Eat, Shop and Be Merry (Part 2)

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Eat, Shop and Be Merry (Part 2)

By April Lane Benson 09/10/15

Case examples highlight the connection between compulsive buying and compulsive eating.

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As described in Part 1 of Dr. April Benson’s article, eating disorders and compulsive buying can both be perceived as ultimately unsuccessful efforts to meet critical underlying psychological needs. As is commonly seen in substance-based addictions, external efforts to relieve internal states rarely satisfy, and can eventually rise to the level of dangerous or even potentially fatal actions. In Part 2 of her article, Dr. Benson uses case examples to highlight the conundrum and explain how clients use treatment to move beyond their disordered behavior…Dr. Richard Juman 

My own experience with patients is that at least a third of the compulsive buyers that I’ve worked with have suffered with eating disorders. The evidence-based treatment model that I’ve developed for compulsive buyers over the last 20 years helps compulsive buyers break the cycle that leads to compulsive buying and develop the capacity to lead a richer life in the process. The model draws heavily from psychodynamic psychotherapy, cognitive behavior therapy, motivational interviewing, mindfulness, and acceptance and commitment therapy, all of which have been shown to be effective with people with eating disorders and other addictions.

Nevertheless, if someone is severely anorexic, bulimic, or eating compulsively, working with them to stop overshopping at the same time is likely to be counterproductive because their underlying psychological muscles are not yet strong enough to do the heavy lifting that the program requires. Even if eating disorder symptoms have been largely resolved, it’s not unusual for some symptoms to reoccur during the course of the compulsive buying treatment, as you’ll see in some of the following clinical examples.

Clinical Examples

“Donna,” a 45-year old grantwriter, was gaining control over her compulsive buying behavior. She came into the office three weeks in a row and proudly reported that she had been able to resist going into one of her “high risk” stores, and had also been able to tell a salesperson that called her about something new that had come in with her “name on it” that she didn’t need anything now. I noticed, however, that her face looked appreciably rounder. It didn’t surprise me to learn that she was now eating compulsively instead of buying compulsively. What we needed was to create a structure that would take the option of eating impulsively off the table, so to speak.  

In a small journal that she was using to record her over-shopping urges, I asked her to record her overeating urges as well, and ask herself, and answer in writing, questions such as, “How does your body know that you want to eat? What positive thoughts, memories and images go along with your impulse to eat? What negative thoughts, memories and images go along with your impulse to eat? What do you think is triggering you?” This inquiry created enough physical and psychological space between the impulse and the action that she could gather her resources, utilize some of the strategies she’d been learning for tolerating distress and regulating her emotions, and then make a mindful choice about how to proceed.  

Donna also rejoined the online compulsive eating support group that had proved so helpful to her a few years earlier and wrote about the unintended consequence of stopping overshopping, and how it had started to trigger overeating. Group members offered to be available to her by email, text, and phone; she filled up on the emotional food that this contact provided and her overeating became less and less frequent.

“Mari,” who had just confessed to taking $300,000 from her husband’s family’s business, where she also worked, had been buying clothes compulsively for three years and avoiding nighttime snacking by browsing her favorite shopping websites. When she came clean about the theft, she was immediately fired, had almost no access to money, and her anxiety and depression, which was controlled fairly well by the overshopping, broke through. Mari began to gain weight, stopped buying clothes, only to be replaced by bigger ticket items like concert tickets, hotel rooms, and expensive restaurants. By the time she’d been spending compulsively for five years, she’d gained 50 pounds.

During the course of our work, she came to understand that the very premature caregiving role she’d had to take growing up as the oldest of four children with a bipolar mother and an alcoholic father figured significantly in both problems. As she began to give herself permission to take care of herself, her compulsive spending decreased, and she began exercising and eating well. Widening the concept of shopping beyond the acquisition of ever more meaningless goods and services to a search for meaningful ideas and experiences, Mari shopped for a way to spend her time and volunteered at a homeless shelter in her town. Looking at shopping as a way to search for herself and her place in the world had a huge upside; she became much more aware and appreciative of the many blessings in her life.

“Michael” used some of the skills and tools that he was learning in the Stopping Overshopping group treatment program to stay on track when he had the impulse to overeat. He accessed the same four R's that helped him to unhook from strong shopping urges: 

1. Recognizing the urge, or itch. (As I like to call it.) 

2. Resisting the impulse to scratch. 

3. Relaxing into the underlying feeling.

4. Resolving to handle subsequent itches, or urges, in the same way.

This strengthened his capacity to see, over time, that when he didn’t act on his urges, but rather observed them, they became mere background noise or disappeared altogether.

