Real Recovery from Bulimia & Binge Eating

Triggers are the consequence not the cause

Dr. Stacey began an interesting discussion regarding triggers and consequences for us ED folks. It struck me as wrong somehow, so I thought a bit about it, and I’m happy with my response in the comments section. I want to repeat it here.

She described a simple functional analysis of our ED behavior as this:

TriggersàBehaviorsàConsequences

Where the Trigger is the people, places, things, emotions, stimuli, physical symptoms, etc. that lead us to turn to food or not. The Behavior is our particular preference of coping mechanism. And, the Consequences are the positive or negative results of our selected Behavior.

You can read her full post plus several others’ comments here. The below is my response:

I argue that the "triggers" you talk about and that we ED folks fear so much are actually the CONSEQUENCES of our irrational beliefs and interpretations of ourselves and our place in the world. They alone do not cause us to turn to food. At the time we feel triggered, we have already made a big mistake somewhere along the way. The feelings of anxiety, guilt, stress, boredom, fear, regret, resentment, etc. are consequences of our bad beliefs. We turn to food as a last resort to make ourselves feel better. But, if we fix our crap beliefs and learn to make decisions based on rational, reasonable beliefs, we stop feeling those bad feelings. And, subsequently, no urge to turn to food.

I have proven this to myself over and over in the last couple of years since I began working on my crap beliefs. This is the sequence of events:

1)       an irrational, old, subconscious belief leads me to dishonor myself in some way (deny or criticize my own needs or wants, put others’ needs before my own, drive myself to exhaustion, insist on my own perfection, harbor resentment against others, obsessing over my body rather than address something frightening that needs my attention, etc.),

2)       I subsequently feel awful (anxious, guilty, resentful, etc.),

3)       I become paralyzed with my self-defeating feelings and thoughts (as evidenced by my procrastination, lack of energy, depression),

4)       I turn to food for comfort and to quiet the chaos in my head so I can simply function.

5)       Begin at 1) again.

By the time I feel overly anxious or angry or whatever, the damage has already been done. Fighting off the subsequent urge is only temporary. It’s guaranteed that I will get another urge and another until I stop making the self-defeating choice that originally lead me to feel awful and made binging seem like the solution.

When we focus on stopping the coping mechanism, we are failing to deal with the underlying crap that make us feel so bad in the first place that we NEED something to help us cope. We will continue to NEED a coping mechanism until we fight our irrational beliefs that cause us to feel bad.

I’ve found a great book that explains this all very clearly and simply - Self-Defeating Behaviors: Free Yourself from the Habits, Compulsions, Feelings, and Attitudes That Hold You Back.

I believe the functional analysis really should look like this:

Irrational beliefàSelf-defeating decisionàBad consequences (triggers, bad thoughts and feelings)àAddictive behavior

We all know our addictive behavior has horrible consequences (loneliness, rotten teeth, death) but knowing this does nothing to stop us from turning to our coping mechanism. Nothing - except to make us feel worse.

Like I said, by the time we get to the addictive behavior stage, it's way too late. Not many people have the will-power to white-knuckle it through the subsequent urges. I never did. Good thing my recovery was based on fighting my irrational beliefs in stage #1 of the process.

In addition, I think the placement of triggers at the beginning of the process is actually dangerous cuz it leads us to believe that we must avoid anything that might be triggering – stressful situations, a bad day, difficult people, loss, change or uncertainty, new experiences that could be frightening or (God-forbid) overwhelming, or whatever.

But, that’s not realistic or even reasonable at all. To try to avoid these things is to live in a bubble. Is it really living at all?

But, instead, if we fight the irrational beliefs such as the ones we’ve discussed so much in the last few weeks, we’ll find within us just enough courage and self-trust to push through the fear and accomplish what we want and need to. With every tiny little success, we gain courage and self-confidence and fear loses its death-grip of control over us. We soon realize that we can face stress, difficult people, new experiences, hardships, etc. knowing that we’re strong enough and creative enough to get through it just fine.

We make fewer and fewer self-defeating decisions, and so we never have to experience the triggers or addictive coping behavior again. The urges just fade away.

Self-injury at schools increasing

A typical symptom of Borderline Personality Disorder (BPD) and other disorders, self-injury (SI) is becoming increasingly common and/or increasingly visible.

17 pct. at 2 schools practice self-abuse

Just like eating disorders, it becomes addictive. I have never cut myself (I'm already covered in scars just from accidents), but I can see how it would have the same calming effect as bulimia that can become a crutch to help deal with life.

I had other self-calming behaviors besides my bulimia - I also drank like a fish. I might even have met the clinical definition of an alcoholic. Once I began drinking, I seldom stopped until I was drunk. Much of my college years are a haze because I was blacked out through so much of them! The same can be said for any adult party or social gathering I’ve been to where alcohol was available.

