CHAPTER 1

To Eat or Not to Eat, That Is the Obsession

Nowadays, the person who is able to eat freely and enjoy her dining experiences from day to day, unhampered by guilt, anxiety and a dozen other pressures, is truly an exception. If you ever come across a person like this, don't you hate her? Almost everyone is, at the very least it seems, watching her weight. Most of us have lost our love of food and eating. It has been contaminated by guilts, superstitions, prejudices, false information, undocumented beliefs, crazy body-image standards, fashion pressures, diet madness, excessive and contradictory research studies, and, especially, fear. We are afraid of food. We are afraid of food. We believe it makes people fat and that, if we don't stay on guard, it will make us fat, too (if we aren't already so, to some degree).

We are, almost as a nation, obsessed with eating less! The calorie is synonymous with evil, and fat grams have come to represent the very measure of success or failure in foods -- an inverse relationship, of course. Terms like "low-fat," "low-calorie," "light" or "lean" are an integral part of our vocabularies. We think, talk and read these terms and concepts, meditating on their meaning and influence on our bodies. Eat light, eat less, eat low-fat, we say, if we're among the "liberals" who condone eating at all. We are obsessed this way because we are all afraid of getting fat and we are all positive that too much food, by itself, makes people fat.

But where's all this food avoidance, fat phobia and calorie obsession leading, anyway? For a growing number of people, straight to eating problems.

By the time she was forty-three, Paula had dieted, one way or another, for twenty-five years. In that time she had joined Weight Watchers over ten times, tried Jenny Craig, gave Weight Loss Center two efforts and Optifast just one (because it was so expensive), and attended seven years of regular Overeaters Anonymous meetings. In addition, she had read dozens of books and magazine articles in her attempts to control her eating.

Paula was an expert on nutrition. She knew so much about food groups, calories and fat grams that she could have started her own consulting business, Diet Madness, Inc. She knew by heart and in her sleep what she should eat, exactly how much and when, according to the experts. Paula was queen of portion control and truly gifted at policing fat grams. She had been trying to eat less, eat light, eat low-fat all her adult life. And she had been losing control of her eating for just about as long. Paula couldn't remember back to a time when she wasn't preoccupied with her eating and her weight. Over the years she learned multitudes of diet skills and tips, hints and tricks. And now Paula was heavier and more desperate than she had ever been in her life.

Let's not forget the "enlightened" wave of the nineties: diets don't work in the long run so exercise is the answer! And since most people today have passed through the anti-eating culture of the seventies and eighties, many are adding exercise to their deeply ingrained habits of avoiding food. Work that body fat, jog that belly off, burn that blubber with aerobics! And where are all these underfed, overworked bodies headed? Once again, more and more are headed toward disturbed eating patterns and straight into "food jail."

Just after she turned thirty, Arlene started working out with her boyfriend, who was an avid weight lifter. After they broke up she discovered she had learned to love exercise. At first she just felt sort of a natural high when she finished her aerobics class, but later Arlene noticed that her stomach was getting flatter. That was a plus she hadn't expected. Not long after she was "single" again, one of the personal trainers embarrassed her by making a friendly comment about how great she looked. Arlene was flattered. No one had ever really noticed her in this way before. Why not help the process along with a little dieting? She thought, so the fruit and salads began to replace the sandwiches and pasta.

The Friday night of the first week into her new diet/exercise program, Arlene thought about ice cream as she watched TV. She had never into sweets much, so this was unusual for her. Oh, just a little. I've been so good, she rationalized.

Thirty minutes and a quart of Rocky Road later, Arlene was surprised and a little afraid. A quart of ice cream! What happened? At first she felt confused, but quickly shifted her attitude to determination. Tomorrow I'll work out two hours and just have juice for breakfast, she promised. And she did. Nothing but a Caesar salad for lunch and plenty of mineral water to keep the hunger under control. But after a dinner of broiled fish that night at a restaurant she found herself eating the leftover fries from her friends' plates and drinking four beers. French fries were definitely forbidden for Arlene. And beer, well, one was usually enough. Under the influence of the beer, and her nagging hunger, Arlene topped it all off with a big fudge brownie delight, complete with ice cream and hot fudge.

