Tag Archives: binge eating

Mental Health Monday: The BEDO.

As a military-naive civilian, I’m generally opposed to the concept of carpet bombing. Too much potential for collateral damage. Though I suppose that’s the point — to throw everything you’ve got at the problem, unintended consequences be damned.

Again, generally speaking, I’d prefer a more targeted solution. Something focused on the problem at hand and, most importantly, guaranteed to work. But not every problem can be solved that way. In fact, many can’t. And I’m growing a bit fonder of carpet bombing as the best solution to one particularly big problem.

 

I’ve struggled with binge eating disorder (BED) for a very, very long time. Some years are better than others, but one thing is for certain: the older I get the worse it gets. Worse and worse and worse. Every period of binge eating so much more difficult to squelch than the last. When I spoke recently of wanting to give up, accepting that this is who I am, it was the binge eating in particular that I meant. I have fought for so long — 20 years at least. Probably closer to 25. I have tried a million different solutions. Books, diets, courses, websites, psychotherapy, psychiatric care. And I’m tired.

I told Celeste, my lovely Celeste, so at my last appointment. That I was done. That I was giving up.

She told me no. One more solution… one single thing left to try: medication.

Celeste and I have gone round and round about the idea of medication for several years. Incompatibility of the medication with a potential pregnancy has always been a concern though, and I wasn’t willing to put the brakes on that for any amount of time to give meds a shot.

So a few years later — pregnancy’s a no-go and the binge eating is at full force, so we’re doing it. I’m going to try the medication.

 

When I think back on all the years of wishing for a magic bullet, a quick cure, it’s remarkable to think how reluctant I’ve been to try what may very well be just that. However, in the interim, I’ve learned a whole lot about the treatment of substance use disorders (substance abuse, addiction) and, in particular, a lot about the concept of medication assisted treatment (MAT). What I’ve learned has been exceptionally pertinent to the way I think about medication for myself in the context of BED now.

MAT itself is somewhat controversial, for a number of reasons not worth discussing here… but what the group I work with has essentially settled on as a guiding principle is that MAT is somewhat of a misnomer as it implies that medication alone can solve what is a very complex problem. We prefer the idea of TAM — treatment assisted with medication. In the case of addiction, it’s using medication to beat back the cravings to such a point that the mind can get to a place capable of recovery. And what that entails, in addition to taking the medication carefully and as prescribed, is a LOT of work, a lot of different kinds of work, and a desperate hope that some bit of that work sticks. Carpet bombing.

 

Perhaps my situation is not so different. I don’t mean to suggest that BED is on par with or the same as addiction in the traditional sense (although arguments can be made for crossover of elements of BED with elements of substance use disorders as well as obsessive compulsive disorder), but perhaps the treatment paradigm ought to be similar. I don’t want to hang all my hopes on medication and forget about the rest of it. I feel so close to giving up, so tired of trying, if this is to be it — it needs to be it. All in.

Since Celeste wrote my prescription, I’ve spent a lot of time thinking about (and researching) what it would mean for me to be all in. Outcomes for BED treatment are variable and relatively poor — so what to choose? Medication is now on the table, but what else? What else is there that I haven’t tried? The answer, as far as I can tell, is nothing… at least on its own.

So: carpet bombing.

I’m pulling out all the stops and trying it all at once, hoping against hope that something… anything… sticks. My medication finally arrived at noon today and I took my first dose at 12:01, right on time. I’ve ordered an UpToDate-recommended cognitive behavioral therapy (CBT) workbook that I’ll use in conjunction with my routine psychotherapy appointments. And I joined a healthy lifestyles coaching program to focus on the intensive behavioral therapy (IBT) principles espoused by the US Preventive Services Task Force…

The Binge Eating Disorder Offensive (BEDO).

If you drop enough bombs, you’re bound to hit something.

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If you’re new around here… or just don’t remember clearly every word I’ve ever written (gasp!) and you’re interested in learning a little bit more about my historical battle with BED and body image, you might consider reading these:

October 17, 2013: Gratitude for a Gentle Reminder

November 5, 2013: Mind, Body, Prison

Mental Health Monday: Who cares which came first when you’re sitting on a dozen eggs?