But, the beauty of recovery using my coach's approach is that the "need" and even the appeal of drinking like that just fades away. I can now easily have just a couple drinks at a party or a BBQ and not even consider having another. I don't have to "watch" myself or be careful to not drink too much; it doesn't even cross my mind. I enjoy what tastes good (usually 2 or 3) throughout the evening, and then drinking more just loses its appeal.

Like my urge to binge, my urge to keep drinking and drinking faded away. I won't get started right now about how I believe alcoholism can be "cured" using my coach's approach that I share with you. Bulimics are proof that people can get over some addictions (I'm NOT talking about cocaine or heroine, other hard core drugs, or even cigarettes) without having to be abstinent. I’ve already ranted about that.

BPD and me, now

I see in my stats that readers often find this blog as they’re looking for information on Borderline Personality Disorder (BPD). I haven’t talked about this in awhile, so I figured I’d write about how things are going for me now.

A year ago, I was convinced I had full-blown BPD. I had never been diagnosed with it, but at the time I fit all the criteria. On top of that, my mom fit the criteria, and I was pretty sure my sister fit the criteria before they both died. BPD is a relatively new diagnosis as compared with bi-polarity (mom’s official diagnosis) and the standard depression, anxiety, bulimia, and anger issues (my diagnoses).

Below are the official diagnostic criteria. Keep in mind that you only have to meet 5 of the 9 criteria to be diagnosed with BPD. 

1.          Frantic efforts to avoid real or imagined abandonment

2.          A pattern of unstable and intense interpersonal relationships

3.          Unstable sense of self and identity

4.          Impulsive actions that are ultimately self-damaging such as drug abuse, excessive spending, reckless driving, or unsafe sex

5.          Recurrent suicidal actions, threats, thoughts, or self-injury behaviors (or, eating disorders)

6.          Unstable, intense moods or emotions that can be triggered by events and may last hours or days

7.          Chronic feelings of emptiness, boredom, or loneliness

8.          Inappropriate or intense anger that is difficult to control

9.          Temporary, stress-triggered paranoid ideas (“I feel threatened by others”) or severe dissociative symptoms (“I don’t feel real”)

At the time, I believed my symptoms included numbers 1, 3, 4, 5, 6, 7, 8. Of course, as I look back, I can see periods in my life when numbers 2 and 9 also applied.

Since going through coaching and recovery, I no longer have any of these symptoms. Occasionally, I still have to talk myself through an episode when I’m driving, and I get upset with another driver. But, those are decreasing all the time. And, I excuse myself the occasional shout of “what the %#@&* are you doing?!” as just a hazard of living and commuting in LA. And, I can calm myself down immediately and completely after the incident is over.

Not too bad for nine months since my first meeting with my coach, huh? To have conquered all of the symptoms of BPD is really quite a miracle for me. You probably know by now that my rage and panic were much more disturbing to me than my bulimia. Bulimia is predictable and contained, while rage and panic could flare without warning, without reason, and I had no way of calming myself once caught in the midst. Not even purging could calm me down. And, anyone could end up a target.

My coach’s approach to recovery teaches growth from the inside out. It directly deals with all these BPD symptoms. Everything in that list can be conquered by studying and practicing his lessons. No drugs are needed. No therapy is needed. You just study and practice, and the symptoms fade away. Don’t let a doctor tell you differently. Go to the library or book store and get the books I list here on the blog. Start with Wayne W. Dyer: 10 Secrets for Success and Inner Peace. It's short and to the point but packed with great stuff to get you started. I also highly recommend Self esteem tools for recovery. Lindsey Hall, Gürze Books. Lindsey's approach is very similar to mine. This one is also short and packed with good stuff.

Just try it.

BPD and Rage

People with Borderline Personality Disorder (and many bulimics) often have issues with sudden, uncontrollable anger or rage. This is actually what I consider my number one problem because I turn anger into self-destructive thoughts and behaviors. My second biggest worry is my panic attacks, while bulimia is only my third. I have put myself in very dangerous positions (usually involving my car) when I wind myself up into a rage from what I perceive to be a personal attack on me.

What I do, and I bet some of you do the same to some extent, is imagine getting into all kinds of heated arguments and fights with other people, even long after they’ve driven or walked away. When I do this, I say that I’m telling myself bad stories. I have a vivid and wild imagination when it comes to making up arguments in my head, and I can get myself unbelievably angry and upset. And, then I have a really hard time calming down again.

