Stress Getting in the Way of Recovery

This post is heavily influenced by Robert M. Sapolsky’s Why Zebra’s Don’t Get Ulcers, with a smattering of my own additional research references.

Many look for a better time to begin recovery from a restrictive eating disorder rather than “right now, today”. And the most common rationale for delaying a recovery effort is: stress.

A stressor is anything that triggers two chemicals (epinephrine/adrenaline and glucocorticoids) to flood our bodies. We shorten the whole thing and just say something is stressful, or we feel stressed.

Everyone has heard of good stress and bad stress. Biologically speaking, good stress is when the body’s response to a stressor resolves effectively and the body is strengthened by the chemical flood it has had.

In fact, we don’t even call this version of stress “feeling stressed”; we call it feeling excited or charged. Bad stress is when the stress response does not resolve at all, or resolves poorly, and the chemicals now begin to damage the very system they were meant to strengthen. When we say we are stressed, we rarely mean it in a good-stress way.

The stress response has two phases. Phase 1 is instantaneous and generates adrenaline (epinephrine) in the body. Phase 2 is slower release and generates glucocorticoids. Phase 1 is about running away from things that want to eat us. Phase 2 is about preparing to heal from serious wounds that may have been given by the animal that tried to eat us.

Although modern life rarely involves animals wanting to eat us, our stress response is regularly triggered nonetheless— most commonly in complex social circumstances, both professional and personal. Lots of physical damage occurs with the repetitive activation and duration of Phase 2 (everything from heart disease, arthritis, diabetes, intestinal inflammation, depression, shingles, to serious memory loss…) [PC Souverein et al., 2003; A Strangfeld et al., 2009; M McMahon et al., 1988; JE Friedman et al., 1993; JB Meddings et al., 2000; B Çakir et al., 2004; CM Pariente et al., 2001 and 2008;  BS McEwan (I know, it’s not lost on me), 2005;  RM Sapolsky, BS McEwan, 1995; E Ronald de Kloet et al., 2007].

Glucocorticoids (that includes cortisol) are not inherently bad. Like many aspects of human ecology, they have a critical role to play when we are functioning in our optimal state.

Managing Stress Is An Oxymoron

There are several reasons for the overall failure of stress management recipes in our society:

  1. We presume that there is one well-adapted and successful response to stressors in our modern world.
  2. We fail to recognize that higher levels of physical connection to our bodies are required to preempt the physiological impacts of Phase 2 of our stress response.
  3. We fail to shift our loci of control to match the stressful circumstance.
  4. We refuse to acknowledge that stressors may be unmanageable.

Powerhouses Are Usually Time Bombs

There is not one perfect stress response. There are variations in humans precisely because it enhances the survivability of us as a species. We’ll look at the common stress response variations in the next section.

A resilient individual is someone who has good stress, or a stress response that is triggered and resolves. A damaged individual is someone we tend to describe (wrongly) as resilient and unaffected by any stressors: “She’s really dedicated and just never seems to stop”; “She’s a real workhorse and never lets us down”; and “He’s a pit bull. I’ve never seen him crack under pressure”.

Not only do we assume these powerhouses are masters of managing stress, we puzzle at why these seemingly perfect examples of discipline and strength ‘suddenly’ collapse.  Biologically, the collapse is far from sudden.

The movie Thank you for Smoking (2005) had a wonderful scene with Rob Lowe playing a high-powered Hollywood producer. He’s being pitched by Nick Naylor’s character to help the tobacco lobby make smoking cool again. Lowe’s character is monitoring all his business activities around the world and when asked when he sleeps he replies “Sunday”.

Maybe if smoking is no longer cool, might it be possible to make “powering through” equally unattractive?

Scheduling Down Time Often Too Little Too Late

By the time you are taking time for some meditation, or yoga, to “decompress” or “reset”, you may have already had high glucocorticoid levels in your body for many hours. And that means damage already done. Had you taken that break the moment you sensed your heart racing then you might have avoided triggering the glucocorticoid cascade in your body. Problem is many of us are not aware of when our heart is beating faster (Phase 1 of the stress response) because we are pretty out of touch with our physical responses. 

And The Wisdom To Know The Difference 

Yes, that oft quoted serenity prayer I keep harping on about strikes again:

“God, grant me the serenity to accept the things I cannot change; courage to change the things I can; and wisdom to know the difference.”

