When I was in middle school, I remember seeing a documentary on eating disorders. That was when I first learned that bulimia was a disease — and I was repulsed. I thought to myself:
Two years later, when I was in high school, I developed bulimia at age 15. And I felt crazy. I couldn’t control it — it controlled me. I eventually got treatment, but what eluded me for years was WHY I developed this problem. I’d seen half a dozen therapists over the years, and they all seemed to have their own theories:
While some of these statements rang true for me, it was hard for me to see a causal chain of reaction.
I would binge and purge even when I wasn’t stressed out, as well as during times when I was becoming more independent. My bulimia raged both when I felt purposeful in life, and during times when I had no problem expressing my emotions.
While bulimia may partially be about how someone interacts with the world and processes their experiences, I think that there’s more to the story.
And I got that missing the piece from the book Brain Over Binge by Kathryn Hansen.
It’s a best seller on Amazon with ~4.5 stars based on almost 400 rankings.
The book talks about something that doesn’t get brought into the fold nearly enough when trying to treat bulimia: what’s happening in the brain.
First, let’s take a look at what causes bulimia to start.
In many (not all, but most) cases, bulimia sets in when an adolescent girl starts dieting — as was the case for me. That’s a lot of people who are risk. One study showed that two in three high school aged girls in the U.S. try to lose weight. (1)
Let’s ask — why is that? Two reasons: biology and today’s beauty standard.
First, let’s talk about biology.
When puberty hits, hormonal changes send signals to the body saying, “Hey — time for mating display.” This surfaces not just in physical changes (breasts, hips, curves), but in psychological ones as well.
Adolescent girls have a biological drive to achieve the standard of beauty in their culture. The only problem is, that standard is unrealistic in the United States.
Just check out this Victoria’s Secret ad.
To be a Victoria’s angel, a 5’9” model is required to have a 24 inch waist. Slash be genetically blessed. (2)
When young girls try to achieve images like these by way of dieting, that’s when bulimia can set in. Let’s take a look at what happens to Betty.
Betty is in high school, and like many of her peers, decides to restrict her food to lose weight.
The problem is that when Betty diets and restricts food, her body reacts by craving it — which is why diets are unsustainable.
Most people quit and go back to their regular eating habits eventually. Food restriction is just too tolling.
Betty though is very determined. She continues to restrict her caloric intake, which makes her body’s cravings for food even stronger. Some people become numb to these cravings (cue anorexia).
But for many — including Betty — these cravings culminate in a binge – an adaptive response by the body.
Let’s take a closer look at what’s going on in Betty’s brain.
So what we have here are two brains in Betty’s head, fighting against each other. The high level cerebral cortex (“human brain”) is saying to restrict food, while the subcortex (“animal brain”) is craving more of it.
In the beginning, the cerebral cortex (“human brain”) wins most of the fights. But even the best boxers can’t have a career of no defeats. Eventually, the human brain gets fatigued and the subcortex (“animal brain”) wins out.
And because the animal brain is acting based on sheer survival instincts, Betty has a sense of being out of control when it takes the wheel.
Betty binges on high calorie food because her survival instincts drive her too.
But after a binge, the human brain steps in and surveys the damage. Deeply ashamed, the human brain plots a way to get rid of the excess calories. This can be in the form of excessive exercise, laxatives, or vomiting.
The problem is that this further food restriction makes the animal brain think that Betty is starving again. So to protect Betty, the animal brain sends out even more messages saying “eat, eat, eat, eat.” And because this has happened before, the message is even stronger.
A cycle ensues.
For Betty, that cycle is:
Betty doesn’t want to binge and purge. But she’s caught in this cycle and can’t get out.
Even if she decides that she doesn’t want to restrict her food anymore, and starts to give herself enough calories, the harmony between the human brain and animal brain has been disrupted. The animal brain will continue to send out cravings for a binge.
In studies of soldiers who were taken as Prisoners of War and starved, they would binge on food even after returning to a normal weight. The same was true for food-deprived lab rats.
Let’s now take a closer look at the stage when the animal brain wins over the human brain.
The human brain is a strong force, and when the animal brain does win out, it is often because there is something going on to compromise the human brain. Like:
- Lack of sleep
- A fight with a friend
- Being distracted
Or, there are times when the animal brain can get extra strong. For example, if Betty passes by a bakery, her animal brain might get extra activated because it has detected the high-calorie food it thinks Betty needs. This also might happen if Betty’s at a party and there’s lots of cookies and chips. Or if someone mentions cake.
These circumstances are called “triggers,” and they become part of Betty’s cycle.
That cycle becomes a neurologically embedded pattern. When neurons fire in a repeated sequence, the synapses get stronger, making it easier to transmit signals in that sequence again.
And so, similarly to the canines in the Pavlov’s Dog experiment, Betty’s animal brain becomes conditioned so that her triggers can short-circuit to cause desire to binge.
The road to recovery isn’t easy. The first step is for Betty to stop restricting her food. The cravings to binge will most likely still be there. But, as her human brain resists those cravings, the animal brain eventually learns to trust the human brain again.
Bulimia is a disease of the mind. It’s an illness caused by disharmony. And the only way to cure it is to make peace between the animal brain and the human brain. This can be especially challenging for adolescents, since the cerebral cortex (“human brain”) isn’t fully formed until age 25. (3)
For me, I was in my early twenties when I finally sought professional help. And as time went on, it became easier for my human brain to overcome the cravings to binge that were transmitted by my animal brain. And I think this is in part because as my human brain became fully developed, it was able to resist the impulses of my animal brain more easily.
Recovery isn’t easy. For a long time, I thought of the process as a battle. But that’s not true. Really, it’s a process of making peace. And if you are recovering from bulimia, I know you can do it.
(1) Brain Over Binge, page 126