The age old question: which came first, the chicken or the egg?

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A cause and effect deal.

Technically speaking, it was the egg. But I’m trying to make a point — so we’re going to focus on the long time philosophical conundrum for the sake of today’s discussion.

 

I struggle with a lot of different mental health concerns. Perfectionism came first and came early. I was young when my parents started a daily routine — hands on shoulders, looking me in the eye, “Rachel… relax” as I stepped out the door to school.

Binge eating came next. I don’t remember my first binge, but I do remember the first time I got caught. I was maybe 9 years old and had a jar of chocolate frosting and spoon tucked away in the filing cabinet I kept in my bedroom.

Legit depression took root in high school and it’s been off and on and off an on ever since. More consistently on than off the older I get. And always a bodily focus – dissatisfaction, disgust, hate.

Anxiety became a problem only very recently — panic attacks post-miscarriage. An entirely new phenomenon, though relatively easy to tamp down in the worst moments with medication and sometimes a well-timed phone call to the just-right person.

A veritable laundry list of interwoven mental health concerns.

 

Since I started seeing a therapist in college some 15+ years ago, I’ve spent a lot of time trying to unravel the knotted mess. The perfectionism obviously led to the binge eating — but did the depression contribute as well? Or was the depression a result? And while anxiety really became a problem only in the last two years, was there always some of it there? I mean, I’m definitely an introvert and social anxiety has been a constant since I was very young — how did that factor into all of it?

The age old question.

Which came first, the chicken or the egg?

 

Round and round and round… for years on end. Exhausting. And more importantly, stupid.

Who cares whether it was the chicken or the egg that came first when you’re sitting on a dozen that can hatch at any given time — running and pecking and clucking and so on?! No one. That should be the answer. And when did I realize that? Last week… maybe this weekend. Either way, it wasn’t soon enough.

 

I struggle with an embarrassingly long list of things. (Honestly, I’ve never felt so embarrassed before talking about these things one egg at a time — the whole carton on display at once? Yikes. Please don’t hate me.) But it doesn’t really matter why. Why doesn’t help. The only thing that matters is what I do, how I deal, the actions I take for the purpose of self care and mental health in the now.

Looking for a cause and solving the root problem is a great plan if you’re dealing with a plumbing issue. Or even trying to do some evolutionary mapping (a la chicken and egg). But it seems that lately, with respect to my mental health, getting stuck in that which-came-first, why-why-why mentality really prevents me from moving forward at all. I get stuck in a place that’s not solution-based, but problem-focused, and I can’t get out. In other areas of my life, I despise that attitude — in work, in personal relationships, when dealing with my physical health. Solutions are where its at. It’s time I took the same tack with my mental health. Enough with the why, the psychoanalysis, the which came first. Freud and the chickens can suck it. I’ve got eggs to deal with by the dozens and I don’t have time for the rest.

 

ASSUME :: EMUSSA

My freshmen year of college, some friends and I went taert-ro-kcirt-ing in the dorms on Halloween. Taert-ro-kcirt-ing is trick-or-treating backwards. Obviously.

We dressed up (just barely– some cat ears and butterfly wings or something of the sort) and went from door to door with a plastic jack-o-lantern full of candy that we handed out. Maybe we collected for UNICEF or something while we were at it? I can’t really remember… but I do remember it being an absolute blast.

I’m normally pretty scared to interact with people, especially people I don’t know. And people I do know. So all people, actually. But when we taert-ro-kcirt-ed, I don’t really remember minding at all. I felt silly and confident and fun as we knocked on each door and handed out candy and a smile– people didn’t expect it, they were so happy. Like I said, an absolute blast.

And maybe it is that simple. When you want to do the opposite of something, just turn the word around and do it. That easy.

I hope anyway. And here’s why.

Remember that chocolate I told you about earlier this week? All of that delicious and amazing chocolate?

Do you also remember about that little binge eating thing that tends to haunt me from time to time?

Welllll…. this:

A trash can full of shame...
A trash can full of shame…

Sigh. It was not the best afternoon of my life.

Delicious, of course, but so very out of control.

But why? When I have so much to look forward to!