Arlene looked at herself in the mirror in the ladies' room at the restaurant and felt disgusted. What is wrong with me, anyway? she wondered. I I've got to get rid of this feeling -- I'm completely stuffed. I can't stand feeling this full. I'll just throw up this once, then get back in control. My college roommate did it all the time and it never hurt her.

Of course, if we are already fat, we've proven it to ourselves repeatedly: food and lack of exercise have made us fat. We stand as a warning to others: Beware! This will happen to you, too, if you eat too much and/or drop your aerobics class. Those who are already overweight are sometimes the most afraid of eating because they stand as a nonstop warning to themselves: The pounds and bulges will keep piling on if you don't stop eating so much. Eat less! Don't eat at all if you can help it! You're not that hungry. Get some exercise. What's the matter with you?

Is there another way? Is there hope? Is it possible for us to befriend food without getting fat? Is there a way to improve our diets without going off the deep end? Can we ever get back to enjoying the natural, lifelong pleasure of eating? Can exercise ever be enjoyable, free of obsessive pressures and fears? And the most important question of all: Can we learn to enjoy eating plenty of good food, have moderate activity levels and be thin, too?

To all of these queries, I answer a resounding YES! Keep reading. The "hows" are just ahead.

THE WRONG TREE

At the heart of all this confusion about food, weight gain and eating struggles lies a very real problem -- prejudice, even among professionals and researchers, about the cause of overweight and eating disorders.

For decades we have been taught that overeating and underexercise cause overweight, and that psychological problems cause eating disorders. I believe these two presumptions are overly ] simplistic and incorrect, and account for the immense frustration within this field of study and among the millions of people who suffer from eating and weight problems. We have truly been barking up the wrong tree in this important field of human behavior, with extremely serious consequences to both mental and physical health for millions of us.

Complete with plenty of diet advertisements, and occasionally an ad for an eating disorders treatment facility,popular women's magazines rarely fail to highlight a weight-loss method on the cover or tell some celebrity's story of weight loss, weight gain or eating disorder. These topics ensure sales because editors know what women are obsessed with. We seem to have an insatiable appetite for information about dieting, weight loss and eating problems, but what we're being fed is almost all junk food.

Everyone in this culture has been programmed by the media and especially by health professionals (who inform the media) to believe that fat people need to eat less and exercise more, and people with eating problems need to see a therapist. Moms and dads learn it from newspaper articles and doctors, and pass it on to their children. Teachers teach it, preachers preach it. There isn't a shadow of a doubt about these two sacred tenets in most people's minds, especially in those who are overweight or eating disturbed themselves. (The term "eating disturbed" applies to anyone for whom eating has become a problem.) The funny thing is, these well-established approaches rarely lead to cures. They cause a lot of people to work hard and dole out plenty of money off and on over decades, but they just never manage to correct the problems they're designed to remedy. In fact, they often make them worse! The reason is simple: The theories behind these treatment methods are not completely true, so the methods cannot succeed. They are more likely to backfire.

Although the physicians, therapists and other professionals who work with this clientele may be committed, caring people who make sincere efforts in their roles, they are so misled in their understanding of the problems they treat that, like their clients, their struggles usually bear little fruit.

Let's take a look at some specific eating problems, from the traditional descriptions as well as from some newer popular terms and definitions. This will help you identify your own symptoms and later, in Chapter 3, learn why you experience them.

EATING DISTURBANCES -- WHAT'S WHAT?

Along with the traditional definitions of the best-known eating disorders, anorexia and bulimia, we'll discuss some popular descriptive labels: bulimarexia, compulsive undereating, compulsive overeating (including emotional overeating), food addiction and the new, broader term "eating disturbance."

Anorexia Nervosa

"Anorexia" simply means "without appetite," and "nervosa" means "mental in origin." This lack of appetite is the hallmark of anorexia, but it is a bit misleading. Although it appears that anorectics do not experience hunger because they eat so little, most do get hungry and at times their hunger is so extreme that it frightens them. Although anorectics experience mental symptoms, I believe these symptoms do not cause anorexia. Instead, they usually result from self-starvation.

Here's a checklist of the symptoms usually associated with anorexia. Check any symptom that applies to you.

