Tuesday 14 October 2008

Emotional Eating 101 pt 3 of 4

Emotional Eating 101 (Part 3 of 4)
by Roger Gould, M.D.
In Part 1 and Part 2 of this series, we discussed emotional eating and food addiction. Today, we are going to talk about how food addiction starts and the initial steps to breaking it.

Learning the Patterns
Just like everything you know how to do in your life, you learned to be addicted to food. We touched on this subject in the last article when we discussed how people overeat because it worked for them.

All addictions follow the same basic pattern. First, you are in a distressed state of mind and the substance (whether it be alcohol, nicotine, marijuana, or cupcakes) offers you almost instant, albeit temporary, relief from your distress. If it works the first time, you do it again, and again. When it becomes the mechanism of choice, you are addicted. It is the short route to the temporary control of personal stress. If you are addicted now, it means you became too dependent on this mechanism and you created a short circuit to feeling good that now works against you.

It's a short circuit in many ways. It's the fastest route to feeling better, so in that way it is literally a short circuit. But it is also a short circuit in another sense. The more you use this mechanism, the more you bypass some essential work of life, and short circuit the new learning and new ways of managing your feelings that can make life more fulfilling and a lot easier. You are trading the short-term gain for a real long term-loss.

The more you eat, the more you avoid doing what is necessary to resolve the stress, depression, and anxiety in real life. The more you avoid, the less you learn about how to manage your mind and your life, or at least those critical parts of you that have not fully matured and been brought under rational control. It's a vicious cycle. Gradually the stabilization of mood and mind state is more important than the rational and thoughtful management of your life.

It may feel like this patterns has been with you since birth, but it has not. You learned that eating can give you relief, so you eat. But, you can unlearn it. Realizing this is one of the first steps on the road to recovery.

Although food addiction is learned behavior, I don't want to make it seem that the unlearning process is just a matter of education or reverse engineering. No, once food has become installed as a primary regulator of mood and emotions, it is an essential part of the person's mind, or at least feels that way. Food is no longer food. The taste is largely irrelevant. It's the mental effect that is being looked for in the burrito, not the calories or the flavor.

Some have described the relationship between the self and food as that of a lover that you jealously possess, hoard, hide and clandestinely have as your own. There is a great deal of truth in that description, but it doesn't quite get to the quality I hear in my patients. What I hear is that it is more like this eating pattern has become a part of one's mental self the same way an arm is part of one's bodily self, and defended in a parallel way. You wouldn't let anybody convince you to cut off your arm. In the same way, you won't let anybody convince you to give up this mechanism of internal control. This is why unlearning food addiction is so hard. It feels like you are unlearning an essential part of yourself.

Food addiction has the same imperative quality as the heroin addict who has to have his fix, or the smoker who must have one more drag, or the alcoholic who must have one more drink. If this comparison seems too harsh, think about how many people you know, including yourself, who have endangered their health through their eating habits. This is what we are up against when we battle food addiction. On some level we learned the behavior as adults or in our youth, but it goes even deeper than that; food addiction goes deeper than nicotine, alcohol or cocaine ever could. We need food to survive; it is even mixed with happiness in our infancy. Unlearning food addiction, or better yet, rebalancing your relationship to food, for this reason is not a simple process. It's not just a matter of reading one article and being cured. And you obviously can't go cold turkey from food to sober up!

Nevertheless, you do not need food to handle your emotions, your stress, or your internal critic; you do not need to overeat to handle your life; you do not need to overeat to make things feel okay, although it probably feels like you do. The process of breaking food addiction is learning that you don't need to overeat to be okay. It's usually a rocky road, but you can succeed.

The First Step: Confronting Denial
Everyone who is addicted to food in the way we have been discussing has the same starting point in this healing process.
You know, but you don't really know.

That is to say, you are living with a big internal contradiction about your addictive relationship to food. Some may call it denial. You know there's a problem, and you know you know. But, you know you are afraid to dig to find out what is below the surface. You may be reluctant to go there, but you are not in denial that you need to go there. If you were in total denial, you probably wouldn't be reading this right now.

Let me tell you about Kaisa, who is a 49-year old married woman, who at 5'4' weighs 202 pounds. She said the following as I began to help her with emotional eating and food addiction:
"I am generally quite a happy person, living a fulfilled life. Why then is there a feeling of being unfulfilled in me that seems to be fulfilled only by sweet carbohydrates? I just can't imagine a day without dessert. Without having a dessert I would be anxious and missing something for the rest of the evening."