I mean, first thing tomorrow morning, I’m getting on a plane and heading to Miami, one of the only places in the country currently untouched by this mess:

So much cold, so much snow.
So much cold, so much snow.

… where I will meet my husband for a lovely long weekend and to attend his work Christmas party where all of his co-workers and their spouses will be waiting to meet me and look at me and talk to me and realize how ugly and stupid and weird and lame I am…

Ah ha!!

I’m stressed. Stressed backward is desserts. So I’m eating desserts. Doing the opposite.

It’s science, don’t think too hard about it.

And the reason I’m stressed?

Really… it’s because I’m terrified. And even worse, I am certain that all of Seth’s coworkers and their spouses and basically all of the people of Miami are going to hate me.

What’s not to hate?! My jaw is so square. My hair is going to be so frizzy (Miami?! of all places!! with this HAIR?!). I haven’t lost any weight (I wanted to lose weight first!) and my clothes come from Target. I’m almost thirty-ONE and I have ZERO kids and I’m a NERD. A huge nerd. I really wish my right eye would open up as far as my left. Oh god oh god oh god. What am I even going to WEAR? What in my closet is the least make-you-hate-me-able of all???

 

Cheese and rice.

I have got to stop.

 

I assume that everyone who meets me down in Miami is going to hate me.

All evidence points to the contrary, of course– Seth loves these people and they love him back. Seth is awesome and Seth chose me so of course they’ll love me too. And if they don’t? B… F… D…

Not everybody clicks, and that’s ok. A truffle for everyone, you know?

But maybe it would be better to head to Miami with my jack-o-lantern full of candy before I start knocking on doors, if you know what I mean. To ditch the assumptions and just emussa instead that everyone is going to love me. That’s the opposite, of course.

Think it could be that simple?

 

Probably. And here’s why.

 

… I assumed that Theresa wouldn’t want to be in my book club because she was pretty and wearing fancy jewelry and drinking a fancy drink and married to a doctor and just seemed so cool. She overheard me telling someone else about it, though, and begged me to let her in. We’ve been texting ever since. I really, really like her.

… I assumed that Kristen wouldn’t want to be my friend because she’s pretty and thin and a pediatrician and therefore a “class A” doctor (not kidding about the classification system at my place of employment, that’s real), but today, after we ate lunch together, which we do pretty regularly, that Grumpy Gus told me I had “lifted her spirits” and wished me well  on my trip to Miami. We’re hanging out for my birthday next week.

… I assumed that my very young friend Emily (like younger than my sister AND brother) wouldn’t want to be my friend anymore after our mutual slightly-closer-to-both-our-ages-friend moved away over the summer, but Emily’s coming to my birthday dinner next week too. And also we do yoga and crafts and watch trash tv together. Traaaaaaash.

 

I wonder how much time, stress, and probably desserts, I could have saved myself from wasting, experiencing, and eating, respectively, had I gone in emussa-ing instead??? Not to mention how much cooler I could have played it if I hadn’t been busy trying to keep them from hating me instead of letting them like me like they were always going to do. (That’s a super confusing sentence. Leaving it.)

Eventually, this afternoon, I went to a little mini holiday party and ate some cocktail weenies (oy, so good) and got over it just a bit. I chatted with some people from another department (who I originally assumed hated me… but totally don’t– another excellent example of that assuming crap) and stopped the spiral. I’m going to face the day tomorrow essuma-ing instead of assume-ing and everyone is going to love me in Miami.

Or not. But it honestly doesn’t matter.

Regardless, the weather will certainly be warmer and I’ll get to spend a bit of time with my long lost husband (it’s really only two weeks, I’m being dramatic) and (you do the hokey pokey and you turn yourself around) that’s what it’s all about!

 

 

Coincidentally, I’ve talked about assuming before. But unfortunately, Tim Haight never taught me what happens when you assume something about yourself. Like that you’re super hate-worthy. Lessons are so much more difficult to learn on your own. I wish Tim were here.

He’d probably hate me anyway 😉

 

I’m so neurotic. You knew that already. Don’t hate me, k?

N is for Nutella. And other nectars of Satan.

