still works) on her behalf.  But lately she has given up.

I believe that the AN piece of her brain disorder is significant.  I know that she can make the choice to stop her bulimia and has several times.  But the AN is still there, no matter how well nourished she has become - twice about 10 pounds over a suggested set point.  I don't often write about her so directly but I do so now to illustrate the point that something else is involved in AN.  Going across the line, so to speak, into starvation is not, I believe, a choice.  As I said in an earlier post, something goes haywire.

Nutrition must come first to get the person back across that line and to help them hold that line until the brain rewires itself somewhat.  It is then that therapy has a real role in helping the person develop a solid sense of self as well as total awareness of this underlying syndrome and more importantly how to prevent its recurrence.  Whether or not that syndrome remains lurking there is yet to be determined. 

The answer is somewhere in the brain as well as, of course, in the individual's genome.  As I've said before, we're all like snowflakes.  Not one of us is totally alike.  But something is in there that those who develop anorexia have in common.  

I'm looking forward to further research in this area and hoping that Dr. Walter Kaye and his colleagues will obtain funding to further understanding of this dreadful disease.  Here's a link again to recently published research.

"Cells that Fire Together, Wire Together" - book review of Brain Over Binge

The title of this post, Cells that Fire Together, Wire Together, is the basis (to me) of a remarkable book titled Brain Over Binge: Why I was Bulimic, Why Conventional Therapy Didn't Work, and How I Recovered for Good by Kathryn Hansen.  This expression, found on page 140 of her book, and drawn from page 107 of The Mind and the Brain: Neuroplasticity and the Power of Mental Force by Jeffrey M. Schwartz, M.D. and Sharon Begley (New York: HarperCollins, 2002), sums up what happens when we humans carry out an action enough times that it becomes a habit.

I've attempted to write this review at least three times and because there's so much in her book, I found it difficult to summarize.   So here's my brief synopsis.  I strongly believe buying her book is a good step for those who haven't found an answer to their bulimia.   Her book contains material that I've studied as well as heard from researchers in the field of neuropsychology here at the University of Arizona.  The material dovetails so very well with my own experience, too.  

[update comment July 2, 2015 - I noticed that people are selecting this link.  I've placed a link to this post in my "Of Note" section.]

A good habit obviously is a good thing.  But those with the tendency towards (genetics?) strong reward-seeking behavior that is not tempered by the temporal lobes can run into trouble.  So, what is the solution?  And, can stopping binging and purging be a choice?  I happen to think so but I reached that conclusion long after (in terms of the length of time I battled bulimia) Kathryn did and I reached it because I was sick and tired of being sick and tired. 

Kathryn reached this decision because she encountered a program - Rational Recovery - that worked to steer her into a different perspective and she then spent a lot of time learning about her brain and how it's currently understood to work.  I also know people who've managed to use Alcoholics Anonymous with the same results.  I believe that there is an underlying biological reason for all of these disorders. 

Interestingly enough, I've also learned recently that people during the 1800's used sugar/sweets to get high.  Stop and think about that for a moment.  

The beauty of our brain, as Ms. Hansen eloquently and with considerable research puts it, is that the neurons and other material in our brains can continue to develop new pathways throughout our lives.  The neuroplasticity of the brain -- something I learned about in my class here at the University of Arizona last spring -- is our saving grace in so many ways.  We can learn new habits, we can learn to use a hand or walk  again after a stroke or injury, we can learn to speak new languages, soldiers returning from battle can overcome PTSD, and some can continue to function seemingly normally even with Alzheimer's Disease (as revealed by autopsy following death).  We can quit binging and purging.   Neuroplasticity is a remarkable thing.  Basically, to quote Ms. Hansen, "neuroplasticity refers to the brain's ability to rewire itself."

And she worked hard to rewire her brain.  She decided that she needed to do this.  I agree with her that others can, too.  She takes the reader through her disease and then recovery using knowledge of the workings of the brain as well as her discovery of what was driving her and why. 

She also thoroughly looked at herself through the lens of much of today's focus in eating disorders therapy and she concluded that the therapy doesn't really get at what started her disease in the first place.  She realized that getting to know herself and understanding her behaviors certainly helped in her development/her growing maturity but to her it was not a cure or a means of stopping the binge eating/bulimia.  I, too, turned to therapy after I quit binging and purging and found therapy to be instrumental in my personal development.  But, to repeat, by then I no longer binged and purged, either.  And she also believes, and so do I, that bulimia is triggered by something much deeper and at the same time simpler.

She has taken complicated information and presented it in a way that most should be able to understand.  The brain is complex.  Our anatomy is complex.  The media is also examining the workings of the brain thanks to the efforts I've outlined previously here on my blog in response to the needs of our returning military, of those who have suffered strokes, of those with brain disorders like schizophrenia, depression, and eating disorders, and more recently and quite tragically for us here in Arizona, of Representative Gabrielle Gifford's recovery from a point blank gunshot wound to her brain.

