You all know the clinical data that confirm just under two-thirds of those who have an active eating disorder shift from restriction to cycles of restriction/reactive eating and subsequently purging within eight years of the onset of the condition. 1
You also all know that binge eating disorder (BED) within the DSM-5 (the diagnostic bible for mental illness) is now the classification for sub-clinical bulimia: Binge Eating Disorder & Conflict of Interest and What Does BED Really Look Like? In fact, BED is now part of the restrictive eating disorder spectrum as per the new DSM-5 definition.
If your focus on recovery remains limited to re-feeding and resting, then the risk of shifting your active eating disorder from one set of damaging compensatory behaviors to another is very high. You have to attend to your direct relationship with the panic that eating food generates if you want to wrestle the thing into full remission. And that requires psychoeducational support—therapy.
I’ve talked about the propensity of treatment programs today to kowtow to cultural misconceptions of weight reflecting any kind of health status in the blog post: Target Weight: Recover, But Not Too Much. Many treatment programs will smack you on the rump and send you on your way “cured” when all that has happened is you have swapped out outright restricting of food, with abusive levels of clean eating, exercising, purging, abusing laxatives and diuretics or other prescription and illicit drugs to try to maintain the target weight you were assigned in treatment.
Here are several frameworks and techniques that are often quite successful in helping you avoid just shifting the expression of your eating disorder and actually making a run for full remission instead. These are all ideas to discuss with your therapist or counselor to see if they are well suited for your specific circumstance or not.
The panic is not real. Feels real. It’s not real. I use this analogy as a way to frame that reality for an active eating disorder as follows:
Think of it like some sci-fi movie where you've been injected with a drug that will make you see horrific monsters all around you, but you were told beforehand that that is what the drug would do and you have to override what you are pretty sure you're seeing by holding onto the thought that the monsters are not real.
No matter what you think your reasons are for continuing to apply restrictive and compensatory behaviors even when you know it's harming you badly, those reasons are a complete mirage. You are doing so for absolutely no other reason beyond the fact that your brain's threat system is seeing monsters every time you try to eat and rest.
Breathe. Very slow breaths in and out. You can yell, you can cry, you can flap your hands, rock back and forth, dig your finger nails into the palm of your hand (not too hard so as to break skin obviously), stick your head between your knees, lie on the floor, curl up in a ball—but don't step away or avoid.
Remember that willpower is of no use, but planning will work wonders. In this post, we’re addressing the mounting pressure to purge because you are now responding to hunger and it fires up the panic.
First of all, you need to enlist the help of the folks who live with you. If you live alone then use some accountability via texting with a friend.
Purging is about avoidance. The fight/flight/freeze mechanism keeps ratcheting up as you continue to eat and it's that physiological discomfort that drives you to want to purge.
There are several techniques that may help you through the peaks of that intensity. Keep in mind that the intensity of wanting to purge doesn't stay at a peak level more than about 45 minutes or so, so that's your time to apply a combination of replace and distract.
Distraction options: TV, fire up Netflix, watch YouTube videos and keep munching away while you watch something that is sufficiently up-beat and not too hard to follow that you can be distracted from the panic a bit.
Replacement options: When the panic is at the hand flapping, shallow breathing, sobbing levels, then it's time to use immediate lower-impact replacement strategies. You can grab ice cubes from the freezer and hold them in your hand (it hurts but it won't damage). Have piles of sliced lemons waiting in the fridge and suck on them. Get a plastic tub and fill it with ice water and stick your feet in it. These are intense and distracting stimuli that can help get you through the worst of the panic.
You can also replace the drive to purge with a lot of less intense options as the panic eases. Load up your favorite music on your iPod/mp3 and play it incessantly as you continue to eat. Writing in your journal, drawing, coloring and doodling all work well.
Have these things lined up ahead of time so you can easily grab what you need. A lot of people find the adult coloring books of mandalas very useful for supporting a need to apply some calm to the mounting panic. And yes, there’s some clinical data on the usefulness of coloring in mandalas for targeted meditative relaxation. 2 You can locate piles of color-in mandalas online to just print off and work on as needed.
If you hit that moment where you are heading to the washroom to purge, then it's time to enlist your support—text your friend and ask for some immediate distraction. She can text about her day, her irritating boss, or whatever comes to mind and it can help keep you engaged. And if there's no one home and no one to be accountable to, then head out the door to the nearest bench outside (local park, or even a bus route bench). Sit. Breathe. And wait for the panic to ease. It will.
1. Eddy, Kamryn T., David J. Dorer, Debra L. Franko, Kavita Tahilani, Heather Thompson-Brenner, and David B. Herzog. Diagnostic crossover in anorexia nervosa and bulimia nervosa: implications for DSM-V. American Journal of Psychiatry 165, no. 2 (2008): 245-250.
2. Curry, Nancy A., and Tim Kasser. "Can coloring mandalas reduce anxiety?." Art Therapy 22, no. 2 (2005): 81-85.