Symptoms of Anorexia Nervosa

-- Self-starvation, chronic undereating

-- Obsession with being thin

-- Refusal to maintain body weight within normal limits

-- Weight loss 15 percent or more below normal limits

-- Failure to gain weight appropriate for body growth

-- Intense fear of gaining weight or becoming fat

-- Body-image disturbance; a claim to feeling fat even though underweight or emaciated

-- Absence of three consecutive menstrual cycles (without other cause)

-- Abuse of laxatives and diuretics to control weight

-- Purging of food by excessive exercise or self-induced vomiting -- after eating

Marianne became concerned about her eating when she was just twelve. About a year after she started to develop breasts and hips, she saw a TV program about our country's high-fat diet and abruptly decided to go low-fat in her own eating. At first she continued to eat with her family, avoiding fatty foods, but after a while nothing her parents served was acceptably low-fat for her. She grew preoccupied with eating and food preparation. She developed strict rules and standards for food quality, gradually lowering the fat in her diet until it was absent. She started jogging. Her appetite became erratic. She skipped meals, sometimes going all day on a few rice cakes or crackers. She lost weight. At five feet and 105 pounds, Marianne was never big to begin with, but she liked feeling smaller because she felt more comfortable åround her slim girlfriends. This fueled her anti-eating and exercise efforts even more.

Marianne's parents began to argue with her, suggesting that she eat a little more and relax her strict rules. Eventually she wouldn't talk about her eating with anyone. She seemed locked in a world of her own determination. Eight months and twenty-two pounds later, Marianne seemed to have wandered into a hopeless pattern, beyond help. She insisted she was much too fat, but her bones were visible everywhere.

Anorectics, like many other people with eating disturbances, are usually "experts" on nutrition, capable of listing the calorie and fat contents of dozens and sometimes hundreds of foods. They talk, think, read and worry about food; and hoard it. Their world revolves around the topics of food and eating while they carefully and persistently avoid taking any substantial nourishment into their bodies. They may even prepare elaborate meals for others, spending hours at the grocery store and in the kitchen, but then refuse even to taste their culinary creations. It is the intensity of theiir fear of weight gain, coupled with their success at avoiding food, that sets anorectics apart from those suffering from other eating struggles.

Bulimia

"Bulimia" means "a constant and insatiable craving for food." This extreme sensation of hunger causes anxiety and even panic for those who are fearful of becoming overweight because they know that satisfaction of this morbid hunger will lead to weight gain. Loss of control over their appetites triggers bulimic bingeing, and panic about gaining weight prompts purging. Many popular medical reference books refer to bulimia as an emotional disorder, but I haven't found that theory valid in my work.

Here's the symptoms checklist for bulimia or compulsive overeating. Check each symptom that applies to you.

Symptoms of Bulimia

-- Strict dieting or fasting to control weight

-- Recurrent episodes of binge eating (consuming large amounts of food in a short time)

-- A loss of control over eating behavior

-- Self-induced vomiting, use of laxatives or diuretics, vigorous exercise and/or use of amphetamines to control weight

-- Preoccupation with diet, weight and body image

-- Distorted body image

Like anorexia, the number-one symptom of bulimia is undereating --eating significantly less food than you need. Bulimics are just as afraid of being fat as anorectics, but they are less successful at staying away from food. They are determined to control their eating by strict food avoidance and often develop elaborate rules and systems, just like anorectics, but they lose control of their eating in spite of their determination and because of their misguided efforts. Compulsive overeaters have all the symptoms of bulimia, except they may not purge.

Bulimics may be underweight, overweight or of normal weight. Many bulimics have been anorectic, and vice versa.

Bulimarexia

This self-descriptive term is relatively new. One definition for "bulimarexia" is "a psychological disorder in which a person alternates between an abnormal craving for food and an aversion to it, found especially among young women." In my experience, this condition is always accompanied by strict dieting, food phobia and avoidance, and obsession with food and eating. It's really no more "psychological" than dieting! This term is often used interchangeably with anorexia or bulimia. More on bulimarexia at the end of this chapter.