As a psychiatrist, the first thing I see in this statement is the addiction. She may indeed be a happy person, but she is also an addicted person who is trying to get rid of the feeling of being unfulfilled. And from my way of thinking this is a contradiction. She may be happy on the surface, but she is covering up something important, something that just doesn't go away for very long.

The second thing I see is the illusion of safety that dessert delivers. "I would be anxious and missing something for the rest of the evening." Those pieces of cake are powerful medications that operate on the placebo principle. If you think it will work, it will work for a while, as long as you continue to believe. But it's not the sugar that is the medication. Sugar doesn't have those medicinal properties. It's the symbol or the meaning of the sugar that is at work to create the illusion of warding off the anxiety.

I knew from experience that at this point in the process I could never convince Kaisa to experiment and give up her cake to see what would happen - to see if she will really have uncontrollable anxiety for the rest of the evening without this placebo prop. She wouldn't do it. She was terrified by the prospect of out of control anxiety. She knew there was a problem. She knew she knew. But, she was scared to go any further.

Let's examine another starting point. Helen, a housewife in her early thirties, said this about her eating habits:
"I don't keep my weight in mind when I sit down to a gourmet meal, so I eat as much as I want to. Therefore, I don't control my portions. I don't listen to my body and eat not only to satisfy my hunger, but mostly for the pleasure of eating, that I want to prolong. My diet is not well balanced, because I eat too many sweets."

This is what I see in case after case. Dieters like Helen have enough information to analyze a situation and give advice to themselves, but that is not enough to be able to do something. It's only a baby step in that direction; it's a little bit more knowledge, a little bit more consciousness, but it's still just scratching the surface.

That's the position I find almost everybody who starts this process and I presume that is where you are. They know there's a problem, but they are afraid of moving forward or getting everything out in the open.

While working with Kaisa, I helped her think about what it would be like if she didn't begin to change her eating habits. Here's her sober prediction of the future if she doesn't make these changes. She wrote:
"I would simply not lose weight or even gain weight. I will focus more and more on eating as a source of pleasure this will diminish me as a human being and

prevent me from growing and focusing on things that are worth it. I will feel out of control. My self-esteem will diminish. I would hate every morning, waking up and realizing how I look like and having to put on clothes that are too small and too tight. I will be afraid of food instead of enjoying it."

This negative vision of the future is a strong motivator to do something in the present but it is still not strong enough to combat the compulsion to over eat below the surface. The hope for success and the vision of what failure means has been there for years and hasn't done the job.

As our worked moved on, Kaisa realized she was not just a happy person who had a compulsion to eat too many sweets. There was much more to the picture. She realized she overate whenever she was depressed, bored, or feeling empty. She ate too much when her children clung to her, when her husband neglected or ignored her, when she had no one to talk to. She wrote about one specific incident right after it happened so it has a fresh feel to it. She said:
"I got home from work today and no one was there. I had a medium sized dinner and decided to have dessert. Right now, unfortunately, I can't imagine my day without dessert. So I had it, and instead of one piece that at this point of life I'm allowing myself to have, I had two pieces of cake. I know that with two pieces of cake a day I am not going to lose weight. I didn't even keep my weight in mind while I was eating. I just lived in the present and thought only about the pleasure and satisfaction and feeling fulfilled by that dessert. I probably would have had only one dessert if someone was there, but since no one was there, I had two."

As I talked to Kaisa about this incident, it became more and more apparent that she would eat when no one was there because she was lonely. As she began to let this secret out of her, as she began to acknowledge this fact, and as she snipped the last threads of denial, she began to really make progress.

Think about your own state of denial. What part of your relationship to food are you aware of but reluctant to acknowledge out in the open? Don't let this exercise lead you to despair. Just try to let some secrets out of the bag. It will help.

Everyone who is still addicted is in some form of denial because that denial fends off a worse feeling, the feeling of helplessness and hopelessness, which probably feels like a vague but powerful shadow hanging over your life. The denial has a twisted logic that goes something like this: "Why know all about something that I can't do anything about." But as you continue on in this forum, and continue on your path to recovery, I hope to show you that you can do something about this addiction, and that you are not helpless, and the problem is not hopeless. You can unlearn emotional eating, but the first step is to get past this hopelessness and to start letting go of denial.

The Second Step: The 12 Types of Emotional Hunger
The second step to stopping food addiction is to become familiar with the 12 types of emotional hunger. The more you can "see" your own reasons to continue your addiction to food, the more clear you will be that there is something you can do about it, even though you will probably need some form of help and guidance to do it well and effectively.