We can get very stuck believing that we are either mercilessly buffeted by bad luck, or that we unequivocally make our own luck. Neither worldview is going to be right all the time.

Locus of control means the location of control (internal or external). You can’t have just one response: victim or martyr. You must shift between the two depending on the actual circumstance. It’s very damaging to insist that something is in your control when it’s not, or to insist that something is out of your control when it’s not.

John Henryism

John Henryism is based on the legend of the African-American John Henry who possessed amazing strength and decided to compete against a mechanical steam drill in a race to drive railroad spikes (his job at the time). John Henry beat the machine but died immediately afterwards from mental and physical exhaustion.

“…the term John Henryism now symbolizes the coping strategy characterized by aggressive tenacity, determination, and hard work while unconsciously sacrificing health issues in reaching the goal of meeting an environmental demand.”

[CL Edwards, G Bennett, Encyclopedia of Multicultural Psychology, [ed.] Y Jackson, 2006]

John Henry not only represents the archetypal powerhouse/time bomb response to stress, but he also provides an example of failing to identify an external locus of control. John Henry worked with only an internal locus of control, meaning that he was convinced everything was within his power to change.

The Stress Types in Detail

We are used to calling these categories “personality types”, but really they are biological differences in individuals. Of course when we speak of biology, we are speaking of predispositions that are heavily impacted by environmental inputs. And while we love labels and categories for everything, human beings are never easily pigeon-holed and so you may find that your stress response style spans more than just one category, depending on the circumstance in which you find yourself: 

The Reactive One

These people have an exaggerated startle response: when you startle them they usually react very strongly. They immediately notice sights, sounds and smells in the vicinity when others are not aware of them or have blocked them out. Being a reactive type does not automatically mean the person suffers from an anxiety disorder, but he or she may. They will have had a lower-than-average vagal tone from birth. The vagus nerve is the longest of the cranial nerves and travels along the pharynx (neck area) and provides control of the heart.

If you fit this category then the best way to think of yourself is that you are high reactor. The value of this type of stress response in society is that you can detect danger before others. However, you need to be very aware that your responses will not be the same as average reactors. Noises, smells, or large gatherings may trigger a stress response. Rather than ignoring your response and then becoming irritable and exhausted, it is best to explain your needs openly. 

Getting to a quiet space for even as little as twenty minutes every day can make an enormous difference for you. If you have undertaken a career path that is ill suited to needing a lot of quiet, then you may need to evaluate how to move your skillsets in a new direction.

The Aggressive One 

We’ve all heard of “Type A” personality. Type A’s respond to all things as menacing threats. They will power-up their massive stress response for any and all insults (real or imagined).

There is good news and bad news for an aggressive (Type A), and those dealing with them as well: they can actually moderate their stress response. Unlike the others in this list, aggressive types can moderate more easily because their stress response is likely a learned set of behaviors.

The bad news is that getting them to change usually cannot happen before they experience negative health impacts (usually a heart attack).

When most things around us are threats, for example in times of war, then aggressives will have a distinct advantage. However, they cannot readily distinguish between being in a war zone and having to wait in traffic and hence fire up their massive stress response and accompanying rage for multiple irrelevant events each day.

If you can recognize you fit this category before you have your first heart attack, then therapy actually works well to recalibrate your threat-response behavior. If you recognize this fits a loved-one, then give them a copy of this when they are not angry.

The Fearless One

Fearless folk tend to have an addictive style and not just to substances, but also sports, relationships… pretty much anything.

For all of us the Phase 2 release of glucocorticoids also triggers a release of dopamine in the brain. Dopamine are neural opiates (a natural high). This dopamine release makes sense if a lion has taken a chunk out of you—that some endogenous painkillers are floating about in your system to manage that unfortunate possibility is a good thing. It is why dopamine release is stimulated by the presence of glucocorticoids in your body.

When everything settles down and the glucocorticoids dissipate, then the dopamine level returns to a normal set point too. However for the fearless, the dopamine level returns to a point just below the previous set point.

It means that the fearless actually won’t feel “normal” so much as “just below normal”. That will drive them to seek out a bigger kick the next time just to pull the dopamine up.