THE COMMON DENOMINATOR IN EATING DISORDERS -- DIETING

I have never met an overeater who wasn't also an undereater -- eating less food than she needs at times. I have never met an undereater who wasn't afraid of food because of traditional diet propaganda: that eating less and food avoidance are the keys to weight control. Every eating disturbance that I have encountered in more than five hundred clients started with dieting. And I have observed that most typical dieters suffer from at least some symptoms of bulimia.

Linda began her dieting efforts rather innocently after her first baby was born. Just two weeks postpartum, she was still about thirty pounds overweight and fearful of never losing it, like her mother. So Linda joined Weight Watchers and enjoyed her early success -- a ten-pound loss in just three weeks. This is easier than I thought it would be, she reflected. But two weeks later Linda found herself raiding the refrigerator in the middle of the night -- Swiss cheese and mayonnaise and chips and ice cream. This raid happened nearly every night, although Linda had never been a nocturnal eater before. In spite of these binges, she lost twelve pounds. When she plateaued, she cut down even more on her meal portions. She tried skipping her snacks, drinking diet pop instead. But her weight wouldn't budge. "You must be cheating," her counselor accused her. She was cheating. She was eating less than she was supposed to be.

One meeting day about three months into her very hungry diet, Linda "weighed in" and the scale showed a two-pound gain. That did it. After the meeting she went straight to the bakery across the street and bought a dozen huge caramel sweet rolls that were full of pecans. Linda sat in her car and began to eat the pastries, one after another, in rapid succession. She ate every last one and felt like a giant caramel roll herself. She caught a glimpse of herself in the mirror with her cheeks stuffed to capacity and the caramel dripping down her chin. This is one of those binges, she thought. I'm becoming an emotional overeater. I got so upset about the weight gain that I stuffed myself.

Embarrassed to return to Weight Watchers, Linda decided to try cutting down on her own. She found staying away from food altogether even easier in some ways than controlled eating. So most of the day she just skipped any serious food and sipped low-or no-calorie drinks. The only problem was in the evening. Her hunger seemed to get the best of her then, and she often lost control of her appetite, overeating the worst foods possible: chips, dips, ice cream, cookies and peanut butter. Now and then Linda would eat an entire pan of brownies or fudge, driven by a compulsive urge that she didn't understand. As her weight increased gradually, Linda's efforts doubled and she began a round of local diet programs. It didn't matter what program she tried, sooner or later the bingeing would creep back in. She simply could not control it indefinitely. Finally, out of desperation, Linda joined Overeaters Anonymous, where she learned that she was "addicted to food."

With researchers and "experts" leading the way, we have developed some superficially logical psychological theories to explain bizarre eating patterns. Although anorexia and bulimia seem to be very mysterious and complicated (as psycho-emotional problems can be), and have historically been classified as mental disorders, I will explore a simpler formula behind the development of these disorders: a desire to be thin that leads to undereating that leads to eating disturbances. It is this simple equation that links all these sick eating patterns together and promises to shed new light on their common physical cause.

LOVE HUNGER OR FOOD HUNGER?

The symptoms of eating disturbances we've looked at never seem to develop in people who aren't trying to get or stay thin by ignoring their hunger and eating less food than they need. The desire to be thin that motivates undereating occurs in a culture which equates thinness with success and unilaterally rejects people who are overweight, so it's not too hard to understand why people want to be thin or fear weight gain. What may be hard for some people to understand is the degree of self-destruction to which a person will go on this road to a fat-free body.

Eating problems appear to be psycho-emotional in nature because, as many of us know, people with eating disorders can get so weird! But the eating disturbed really aren't as weird as they act, considering their dilemma. The physical nature of that dilemma is explored in Chapter 2.

It is the understandable desire for thinness, coupled with a gross misunderstanding about the real cause of weight gain, that sets highly motivated individuals up for bizarre eating patterns that threaten their health and vitality. Emotional troubles and unmet psychological needs are not at the heart of crazy eating habits. Fear of food and undereating are. People with eating problems may or may not have enough love in their lives, but one thing is certain: they do not have enough good food when they need it.

