Thursday, November 09, 2006

Addictions

I’ve been thinking a lot recently how eating-disordered thoughts and behaviors mimic other addictions. Just like a drink or drug, an eating-disordered action can be compulsive (or impulsive), can rescue us (temporarily) from difficult feelings, and can create a host of new problems that obscure what originally led us to these behaviors in the first place.

With addictions, we often use functional analyses to understand the patterns associated with alcohol/drug use. In its simplest form, a functional analysis looks like this:

Triggers-->Behaviors-->Consequences

That is, certain situations or events lead us to respond in a certain way, and these responses have various consequences. With alcohol/drugs, we often focus on the triggers (people, places, things) that lead us to drink/use (or not), and the positive and negative consequences of using (or not). To apply this to eating-disordered behaviors, we first need to identify the behaviors in question. Here are some examples:

1) Restricting
2) Bingeing/purging
3) Emotional eating
4) Excessive exercise
5) Excessive weighing/mirror-gazing
6) Engaging in critical thinking about our bodies
7) “Feeling” fat
8) Desperately turning to the next diet

As for triggers, to expand upon people/places/things, they are often thoughts we have, emotions we experience (the concept of “emotional eating” itself addresses 2/3 of the equation above), stimuli we encounter (e.g., a fashion magazine, gaining weight/losing weight, a picture of ourselves, a bad day), physical symptoms (e.g., feeling overly full, tense, lethargic), etc. What other triggers do you experience?

Once we encounter these triggers, we have a number of behavioral responses that we may employ (some repertoires may be larger than others). For the purpose of this discussion, the critical distinction ultimately occurs between engaging in an eating-disordered behavior (see above) or not, instead relying on a more adaptive coping resource. Each option is associated with consequences, good and bad. Bingeing might make us uncomfortable, but having access to unlimited, tasty food feels good in the here-and-now. Berating ourselves for the size of our stomachs may cause us to experience anger or grief, but it potentially distracts us from even more uncomfortable thoughts and feelings. Examining some of the other consequences—good and bad—of engaging in these behaviors may help elucidate our decision-making processes.

13 comments:

WifeMomChocoholic said...

It's hard to know what triggers my binges these days. Two years ago (and 25 lbs ago) it was pretty clearly due to deprivation. I was constantly hungry and thought about food as much as those men during the famous (or infamous?) WWII study. I cut out so many recipes and was clearly obsessed with what I wasn't allowing myself.

These days, it's less clear-cut. I know some of triggers are procrastination and anxiety. I don't always give into my urge to binge, but somehow it seems to build up to an unbearable height. I'll resist and "talk myself down" several times over the course of a week or two. Then I just....can't do it anymore. I'm at the point now that I'm fully concious that I'm choosing to binge to avoid....something....but can't quite make the choice to stop.

Anonymous said...

eating disorders are totally similar to substance dependence. They both fall into a category of more general self-injury, a hurtful and counter-productive behavior that becomes an addiction, psychological or physical. Once the body and/or mind adjusts to the repeated behavior it becomes normalizing rather than detrimental, which is why it's so hard to stop....

PalmTreeChick said...

The difference btwn EDs and other addictions...we can't live without food. We CAN live without drugs/alcohol, etc...but food we need, which makes it so much harder.

Michelle said...

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 also write about everything I’m learning from the book at my blog: onbulimia.blogs.com.

Michelle said...

I believe your functional analysis should look like this:

Irrational belief -->
Self-defeating decision -->
Bad consequences (triggers, bad thoughts and feelings) -->
Addictive 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.

Michelle said...

By the way, Dr. Stacey, thank so much for this post and for putting the process into a diagram. You got me thinking really hard about this stuff. It's a really interesting topic to discuss and think about. I'll be checking back to see what others have to say.

Thanks!

Haley-O said...

I firmly believe that ED's are like any other addiction -- they are the result (in part) of chemical imbalances brought on by the drug (by the *stress* caused by not eating). And, the addiction, like any other addiction, stems from a more abstract anxiety. I know this because when I became pregnant, my anxiety took on objects other than food, but the obsession and other symptoms were exactly the same. I hope that makes sense. It's just like a smoker turning to food when s/he has to quit smoking.

littlem said...

I think Haley-O definitely has something there.

I've read about changes in the brain of alcoholics and cocaine addicts -- people with a tendency to the addictions are born with less dopamine or serotonin or something in the brain, so they drink/snort more to try to change the balance, but since the drugs act on those same receptors they end up with less of the neurotransmitters than before. And so on ... vicious cycle.

I can't help but think something similar happens when we starve, or when our hormones are just out of control -- doesn't starvation (even periodic/cyclical starvation, like dieting) change the brain's neurotransmitter and glucose balance?

It's MUCH less frequent than it used to be when I was an anorexic dancer, but if I have a little too little protein and a little too much sweet fruit at the same meal, if it's also around my period, I MUST HAVE CHOCOLATE MUST HAVE CHOCOLATE MUST HAVE CHOCOLATE within the hour.

(It's actually a little scary and a lot less fun than it sounds, since diabetes runs in my family, even though so far so good.)

I can't help but think there's something going on there that I may be goosing, but which is NOT entirely within my conscious control.

Michelle said...

It's true that PMS seems to increase my appetite quite a bit. Now, I don't even fight it. I just accept that it's temporary and out of my control. I HATE the feeling of being hungry, so I just try to choose healthier foods when I get that way. But, granted, I pretty much always gain weight during PMS. I prefer to go with the cravings for a few days than fight it.

drstaceyny said...

wmc--seems like you know some of the triggers, but are still trying to figure out what you might be wanting to "avoid." Perhaps some answers might lie in this exploration.

anon--good point, though I'd add that while they are both "hurtful" and "counterproductive," they are also serving a v. important purpose.

ptc--true, we can't live w/out food--but I don't think the addiction is to food--it's to the maladaptive thoughts and behaviors around it.

michelle--as I commented on your site, I actually agree w/you. You present a cognitive-behavioral model, which I hope to post abt soon. In this way, faulty cognitions influence feelings and behaviors, all of which fall under
"triggers" in the simplified model I presented.

haley--very good point abt underlying anxiety being the fuel for many of these disturbances. The neurotransmitter serotonin has been linked to both anxiety and ED's, so this makes sense. I just read an interesting article on the comorbidity of OCD and anorexia and hope to post about it soon.

lm--good points. Certainly, starvation affects brain chemistry--and now that Prozac/Serafem are being prescribed for PMS, again we see the serotonin link. Hmm. . . more to think about. . . .

michelle--seems like a good approach. Actually, metabolism speeds up during this time, so it's not "all in your head."

PalmTreeChick said...

yeah, you're right. I wasn't thinking along those lines. Not that it's easier to adjust to not using drugs or alcohol as a coping mechanism, I think it would probably be easier than food because we can survive without the drugs. I have NO idea what I'm saying. I know what I mean but I don't know what I'm saying. ;)

littlem said...

Palm Tree Chick - I think you're saying that alcohol and drug addictions are easier to handle than a food addiction, because you can just quit cold turkey and don't have to see them.

By contrast, with food, you actually have to "handle the substance" daily because our bodies need food for survival -- and even if you're an anorexic in your "starving" cycle, the "substance" is shoved in your face daily by primary media because its use is both legal (unlike most drugs) and "permissible in polite society" (unlike obvious drunkenness).

How close did I get?

PalmTreeChick said...

Thanks littlem! Can I hire you?? :)