Today's question is on what to do when therapy doesn't seem to help with a binge eating problem.
I am a binge eater. Every two or three months or so I go into a panic and can't stop eating. Therapy hasn't helped yet. I read the medical literature and know this is dangerous and that there are millions of us who have the same problem. What's your suggestions about what I should do?
Stacey Rosenfeld: There are a few ways to address binge eating. Therapy isn't an overnight solution, so while I understand your impatience, I'd encourage you to give it some time. That said, I'd make sure you and your therapist are working from an evidence-based model - using techniques from cognitive-behavior therapy and perhaps some skills from dialectical behavior therapy - to help get you on your way.
Have you noticed what seems to lead to your binges? One helpful technique is keeping a log of the episodes. This allows your to keep track of some of the patterns that might occur around them. If you binge, try not to beat yourself up for the behavior. Instead, use it as a data collection experience. Make careful notes on what was going on prior to the binge episode. Do you tend to binge when overly hungry, when you didn't get enough sleep, when stressed at work, after you've had an argument? What seems to precede the panic you mention?
Looking for some of the precursors to the episodes might help you address them over time. Speaking of hunger, we know that a common trigger for overeating is under-eating. Are you dieting or otherwise restricting your food? If so, I'd discourage this and encourage you to flesh out your intake so that you're eating three meals a day and likely 1-3 snacks. People who binge often skip meals - make sure that you're keeping yourself fueled throughout the day. If you need help with meal ideas, I might consult with a dietitian who specializes in eating disorders. In any case, make sure you aren't ignoring hunger - again, this can be a big trigger for a binge.
Are there certain foods that tend to trigger your binges? I wouldn't eliminate these foods from your diet - this only tends to result in an experience of deprivation that can further trigger binge eating. However, I might be mindful of how you interact with these trigger foods. For instance, if you tend to binge on bread, you can practice eating bread in moderate amounts (e.g., ordering a sandwich at a restaurant), but you might decide that keeping a loaf of bread in the house might be too difficult at this point in your treatment.
Do you find your binge episodes are a way to cope with difficult emotions? If so, you might want to work with your therapist on alternate ways of experiencing and expressing these emotions. Sometime people will experience the urge to binge as a wave, which ultimately will die down if they sufficiently distract themselves and engage in an alternately soothing or tension-relieving behavior. Again, none of this will work if you're trying to restrict your food - the binges can be your body's way of keeping you nourished.
Finally, many people who suffer from binge eating are concerned about the weight implications of their behavior. Most of us who treat eating disorders have found that successful recovery efforts typically involve putting weight-loss or weight-maintenance as a goal aside and instead focusing on developing a healthy relationship with food as the primary goal.
Stacey Rosenfeld, PhD, is a clinical psychologist who treats patients with eating disorders, anxiety/depression, substance use issues, and relationship difficulties. A certified group psychotherapist, she has worked at Columbia University Medical Center in NYC and at UCLA in Los Angeles and is a member of three eating disorder associations. The author of the highly- praised Does Every Woman Have an Eating Disorder? Challenging Our Nation's Fixation with Food and Weight, she is often interviewed by media outlets as an expert in the field. www.staceyrosenfeld.com Full Bio.