If you fit this category, you could push yourself into a cycle of ever-increasing and physically punishing chaos in the pursuit of an optimal dopamine level. 

While distress tolerance is something we all need to develop, it is a skill that is particularly useful for the fearless. Many with this dominant response to stressors benefit from dialectical behavioral therapy. 

Sometimes you will be bored and struggling to feel ok about it. Taking the time to contemplate how best to provide yourself with competitive challenges that support a rise in dopamine, while keeping you safe from either addictive or self-destructive cycles is an important facet of protecting your health and wellbeing for the rest of your life. 

The Repressive One 

Whereas we can locate reactive, aggressive and fearless types using personality tests, the repressive can only be found using stress tests. On personality tests, they indicate they feel fine and there’s nothing in their responses that would indicate otherwise. However, when a repressive’s heart rate and glucocorticoids are measured, it becomes clear they have massive responses to stressors.

Repressives have an over-aroused stress response and they are completely unaware of it. They have the emotional center of their brains (the limbic system) in a complete lock-down. Whereas anxious ones appear intimately connected to their limbic system, repressives are very disconnected.

They expend tremendous energy trying to construct a world without stressors. They dislike ambiguity and absolutely dread social disapproval. Unlike all the others, they actually cannot ‘feel’ their own stress.

So how do you know if you’re repressive? Well, are you drawn towards black and white answers to things and often think about what others might think of you? Would others describe you as calm and unflappable but maybe loved ones also worry about your health condition(s)?

If you answered yes, then you may want to get a fingertip pulse monitor. Throughout the day, as you interact with people, take your pulse. It’s about trying to connect with the reality of being stressed (your heart rate is elevated) and practicing feeling that response more consciously.

Beyond these predispositions there are a host of other critical things that will impact your stress response: pain, sleep issues, depression, crisis, disease…It means that even if you don’t fit into the categories above, you will still have times of increased and decreased resilience to stressors.

Further suggested reading on these topics:

Why Zebras Don’t Get Ulcers

Highly Sensitive Person

Quiet

Too Perfect

When The Body Says No

And the blog posts:

Rebounding to Calm: Part I and Part II.

Unresolvable Stressors

You are out of work. You are caring for a sick child, parent, or partner. You have a boss at work or kids at school that bully you. You hate your job but can’t find another. You have flunked out of school/college/university. You don’t know how you’ll pay your student loan debt. You have an unhappy relationship full of strife and disharmony—with parents, partner, friends, siblings, or other family members. You are sick. You are disabled. You cannot pay bills. Creditors harass you. You are homeless. You hold down multiple jobs and get little sleep. A person you love is in crisis. You have secrets you are keeping from those closest to you. You have a hard time keeping all your lies strait in your mind. You cannot afford to buy the prescription drugs or food you need. You are dealing with substance abuse (yours or a loved one’s).

While no stressor (either outside or within your control) is entirely unresolvable, many of the examples I have just listed become an extreme exercise in endurance and creativity. Creativity? Yes.

It indeed takes creative thought to identify that within a single stressor usually lurks both external and internal loci of control.

Creative Stress Response

To lay the groundwork for even finding the spaces of internal and external influence on an unrelenting stressor in your life, you first have to identify the stressor.

That may sound self-evident, but our culture is such that we have socially acceptable and unacceptable areas in which we are even allowed to identify a stressor.

To give one example of this, I was recently scrolling through a young teenager’s Tumblr account. No, she is not a member of Your Eatopia at least as far as I am aware, but she has an eating disorder and has visited and mentioned my site. Her most recent posts had been to express extreme frustration with the interactions she was having with her mother.

She was in fact very angry at her mother and expressed a lot of disrespect and disdain. Many had understandably responded to these diatribes with recommendations that she try to see things from her mother’s point of view. They suggested her mother was simply very worried and that her mother loved her. 

Nothing wrong with that, right? That depends. 

It is not socially acceptable to shun your parents. I have lost count of the number of times I have heard or read “But, she is your mother after all,” or “they’re my parents so of course I love them”.

It wasn’t until someone recommended to me that I read The Drama of the Gifted Child by Alice Miller, that I realized I was as enmeshed in the “love and honor thy parents” mantra as anyone else in my culture.