Compulsive Undereating

Although this term sounds suspiciously like a synonym for anorexia, it isn't. Compulsive undereating refers to the chronic urge to avoid food, eat less than you want or restrict your eating in other ways, in order to control weight. I have found that the label "compulsive undereater" usually applies to anyone who seriously adopts traditional diet principles, and this includes a huge population, especially women. Diet methods train individuals in compulsive undereating. And it is compulsive undereating that propels the vicious Feast or Famine Cycle (see Chapter 3), and all the eating disturbances associated with that cycle.

Compulsive Overeating and Emotional Overeating

These labels are used as a self-diagnosis by many who regularly lose control of their eating and overeat or binge compulsively, often in response to emotional stress. Overeaters Anonymous has helped make the term "compulsive overeater" popular, since members often use it to refer to their alleged addiction. The term is used interchangeably with "food addiction" (which is discussed in the next section, along with more about OA).

I have discovered a very interesting irony in counseling clients from this group. Compulsive overeaters are always very much aware of their overeating behavior and readily admit that it is a problem. Often the evidence is rather obvious. But these bingers just as certainly have another symptom which they almost never identify: compulsive undereating.

Compulsive overeaters rarely recognize that undereating is part of their disorder, but it is just as pathological as its opposite and actually lies at the root of the disturbed eating pattern. Because undereating, unlike overeating, doesn't show up on the body, it is harder to see as part of the problem. Besides, who would ever imagine that an overweight person could actually be eating less than, she should? It doesn't seem to make sense until you really sit down and think it through, which is exactly what we're going to do in the next two chapters. The critical relationship between these two polar symptoms is the key to understanding eating disturbances.

But why do compulsive overeaters so often start a binge under the influence of heavy emotions? Isn't that proof that their eating disorder is psychological?

All people experience stressful emotions at times, but most don't overeat as a response because the natural physiological reaction to stress is a loss of appetite, not its stimulation. Eating is actually stressful to the body, and digestion will be delayed when more pressures are present. But this normal response is contingent on the eating habits of the individual, so that only when a person is well fed does the appetite tend to shut down under stress.

By contrast, when a person who is underfed suffers emotional stress, a paradox occurs. Rather than representing an additional stress to the body, eating for the underfed is a stress relief, promising to solve at least the chronic, underlying problem of inadequate fuel intake. So emotional problems and other forms of stress provoke chronic undereaters to eat and often overeat. Their bodies are simply using the stress as an opportunity for catching up on their inadequate eating.

Food Addiction

Many people consider themselves food addicted, usually as a result of their affiliation with Overeaters Anonymous. OA is an organization based on the same recovery principles as Alcoholics Anonymous. Instead of alcohol addiction, OA members deal with what they consider an addiction to food, which they also call compulsive overeating. The concept of food addiction is very appealing to many people whose eating behavior feels out of control, compulsive and impossible to explain. Many professionals are engaged in therapies based on this addiction model because they, too, see compulsive overeating and bingeing as inexplicable by another means.

The only problem with this approach is that it is completely unfounded and does nothing to help people normalize their eating behavior or their body weights. People find some much-needed camaraderie and support for their feelings of isolation and despair at OA meetings, but most of the ideas about eating control are superstitious and the counsel shared is typically unsubstantiated diet propaganda. I know I am desecrating a holy cow here because many dejected dieters are extremely loyal to OA. For them it has been the only place left to turn in the hopelessness of dietland failure. But along with positive stories of support, I have heard some alarming reports of OA tactics designed to motivate "food-addicted" members to stay away from food, based on theories that inspire even more fear in these already fear-ridden people.

rdIf you really think you are, in a way somehow unlike normal people, addicted to a substance you must have every day in order to survive, you are doomed to a cycle of fear/control/avoidance/loss of control/fear. This cycle will be described and illustrated thoroughly in Chapter 3.

Everyone is addicted to food, and to air and water, for that matter. We would all suffer withdrawal symptoms if any of these substances was restricted below our needs. In fact, the withdrawal symptoms associated with food restriction are exactly what this book is about.

But why would some people think of themselves as food addicts in a special way? What makes this "diagnosis" seem so right? And what makes even professionals buy this food-addiction theory?