For example, every time someone cuts me off while I’m driving or doesn’t use a turning signal or something, I envision getting into an accident as a consequence of their actions. Next, I vividly envision the argument that ensues when the cops arrive. I then usually make it much worse, envisioning my adversary being the better arguer and making the accident sound like it was my fault. I try arguing back, but I’m so angry, I become irrational, and eventually the cop has no choice but to put all the blame squarely on my shoulders, even though it wasn’t my fault at all. By this point in my ‘day-dream,’ my heart is beating wildly, my breathing is fast and shallow, and I’m completely upset and in a full blown rage. At times, I can carry this anger and victim mentality with me throughout the rest of the day. And, you know what, it was created completely in my own mind! Isn’t this unbelievable??

I find that I do this with my friends and boyfriends as well if I perceive them to be doing something that will hurt me, directly or indirectly. I always really regret this later when I calm down and realize I was responding irrationally – because I interpreted their actions incorrectly or I was feeling particularly vulnerable at the time.

Since my mind is the source of almost all of my upset and anger, I’ve been working REALLY hard at stopping the bad stories as soon as I feel them starting. Last week I felt like I was making real progress at this. Of course, this morning’s commute was a disaster, and as soon as I had let go of the anger from one incident, another idiot driver would piss me off! It was the toughest commute I’ve had in a long time. I clearly have much more work to do in this area! At least I’m almost all calm now, only one hour later. I consider that a success since, in my past, I could stay angry for hours or all day.

I actually think that putting our efforts to stopping the bad thoughts as soon as they begin is slightly more important than putting our efforts to maintaining positive, good thoughts at all times. In reality, stuff happens to us that makes us angry and upset. Completely denying that anger and upset is best left to the really enlightened people like Gandhi or Mother Theresa or people like that. It’s how we, as normal human beings, recover from our anger that determines how we feel about ourselves.

I am really good at making myself feel bad. But, I am working really hard to stop doing that. I will allow myself to feel angry at the other driver’s stupidity, but only for an instant. I will not allow myself to blow it out of proportion or carry it around with me anymore. I turn on a calming song to focus on; I pet my dog if she’s in the car; I focus on a happy memory (you should have one always at the ready, even if you use the same one over and over again); I focus on deep breathing techniques; I repeat my affirmations over and over. Using these healthy responses, I am learning to release my anger quickly and easily.

Taken from Sometimes I Act Crazy, Living with Borderline Personality Disorder:

“As opposed to other expressions of anger, Borderline rage is marked by a suddenness and unpredictability that could be described as emotional spontaneous combustion. Even though Borderlines may seem to explode for no ostensible reason, the anger is always present, lying hidden under the surface, suppressed by the fear of abandonment, or turned inward and transformed into self-destructive behavior.”

“Often there is no buildup or observable progression. Calm may be shattered by a violent eruption spurred on by a minor incident.” “Fury can be so overpowering that it might distort reality.”

“For many Borderlines, anger derives from frustration. Continuous disappointment simmers undetected and eventually boils into a fury directed blindly at a hostile world. In other cases, the anger may be camouflaged by ostensibly opposite behavior, such as trying to please everyone, regardless of the price. In these situations the borderline tries to avoid his anger by covering it over; yet, ironically, his fruitless quest for reciprocal nurturing only increases the frustration.

Once again, we must work to identify when we are allowing our anger to become irrational, and we must interrupt those bad thoughts immediately. We are re-training our minds to react in a healthier way. We will get better and faster at this with consistent practice and effort.

And, so we begin our work toward Recovery

In my essay “On Therapy and Prozac,” I introduced a disorder that encompasses my many different, separate issues. I need to tell you about it, because strangely enough it was like a miracle to me when I first realized that I had it. And, it’s very possible that you have it, too. It meant that I only had one big issue, rather than many distinct issues, and if I understood and attacked the core, the other issues would resolve themselves altogether. What’s more, the statistics show a much greater likelihood of recovering completely from this big disorder when treated, than of recovering from bulimia when treated alone. That gave me a great deal of hope.

The disorder is Borderline Personality Disorder, or BPD. It generally occurs to people who suffered prolonged stress or trauma as a child or young adult. That trauma could be a result of a severe trauma like losing a parent or sibling or being abused, or simply (as is my case) family chaos and instability.  I’m copying the official diagnostic criteria below for you to consider.  Keep in mind that you only have to meet 5 of the 9 criteria to be diagnosed with BPD. 

1.       Frantic efforts to avoid real or imagined abandonment

2.       A pattern of unstable and intense interpersonal relationships

3.       Unstable sense of self and identity

4.       Impulsive actions that are ultimately self-damaging such as drug abuse, excessive spending, reckless driving, or unsafe sex

5.       Recurrent suicidal actions, threats, thoughts, or self-injury behaviors (or, eating disorders)

6.       Unstable, intense moods or emotions that can be triggered by events and may last hours or days

7.       Chronic feelings of emptiness, boredom, or loneliness

8.       Inappropriate or intense anger that is difficult to control

9.       Temporary, stress-triggered paranoid ideas (“I feel threatened by others”) or severe dissociative symptoms (“I don’t feel real”)

10.   