Ms.Hansen speaks an underlying truth that  her eating disorder was indeed about the food!  Or in her case, as with so many, with the results of the lack of it.

My own thinking has gradually come around to her thesis, too, which is that dieting in the sense of purposefully restricting one's caloric intake, sets off a chain of events in the brain that leads to the development of a potentially fatal disease:  an eating disorder.  She focuses on binge eating disorder (BED) and bulima.  

The word diet has been defined in our society not as what one eats daily  but rather the purposeful  change of eating patterns to lose or gain weight but that for some something goes haywire (interesting that the word "wire" is in this expression and the word haywire was used long before the workings of the brain became better understood) and leads to excessive restriction of food or to excessive eating and for some, death.  What is that something?  An imbalance?  An endocrine disorder?  An  immature portion of the brain?  Dr. Cynthia Bulik terms it a "negative energy balance."  Here is a link to Dr. Bulik's paper.

Once food is restricted, she proposes that the rudimentary part of our brain (she calls it the animal brain) recognizes that there is a threat to our organism's survival and the animal brain takes over.  One binges because one is starving.  One goes on to develop the habit of binging because it helps to feel better.  Sure it does!  You're no longer starving!  Remember, cells that fire together, wire together.

One purges because one who develops either BED or bulimia also either develops the habit to purge, in whatever way works, or continues to gain weight because they are caught in the habit of overeating.  The goal is to stop binging by eating rationally in response to the body's needs and therefore to stop purging (by vomiting, exercising, etc.) because one comes to understand -- to "get it" -- that they don't need to any longer.  Again, this can be hard work.  And, it can be done!

It would seem to me that for those who have the urge to binge eat without purging and who have developed the habit of binging, an underlying endocrine disorder in combination with, for some reason an uncontrollable urge to eat, must be addressed at multiple levels.

Some readers (and parents) will question how this process can work for a younger person.  I believe the parent needs to step in and learn about the brain, habits, and nutrition.  This book would be an excellent start.  The parent needs to serve their child as the light along the path and if the parent cannot or is not available, then the person with BED or bulimia needs to enter a residential program or live with a competent, knowledgeable and determined foster parent where s/he is monitored to eat well as well as not to purge until the new behavior becomes not only a habit but also believable.

This is not an overnight thing.  It's absolutely not easy.  But it sure does feel good to no longer be doing something that is so harmful and that interferes with a normal life.  I highly recommend this book as a valuable different perspective on overcoming bulimia and as a means of getting a handle on binge eating.

An important P.S. - this thesis does not address the difficulties encountered by those who are fighting other co-existing diagnoses such as Borderline Personality Disorder, Bipolar Disorder, Anxiety Disorder, or Obsessive-Compulsive Disorder.  I think this is where Dr. James Lock's recently published research will add much to the discussion.
P.P.S. - Kathryn has self-published this book.  It is available on Amazon.

 

Reward Seeking Behaviors: Part II

Shortly after I blogged about reward seeking behaviors, Dr. James Lock published a study linking bulimia to impulse control.  He also is beginning a study of bulimia in adolescents and is recruiting patients to participate:

I think this published study is hugely important because one of the symptoms of a person diagnosed with what's [incorrectly, in my opinion] called Borderline Personality Disorder is also faulty impulse control and emotional disregulation.  Twenty-five to 28 percent of those diagnosed with BPD are also battling eating disorders.  Faulty brain function appears to be involved.

So back to my earlier post re Ameliorating Reward Seeking Behavior.

Hopefully more research will uncover ways for a person to overcome this behavior that so undermines one's ability to live well.  

You Don't Know What You Don't Know

Let me repeat that:  You don't know what you don't know.

The first time I heard someone say this, I was attending a class offered by the National Alliance on Mental Illness, otherwise known as NAMI.  The local Tucson chapter is NAMISA.   The class, Family to Family, is still offered and I will be forever grateful to a friend of mine who not only told me about NAMI but also about this class.  I gained a tremendous amount of knowledge and also insight not only about the workings of the brain but also an inkling of what it must be like to have illnesses like OCD and Schizophrenia (through intensive class exercises) and more importantly resources in Tucson.

The point is, we aren't omniscient.  I know many of us whose children/loved ones are embroiled in an eating disorder or addiction or have been diagnosed with another brain disorder wish we had seen this coming, or understood what the early signs were, or somehow wish we could turn back the clock with the knowledge we have now.  But, we can't.

My goal and the goal I encourage others to have is to move forward from now, become the best advocate you can be for your loved one by learning as much as you can to change his/her ship's direction, and help your loved one get onto the path to recovery.  Spinning your wheels about could have's and should have's is a tremendous waste of energy.

You don't know what you don't know.