Eating Out of Control

People who consider themselves food addicted describe their symptoms: uncontrollable cravings for food (usually sweets and rich foods); bingeing or eating huge amounts of food at a time (usually forbidden food); obsession and preoccupation with food; fantasizing about food and eating; feeling "high" during or after food binges; depression and/or irritability during binges or periods of abstinence; terrible guilt about eating; inability to control eating once it gets started; inability to stay away from "bad" food; serious physical, emotional and social consequences of overeating. Doesn't this sound like "foodaholism"? Indeed it does, but it isn't. It just sounds like it.

There are physical reasons for these symptoms, which, by the way, are reported to some degree by most dieters. People who have these symptoms are no more food addicted than people who don't. The main difference between the two groups is this: people with these symptoms are trying to avoid eating a good part of the time and those without symptoms are eating. What's behind these so- called food-addiction symptoms will be discussed at length in Chapter 3.

Self-Check: What Have You Been Taught?

Check off any question that applies to you.

-- Have you been told that your eating problems are about your dysfunctional family?

-- Did anyone ever suggest that your mother's using food as a reward when you were a child caused your compulsive eating?

-- Have you been "helped to discover" what purpose your extra fat plays in protecting you from something bad that happened in your past?

-- Was it ever pointed out to you that your eating behavior is connected to your sexual hang-ups?

-- Were you ever told that your overeating is about your fear of men? Of women? Of sex?

-- Have you sought help for your disturbed eating patterns from a therapist and learned all sorts of interesting psycho-emotional reasons for your disorder, such as every problem you ever had?

-- Have you tried any spiritual remedies, such as prayer or meditation, for your eating problems?

-- Have you been labeled a food addict, a foodaholic, a compulsive overeater, a glutton? Other words?

Has any of this helped you get your eating back to normal?

I didn't think so. It's been my experience that most people afflicted with eating struggles have psychological problems, and sometimes serious ones. And virtually all, I have observed, suffer emotional and mental consequences of their bizarre eating patterns. One universally cited symptom associated with eating disorders is anxiety -- about food, about eating, about weight gain. That certainly is a predominant psychological feature. But are rational fears really symptoms? And is it abnormal for overly hungry people to have emotional distress over food?

OVEREATING -- A SYMPTOM, NOT THE CAUSE

Overeating has been identified as the singular cause of weight gain, and if it really is we are left to explain the cause of the overeating. Here is where all our colorful theories come in. What makes people eat too much, especially when they know that overeating will make them fat? Since everybody rejects fat people, it must be something very powerful that compels a behavior that causes weight gain. Aha! It must be deep-seated needs, like love. Or perhaps deep-seated hurts, like childhood trauma. Or maybe deep-seated issues, like sexuality. Yes, these things could do it! And voilà! The clients we counsel, one after another, just happen to have at least one of these deep- seated problems. Aren't we smart?

I have discovered that overeating, by itself, is not the cause of overweight but merely a symptom of an underlying problem. In fact, overeating is a healthy, normal response to this problem: undereating. I believe that undereating provokes compensatory overeating, preoccupation with food and all the symptoms of eating disturbance. These symptoms are really manifestations of adaptation -- the body's survival system -- designed to keep body and soul together under stressful environmental conditions. Lack of food is one such condition that forces the body to make changes, sometimes rather drastic ones, for survival's sake.

Undereating, food avoidance, portion control and meal-skipping because of busy schedules all inspire the adaptive make-up eating and preoccupation with food that we have all experienced. There's nothing psychological about it until we start feeling guilty and ashamed about overeating. And that comes from a lack of understanding. If we only knew that food isn't really the problem but the solution we just might have a chance to get over our fear of eating and get on with developing a normal relationship with food. Wouldn't that be something? It's all coming up, so keep reading.

Almost every psychologist and psychiatrist whom I know of reflects a confidence in the theory that aberrant eating behavior is psychogenic in origin. In fact, every individual I have ever interviewed who had a history of an eating disorder has confirmed that she learned from professionals or from books that her trouble with eating was originally caused by, and continued because of, psychological disturbance. Not one, however, reported significant or lasting relief from symptoms as a result of psychological or behavioral therapies as long as her undereating efforts continued.