“As stress level increases, they often find that the intensity and frequency of their BPD thoughts, feelings, and behavior also increase.”  And, likewise, as stress decreases, these behavioral patterns may become imperceptible.

“Approximately 2 to 4 percent of adults have a clinically significant degree of BPD.  This means that at least six million people nationwide have BPD.  It is generally thought that females outnumber males by four to one in prevalence of BPD.”  Plus, let me add, many who have it are not diagnosed with it.  I was not, my sister was not, and my mother was misdiagnosed as bi-polar.

“no two people’s BPD is exactly alike. . . For example, some people with BPD will show psychotic symptoms when under stress.  Others tend toward depression, intense anger, and suicidal thinking and actions.  Still others are overly demanding, manipulative, and self-centered.”

I have taken these quotes from the book that really set me on the road to recovery: The Angry Heart, Overcoming Borderline and Addictive Disorders.  I very highly recommend it if you think you may fit the criteria. 

As an adult, I have struggled with numbers 1,3,4,5,6,7, and 8.  Although as a child, it was very common for me to dissociate from the chaos that was going on around me (9).  My step-mother called me space-cadet since I was usually spacing out and thankfully, completely oblivious to the constant nit-picking, all-out fighting, or just the insidious “you’re not quite good enough for me” attitude.  My most dangerous issue has been intense rage that can be triggered by relatively common, non-personal events such as getting cut off while I’m driving.  I take it very personally and freak out.  I’ve never been outright suicidal, but I’ve definitely done some death-defying driving while in a rage.  I consider myself very lucky that I’m alive and in one piece.  And, I can’t really say I’ve had unstable relationships (2) since for the most part, I’ve avoided relationships with men and even girlfriends like the plague.  Or, I’ve sought out very non-threatening relationships with men where I don’t feel particularly connected or involved.  That limits potential for getting hurt.

You should take some time to think about these criteria and how they might apply to you.  It can be difficult to analyze your own behavior from this perspective, but if you ever want to get better, you’re going to have to do a lot of unashamedly honest self-evaluation.  You might as well start now.  I have my own theory that the majority of true bulimics are Borderlines.  I would love to hear your thoughts on that.

Another passage that really got my attention:

“A supportive family environment composed of love, security, progressive learning, and [fair] discipline helps to nurture a healthy and successful person.  But what happens when these critical ingredients are deficient?  A dysfunctional family environment, which I term psychotraumatizing, creates a person whose heart is wounded by fear and anger and whose mind is often confused and impulsive.  This is someone, who, because of his or her family environment, develops a personality disturbance and is at risk for addiction, failure, and even self-destruction.”

And, here I take “failure” to mean failure to be happy and live a fulfilling life, because it seems to me that people with bulimia are more driven to have success in their careers than people with other addictions.  So, while the focus of the book is primarily on dysfunctional family relationships, any traumatic event like rape or other abuse outside the family can really screw you up and cause BPD, too.  If you meet the criteria, you’re going to have to try to examine your childhood and your family from a more objective perspective.  This can be very frightening since it doesn’t feel too good to examine our parents’ failings, or even just imperfections, and how they may have really hurt us as kids.  But, if you want to ever get better, you have to go through this.  If you’re having trouble doing this alone, this is the one time I will strongly recommend you talk with a professional.  They’re good at digging out the ugly stuff from your past, even if they can’t help you change your behavior.

And, always remember: you were a child and completely dependent on your care-takers.  You learned your behaviors and coping skills from them.  You are not to blame for anything, ok?  The only thing you are responsible for is taking the time you need now to rid yourself of all those negative, damaging skills and beliefs you learned, and to replace them with the healthy, positive skills and beliefs that you missed.  You are responsible for nurturing those good beliefs and behaviors in yourself and getting your life back on track, because you are now an adult, and you deserve to be wildly happy and proud of who you are and wildly excited and optimistic about the life that you lead.  I want to help you (and me) to do that. 

There is so much wisdom and understanding in this book that I don’t know exactly where to begin.  I do plan to copy some of the exercises here for you to consider.  I think they’re wonderfully helpful in getting control of yourself even if you don’t have BPD. 

Tonight I plan to write in my Journal about my experience in telling family and boyfriends about my bulimia (I still haven’t ever told any girlfriends).  I just told my current boyfriend a couple of days ago, and I want to share the good things I experienced as well as the disappointments.  Until then, take care of yourself as well as you can.  You’ve got a wonderful, happy, healthy future down the road.  I promise.