Life… you know? Sometimes it can be so hard to write! Let’s be friends on Facebook, then you’ll know I’m still around. And we can virtually hang out– how fun! (Rachel Stankowski, search for me and I promise to accept you… except if you thank me for “excepting” you, I will probably unfriend you. Grammar.)

I wouldn’t necessarily say I’m “back,” but I am here today. So let’s talk about the letter N.

Since I told you before about my childhood obsession with frosting, it probably won’t surprise you that as an adult with a more refined palate (ha!), my attentions turned instead to Nutella.

Source -- According to this blogger, "Nutella is frosting, if frosting were laced with crack and sprinkled with the tears of virgins." YES.
Source — According to this blogger, “Nutella is frosting, if frosting were laced with crack and sprinkled with the tears of virgins.” YES.

Mmmmm… Nutella. It’s delicious on everything and anything, but most delicious on nothing but a spoon. (Or your finger, in a pinch. I’m not going to lie though, I’ll even lick it off the foil covering when I open up a new jar.)

And yet, Nutella does not feel quite the same way about me. In fact, it hates me.

The hate grew gradually, over time, but that whole “made with skim milk” claim right on the front of the jar has most certainly become a big warning label for me.

Made with milk = contains lactose. And I just can’t do it.

Back in my binge eating days (you know, like yesterday, except when those days also included lactose) Nutella was basically my go to substance for the drowning of feelings and rapid intake of calories.

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While I was on Weight Watchers,* I even calculated that a full jar of Nutella constituted 24 points (FYI: that was on the “old” points system, so don’t go eating a jar of Nutella and recording it as such if you participate currently)… and I’d save up the extras and work out to “afford” to eat at least half a jar. Because what better to spend 12 points on?!

The extremes to which I would go. I wonder if I can help you to understand…

I would save up my WW points all week and on the day furthest from my weekly meeting, I would have everything all planned out. I’d bring a spoon to school with me, even if I didn’t need one, just so that I’d have it ready in my lunch bag. On the way home, I’d swing by the Safeway on Shady Grove Rd in Rockville and I’d park halfway between the Safeway and the Krispy Kreme because not a lot of other cars parked there. I’d run in, purchase my jar of Nutella and a couple other healthy cover foods, and then head back to the car where I would absolutely DIG IN. When I got back to the apartment, I would pull into a spot close to the grill area near the parking lot, where a cleverly placed garbage can allowed me to dispose of the evidence, and then I’d head up the four flights of stairs to my apartment– moaning and groaning all the way because, let me tell you, there’s just no eating a whole jar of Nutella (or even half!) without basically destroying your insides. Try it when you’re lactose-intolerant and it’s even more catastrophic.

And yet, I did it. Time after time after time. In company, I would eat the Nutella on animal crackers or some other suitable vehicle. But man, as soon as I was alone, or at least unobserved, I would eat it as though I hadn’t eaten in weeks and wouldn’t again for weeks more.

Binge trigger? Maybe. But as the title suggests, I prefer to think of Nutella as a nectar of Satan. Ridiculously tempting and easy to acquire, but just waiting to destroy me from the inside out.

Nutella’s not nearly as tempting to me today as it was before I used up all the lactase my body had to offer. (Lactase is the enzyme that breaks down the milk sugar lactose. Not making lactase is what makes a person intolerant to lactose. The more you know.) These days, lactaid (or as Target brand likes to call it: dairy digestive supplement) doesn’t even help much and I voluntarily avoid things like cheese, chocolate, and baked goods simply because I know what I’m in for if I eat them… and it’s not good.

They say an elephant never forgets. And for the most part, I believe that to be true. Things that have stung emotionally are basically impossible for me to forget. Things that sting physiologically, on the other hand? Those, I forget pretty readily. So I do it to myself again and again with, not so much the Nutella, but other tempting nectars that present themselves… things like alfredo sauce (seriously, lactaid does not work in that instance and I need to stop!), cheese curds (Wisconsiiiin!!! WHY?!?!?!), and hot chocolate (because it’s NOT just chocolate, sugar, and water, FYI).