For “Rivka,” having 13 grandchildren provided the perfect rationalization to justify her multi-hour shopping trips several times a week. She wanted to be the preferred bubbe, the one that the grandchildren would run to the minute they heard her car in the driveway. Her trunk was always full, either with dozens of items she’d bought or almost as many that she was going to return. During a recent trip to Lands End to return the dozen bathing suits that her grandchildren had rejected, she’d successfully left without purchasing more, yet found herself bingeing and vomiting, a behavior that she hadn’t engaged in for many months before she came into treatment for her compulsive buying.

Using a decisional balance matrix, she reviewed and evaluated the long and the short-term costs and benefits of continuing to binge and vomit and of resisting this behavior, and saw how clearly the benefits of resisting the impulse to binge and vomit trumped the meager benefits of continuing her eating disordered behavior. We employed this strategy because she’d already completed the same exercise using her compulsive buying as the target behavior to good effect.

With patients that come into treatment for other impulsive or addictive behaviors, it’s common to find that problems with compulsive buying only surface when the other problems have improved.  

“Dana,” a 20-year old college student, came to see me initially because of severe bulimia and alcoholism. Within a month, it became clear that these addictions were so severe as to require a residential treatment dual diagnosis program, which she attended for three months. We resumed outpatient treatment, she participated in AA daily, and the work of the first post-rehab year was to reinforce the important work that she’d done in rehab and enable her to remain clear, sober and binge-free. It was not until she felt in control of her impulses to binge and purge that cigarette smoking and compulsive buying took center stage as other problems that needed our attention. Dana rewarded herself for resisting impulses to binge and purge by stopping by her favorite store, returning home laden with shopping bags. 

Although Debtors Anonymous didn’t prove as useful to her as AA had been, actively using the Stopping Overshopping Text Messaging Program, especially the just-in-time feature, functioned as a virtual sponsor. The just-in-time feature invites compulsive buyers to text the program when they have an impulse to overshop or have already begun shopping or buying. Users immediately receive a return text, some of which are links to one-minute audio clips. Both the texts and the audio clips attempt to talk them down from that precipitous emotional ledge and checks in with the users 10 minutes later to see if the danger is still present or not. Depending upon how users respond to the check-in text, they are sent one more text, either of congratulations at having found a way to resist, or another text reminding them of the benefits of resisting and the negative consequences of succumbing. Not only did Dana text the program when she was vulnerable to overshopping urges, she also texted when she was in the throes of an urge to binge and purge and mentally transposed the text into a message she could apply to it. 

It bears repeating that if someone has an active eating disorder at the time of intake, I’ve found that it’s not usually productive to do compulsive buying treatment at the same time; it’s far too easy for the compulsive buying progress to trigger eating disorder symptoms. Even when working with a compulsive buyer whose eating disorder has been largely resolved, previous eating disorder symptoms can easily resurface. As the previous case illustrations suggest, these lapses can often be worked with by applying some of the same techniques that have been helpful with the compulsive buying symptoms. There are times, however, when the work on the compulsive buying needs to temporarily take a backseat to active work on the eating disorder. In the case of a serious lapse or a full-blown relapse, referring the patient to specific eating disorder resources may be necessary and the compulsive buying treatment resumed at a later point. 

Whether sorority sisters or casual acquaintances, compulsive buying and eating disorders are self-defeating attempts to meeting important and authentic psychological needs; the need for love and affection, the need to belong, the need for self-esteem, the need for the esteem of other people, and the need for autonomy. More or less food, more or less stuff; neither one will ultimately satisfy. You can never get enough of what you don’t really need. With both patient populations, change comes when we can help them uncover what it is they really need and help them get that.

April Lane Benson, Ph.D., is a nationally known psychologist who specializes in the treatment of compulsive buying disorder. Dr. Benson has been in private practice in New York City for over 35 years. She is also the co-founder of the Center for the Study of Anorexia and Bulimia in New York. Dr. Benson is the author of  To Buy or Not to Buy: Why We Overshop and How to Stop and editor of  I Shop, Therefore I Am: Compulsive Buying and the Search for Self. Her website is www.shopaholicnomore.com

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