There is no question that very good parents face very trying times when their children are going through their teen years. And it is very possible that the girl on Tumblr has a mother who deserves sainthood. A more likely scenario will be that both she and her daughter are equally flawed and equally to blame for the strife they have at the moment. 

But another possibility might be what I saw woven into some of the girl’s responses—her parents have had an acrimonious split and the mother heavily leaned on her daughter for emotional support during that time—this might suggest that the daughter became her mother’s friend when she really still needed a mother. 

Of course we have no way of knowing what on earth is really going on with her and her mother. But hopefully the in-person professional support the girl is receiving will not disallow or dismiss the anger and frustration she feels towards her mother right now.

Identifying a stressor is not about assigning blame on others; it’s about finding the locus of control and leveraging that for your own stress response resolution.

There are plenty of people who have children who shouldn’t, plenty of people who partner or marry who shouldn’t, and there are plenty of people who have pets who shouldn’t as well. Such is life.

In my recent blog post Depression in Recovery I referenced the article Depression’s Evolutionary Roots and one of my favorite observations that the authors made was that people are reluctant to disclose the real reason for their depression.

And what commonly underlies an onset of depression? Unresolved stressors. Taking the time to uncover the real stressor has to happen before you apply some creativity to the conundrum.

Wiggle Room 

Apologies to those who find octopi repulsive, I like them. They are emotional and intelligent, brilliant escape artists, rabble-rousers and they creatively use their surroundings and environment for their own survival and benefit. 

We may not have their extra arms, but we can likely match their ingenuity.

Dealing with unresolvable stressors by definition means you are looking for wiggle room within the reality of your circumstance.

That is not to say that exercising some bravery will not ultimately resolve the stress. For example, leaving an unhappy partnership, or putting some physical distance between you and distressing family members, or leaving a miserable job are all real solutions, rather than just modifications.

But what if you have a sick child where leaving is not an option? Or you are in debt with creditors calling you night and day? The bravery in these circumstances lies more in your ability to find the wiggle room to keep going.

Rules of Creative Engagement with Stressors

It may seem counterintuitive that there are rules associated with creative thought, but without some kind of framework, the process can end up a bit too much like fog-sculpting (no substance).

  1. Be brutally honest about what the stressor(s) is/are.
  2. Be aware of what cultural attitudes might be limiting your creativity and put them aside.
  3. Be as morally and ethically creative, without breaking any laws, as you can be.
  4. Be brutally honest about your type of stress response and work within its confines.
  5. Be committed to asking for help. Shun independence in favor of interdependence.
  6. Never stop looking for wiggle room.

The one that might cause a few raised eyebrows is moral and ethical creativity. I will explain this concept by way of an example:

Generally in Judeo-Christian philosophies, we view being unable to pay one’s debts as a moral failure. Many people who end up in financial dire straits are often the victims of illegal harassment from debt collectors precisely because the collectors leverage a sense of moral obligation, shame and guilt in those who owe money.

The fact of the matter is that most of the debt any modern citizen has today is founded on a business deal. The creditor does not undertake any personal or moral obligation to ensure they are not extending credit to individuals unlikely to be able to pay. It is not a loan from Auntie to help you go to school, so don’t treat it as such.

Moral and ethical creativity has to do with an ability to identify when businesses and corporations have effectively leveraged your personal moral and ethical makeup against you. Corporations bring no equivalent moral or ethical tone to the table, so remember to do likewise.

Right Now, Today

And all of that circles us back around to the question of when you start a full-fledged recovery effort from a restrictive eating disorder. You do so now.

Stressors, both resolvable and unresolvable, abound. They will not let up and there will never be a better time. Something always comes up.

Neurobiological conditions, such as restrictive eating disorders, do not improve with continual reinforcement of the same patterns that have you trapped in behaviors of restriction, cycles of restriction and reactive eating, purging, compulsive exercise or compulsive attention to clean eating of any kind.

You also do not grow out of neurobiological conditions for the most part. Some lucky few drift into environmental conditions that naturally reinforce new patterns in their brains that end up supporting a full remission, but that’s the exception and not the rule. Most have to consciously and doggedly work at developing new behavior patterns to proactively enter and stay in remission.

The good news is that there is tremendous crossover benefit to working on your life with stressors at the same time as working on your life with a restrictive eating disorder.

Write it down. Journal your way through.

Start now. I mean right now and not tomorrow.

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