Lactose isn’t the be all, end all though. I told you that my hands went totally crazy while I was in Arizona and that hadn’t happened since I had the piggy pigs (swine flu) and started getting rashes all the dang time while I was in grad school. At that time, I stopped eating gluten and that seemed to help quite a bit. But the doctor (MD, gastroenterology) told me the gluten thing was all in my head, so I ate it again. And then my hands… and my stomach… and whatever. I am a mess! But, I am also a doctor. Not a physician, but close enough right? And I know how I’m feeling better than anyone else.

Recently, another doctor of the same variety as me (i.e. PhD rather than MD, also her name is Rachel, too, except she’s French** (awesome!) so it’s pronounced Ruh-shell, you know, the pretty way) sent me an interesting article she saw in the Oprah magazine about dietary changes for intestinal disorders and the battle to get to a place that’s healthy, or at least pain- and bathroom emergency-free, in the absence of hard evidence and in the face of everyone in MD-style medicine calling you crazy. It was my story, exactly, except much worse. And it was so validating. Especially because Rachel sent it, and because Rachel likes Oprah’s magazine like I do, and I kind of worship Rachel as one of the most brilliant and thoughtful people I know… so….

So, at this point, I avoid lactose and gluten. When I do, my stomach is (relatively) calm and my hands remain human-sized. Perhaps this food avoidance is addressing something that is merely psychosomatic, but if that’s the case… it’s working!

And here’s some super good news: several varieties of store bought frosting are both lactose AND gluten free. Bring it on, Satan!

{Cyanide and Happiness, of course}
{Cyanide and Happiness, of course}

 

 

*I would like to be clear here that this was while I was on Weight Watchers the most recent time, back in 2010-2011, when I wanted to lose weight before getting married. At the time, I weighed approximately 165 lbs, which is, on my 5’10” – 5’11” frame, perfectly healthy and, dare I say, even somewhat THIN! And yet, Weight Watchers happily took my money and let me participate in full. I even lost some weight! Because anyone can lose weight if they restrict what they eat to a great enough extent and exercise (cardio plus weights!) for a mere 1 – 2 hours per day. Easy peasy, right? But let’s be honest here, WW doesn’t care, they’re getting paid, that’s good enough. And that’s why they let me join for the first time when I was still in elementary school. Nothing better for a little girl… who now eats Nutella by the jar. (Except not really because it’s chock-full of lactose and it would destroy me, but you get my point.)

**I’m sure you’re familiar with the bacteria E. coli, short for Escherichia coli, yes? Well, my friend Rachel (the French way) says it so ridiculously beautifully that because of that pronunciation and the movie Amelie (have you seen it?! SO good!) I would consider myself a Francophile. Science is just better with in French-accented English. It’s true. Also, one time, Rachel complimented my dexterity (with tiny little dishes full of Chlamydia— good reason to be careful!) and it made me feel so ridiculously happy that it’s one of those things that this elephant will never forget.

I is for innocence.

Before I get on with the business of the day, I’d like to clarify what I said about academic condescension yesterday. Please be assured that it is 100% knowledge-based snobbery, not title-based. In fact, I have considerably less patience for those with lots of letters behind there name and very few thoughts between their ears and I very much admire those without the letters who have come by incredible and complex thoughts by way of experience (my dad, my friends Marie and Michele– really, really incredible thinkers, no need for letters). True, I have some letters behind my own name, but I am of the opinion that having a “terminal” degree doesn’t mean the end of learning, nor is it the only path to being learn-ed. <End Rant> Hash tag– yes, that’s personal.

Anyway…

I is an interesting letter in this little adventure you and I are on.

Originally I was going to wax poetic about icing. You see, frosting was the first binge food I ever got caught with. (Got caught with… not first binge. Big difference.) Kind of a big deal when it was discovered in my filing cabinet. (Because what second grader doesn’t ask for a file cabinet for Christmas??? And what third grader doesn’t keep a carton of chocolate frosting and a spoon inside?) Except, while working my way to the letter I, I was also reading two books– Innocence by Dean Koontz (to get technical about it, that was actual my Audible book that I listened to while running, walking, or mowing the lawn– talk about motivation! dang!) and My Own Country by Abraham Verghese (a gift from my dear friend Suma because she thought I’d like it… and did I ever!) and the parallels and really interesting points about innocence were too poignant to ignore.