Through my research and practice, I've identified 12 distinct sources of emotional hunger, each driven by a different type of motivation. These different types of emotional hunger are what fuel emotional eating patterns, make you overeat, and until they are handled without food, will keep your food addiction alive. You'll probably recognize some of these motivations easily, while others will seem less applicable to your life. Some of these may not apply to you, which is good. However, battling just one of these can be difficult.

Type 1. Dulling The Pain With The Food Trance.
If you get hungry when you feel angry, depressed, anxious, bored, or lonely, you suffer from Type 1 emotional hunger, and you use food to dull the pain that these emotions cause.

Type 2. Sticks And Stones May Break Your Bones, But Cake Won't Heal What Hurts You.
If you react by getting hungry when others talk down to you, take advantage of you, belittle you or take you for granted, then you suffer from Type 2 emotional hunger. You eat to avoid confrontation.

Type 3. A Full Heart Fills An Empty Belly.
If you crave food when you have tension in your close relationships, you suffer from Type 3 emotional hunger. You eat to avoid feeling the pain of rejection or anger.

Type 4. Hate Yourself, Love Your Munchies.
If you tend to become hypercritical of yourself, if you label yourself "stupid," "lazy," or "a loser," you have Type 4 emotional hunger. You eat to "stuff down" your self-hatred.

Type 5. Secret Desires Have No Calories.
If your hunger gets activated because your intimate relationships don't satisfy some basic need like trust or security, you suffer from Type 5 emotional hunger and you use food to try to fill the gap.

Type 6. Forty Million Big Gulps And The Well Is Still Empty.
If you stuff yourself to make up for the deprivation you experienced as a child, you have Type 6 emotional eating.

Type 7. It's My Pastry, and I'll Eat If I Want To.
If you eat to assert your independence because you don't want anyone telling you what to do, you have Type 7 emotional hunger.

Type 8. I Can't Come To Work Today—I'm Too Fat.
If your appetite kicks in when you're faced with new challenges—if you use food to avoid rising to the test, or to insulate yourself from the fear of failure—you have Type 8 emotional hunger.

Type 9. Aroused by Aromas, Not by the Chef.
If you eat in order to avoid your sexuality—either to stay fat so that nobody desires you or to hide from intimate encounters—you suffer from Type 9 emotional eating.

Type 10. I'll Beat You With this Éclair.
Type 10 emotional eaters stuff themselves to pay back those who have hurt them, often in the distant past. They use their bodies as battlegrounds for working out old resentments.

Type 11. Peter Pan and the Peanut Butter Cookie.
If you eat to make yourself feel carefree, like a child, you have Type 11 emotional hunger. You eat to keep yourself from facing the challenges of growing up.

Type 12. That Stranger In Lycra Wearing Your Face.
If you overeat because you fear getting thin, either consciously or unconsciously, you have Type 12 emotional hunger.

Experience has shown me that you can't treat all of these very different motivations in the same way—each requires a distinct strategy. For instance, if people have talked down to you all your life, you might have become sensitive to that behavior, and your hunger gets triggered whenever someone belittles or patronizes you. You eat to give yourself comfort, to lessen the sting of insult.

First you shut down, and then you eat. Your strategy will involve finding the appropriate behavior to address the grievance directly. On the other hand, if you overeat because you want to avoid sexual intimacy, you have a very different set of motivations, and you'll need to do a different type of work.

I suggest you read over this list several times. Try to think of times that these types of emotional hunger drove you to eat. The more you are familiar with these different types, the easier it will be to recognize them in the future, which means you'll have more control!

Now that you've read this article and thought about it a little, it's time for you to personally evaluate how it applies to your life. Below are some questions and activities that you should answer and do before the next article is posted. Taking these questions and activities seriously will help you get a better understanding of emotional eating.

  1. Can you identify a time when you began to seek food for comfort? What was happening in your life at the time? If you can't remember when you started using food for comfort, try to describe time when this habit intensified or became more severe.
  2. How would you feel if you had to give up the habit of eating when upset emotionally? Describe what your life might feel like. Part of you probably says that you'll be fine, but what does the other part say? What does the part of you that's scared of giving up emotional eating say?
  3. What part of your relationship with food are you in denial about? Which part would you rather not know about? How might you get this out in the open to yourself? What would happen if you did this?
  4. Which of the 12 types of emotional hunger do you suffer from most? What are some ways you could begin to change your habit of eating when faced with emotional hunger like this?

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