In her third year of college, Patti finally sought help for her long-standing struggle with bulimia. She was beginning to feel some serious physical effects -- muscle weakness, heart palpitations, occasional light-headedness and trouble concentrating. The psychologist to whom Patti went, after two sessions that covered her family history, sexual development and relationships with men, told her that she was in a depression and suggested she see a psychiatrist for an anti-depressant medication.

The next six months Patti went faithfully to her therapist. She took the anti-depressant and thought it made her feel better. She talked and talked about her feelings, dreams, hurts and struggles week after week. She never missed. Finally, the therapist began to gently explore with Patti the "significance" of her binge/purge behavior. She told Patti that repressed anger was often a trigger for bulimic behavior, and perhaps Patti would be interested in doing some "anger work." Then again, Patti had some sexual issues that might be coming out in her bulimia. Would she like to explore that possibility?

Gradually, Patti felt better, at least emotionally. The medication was probably helping. Physically, she was dragging a bit and still eating and purging as crazily as ever. Little the counselor had said about her emotional problems really rang true to Patti, except maybe the anger with her father. But she just wasn't into it, so she quit.

If eating problems really do have a psychological basis, why do almost all victims fail to gain lasting relief from their eating disturbances even after years of therapy? And how could so many individuals benefit so dramatically from a program, outlined in my first book, that is not psychological at all, but physical both in theory and in practical application? I am not implying that psychotherapy is not indicated or ever beneficial for some people when they suffer from disturbed eating, especially for other problem areas of life. It may be extremely helpful in some ways, but eating problems continue in spite of this progress when overall eating patterns are not addressed. I am suggesting that the theoretical connection between eating disorders and emotional problems is highly exaggerated, to the detriment of millions who suffer with eating afflictions.

EATING DISTURBANCES REDEFINED

The definition of eating disturbance that I use is this:

Any pattern of eating that interferes with a person's emotional, physical or social balance or health.

In other words, if your eating behavior or relationship with food is a problem for you, you have an eating disturbance. Of course, this definition would include the classic categories and the popular labels. Now forget all the technicalities that we've discussed before. Does this definition fit you? It's important to admit because that's the first step in getting well.

What's the Difference?

I have lumped all eating troubles together in my definition because I believe these disturbances all come from the same basic problem. All eating-disturbed people have several major symptoms in common and the most obvious one is abnormal eating behavior. The other symptoms they share, though not so apparent on the surface, are so similar that they ultimately blur the distinctions among the different categories. The evidence that best points to this breaking down of the distinctions between the classic eating disorders is the new term "bulimarexia."

If the main symptom of anorexia is lack of appetite, and the main symptom of bulimia is excessive appetite, then how can these disorders, which claim opposite central characteristics, possibly overlap? Isn't it remarkable that most anorectics also have symptoms associated with bulimia? Yes, it is. And is it just a coincidence that most bulimics also share the classic symptoms of anorexia? No, it isn't.

Flip Sides of the Same Coin

The term "bulimarexia" has been coined because anorexia and bulimia are flip sides of the same disorder. They share the same basic cause, which is undereating, and only a few symptoms separate these categories: degree of appetite experienced, success in controlling eating, and purging. But, as we've discovered, even these symptoms overlap. What's left to make these disorders separate? Not much.

The Connecting Cycle

Anorexia, bulimia, and all of the other eating disturbances described in this chapter are simply variations on the same cycle -- the Feast or Famine Cycle. The interesting discoveries that come from this cycle model are (1) the similarity of the eating and behavior patterns among the different disturbances, (2) the obvious consistency of symptoms between eating disturbances and the cycle, and (3) the common origin -- undereating -- among all eating disturbances.

The Feast or Famine Cycle is propelled by conscious attempts to undereat for weight control or by unconscious undereating habits (i.e., when schedules interfere with the availability of food). You're about to discover the powerful effect this cycle has on your body, your eating and your emotional life. Armed with this information, you can finally learn to eat normally and start enjoying a long and happy relationship with food.

Prerequisites to Breaking Out

If you really want to get your eating problems solved, you've got to shake off the victim role of the dieter and accept the personal power you have to change what you can now. You can't change your history, but you can carve out a different future for yourself. This is not going to be easy. Change for human beings is never easy. But if you want your life to be free of eating disturbances, you have to eat differently -- and you can.

Copyright © 1995 by Jean Antonello