Therefore, the letter I is for the idea of innocence. Super interesting– just hear me out!!!

The Dean Koontz book is kind of a given here. I’ve been a little bit disappointed with some of his most recent work (77 Shadow Street? It was the pits! Took me for-ev-er to slog through it and even at the end, I was unable to find any redeeming qualities), but this book captured me pretty much immediately. The basic premise is this: a guy who cannot be seen, a girl who cannot be touched, both social exiles, but things change when they find each other. There’s that supernatural Dean Koontz-y element that I love so much and the story was so so good. In the end (not really a spoiler, don’t worry) you find out that the reason for the main characters’ differences was literally their absolute and complete innocence– an innocence so magnificent that anyone who looked at them or touched them was doomed to instantaneous reflection on all the reason that they themselves were not innocent. And that’s not pretty for anyone.

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The Abraham Verghese book? Totally different! Dr. Verghese is the MD who wrote Cutting for Stone, which is truly one of the best books I’ve ever read. Cutting for Stone is fictional, it’s beautiful, it’s amazing… read itMy Own Country is an autobiographical account of Dr. Verghese’s “coming of age” as an infectious disease specialist during the first years of the AIDS epidemic in the United States.

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Where’s the parallel, right?’

I’m getting there.

Verghese is an amazing writer because he is so beautifully honest, even when the things he’s being honest about aren’t so beautiful. He does not write himself as a hero, he writes himself as a man– warts and all. (He never actually mentions warts, just flaws. I say warts because I used to have SO many warts on my left knee, you guys. It was awful. I was in derm every other week because this was before the time of the canned freezy do-it-at-home spray stuff. It was an awful time! Now I wrote about my warts and you will think of me as a beautifully and genuinely honest author, right?)

Anyway, in My Own Country Verghese talks a lot about how his patients were contracting HIV in the small town of eastern Tennessee in which he lived and worked. As you are likely aware, the AIDS epidemic really came to light in the United States amongst gay men. Yes, there were also many cases that resulted from intravenous drug use, blood transfusions, and in hemophiliacs receiving clotting factor concentrates, but it was risky sexual behaviors that were the hot topic. Especially because, at the time, homosexuality was rarely talked about and certainly not well-accepted by any means. As such, Vergheese found himself immersed in a sub-culture that he was completely unfamiliar with and he had so many questions. Not necessarily about the lifestyle, the culture, or anything, although those things were certainly of interest– more so about himself, his prejudices, his biases, his thoughts on innocence and guilt and what having HIV and AIDS really meant.

At one point, Verghese describes meeting a heterosexual couple who were both HIV infected. The husband had undergone heart surgery, during which he had received several units of blood… HIV-infected blood. He then transmitted the virus to his wife. A very sad story, of course, and Vergheese found himself emotionally invested from the get go…  this poor, innocent couple.

Until he questioned his notion of what it actually meant to be innocent. If this couple was “innocent,” did that imply that the gay men he routinely saw were somehow not innocent?

I love so much that he questioned himself, his own beliefs, his own prejudices. How many of us can say that we generally do? That we can examine our own thoughts about guilt and innocence and to admit that maybe we weren’t being completely objective… completely fair.

It was interesting to read these two books simultaneously… the first describing how much we can despise the innocent for emphasizing our own shortcomings, the second pointing out our quick leap to a judgement and dislike of those we consider “guilty.” Such an interesting dichotomy.

Innocent, guilty… ultimately– “who am I to judge?” I think Pope Francis got it right. Who are any of us to judge?

I know that I am not innocent– far from it (remember the chocolate frosting??? also, I’ve been a big fat liar since day one, etc, etc, etc). As such, you shouldn’t find me casting any stones.

Shouldn’t being the operative word.

Because sometimes, I think I do. Ok, I know I do.

I appreciate Abraham Verghese bringing this to my attention, for making me really think about innocence and what my own prejudices might be. And Dean Koontz for underscoring the point when it was brought to mind.

Reading and thinking… do it! Even fiction can make a difference!