AAT: The Purging Trap

In this chapter (which is located in the workbook 'appendix') author Linda Craighead explains why people, who want to compensate for breaking food rules, overeating or bingeing, choose to purge. She also discusses how purging undermines attempts to stop bingeing and eat normally, how to resist urges to compensate by purging, how some people choose to purge after eating small amounts and how to cope with planned binge/purge episodes. Above all, Linda emphasizes: "THE MOST IMPORTANT REASON TO STOP PURGING IS THAT IT ACTUALLY GIVES YOU PERMISSION TO BINGE. Purging ... keeps you stuck in the binge-purge pattern of bulimia. Bulimia is a difficult pattern to change ... (because) you are afraid to stop compensating until you stop binge eating, yet compensating undermines the very motivation you need to stop binge eating. Why stop at moderate fullness as long as you know you can compensate? How do you (escape) that vicious cycle?"

MOTIVATION TO PURGE: Deciding what to do after you think you have overeaten, broken a 'rule' or even binged is another point of intervention, where you can choose to return to normal eating or compensate with further restriction, exercise or even purging by vomiting or using laxatives. People choose to purge for 2 reasons:

(1) Purging gives you physical relief by reducing the pressure in your stomach after you binge eat very large amounts.

(2) Purging makes you feel better psychologically by reducing your guilt and your fear of weight gain, if you believe purging 'gets rid of' the calories you consume during a binge.

"BAD NEWS" ABOUT PURGING: Likewise purging greatly decrease your chances of losing weight or recovering from overeating or bingeing habits in several different ways.

(1) Purging seems to work in the short run. "If you overeat because you like the taste of food going down", purging provides immediate solutions to problems caused by overeating. However, like many short term solutions, purging causes long term health problems with increased purging and greatly decreased motivation to stop overeating or bingeing. Because purging initially may seem reasonable or even safe, "you start to rely on purging instead of relying on moderating your intake." If you give yourself permission to purge, you automatically give yourself permission to binge.

(2) Purging teaches your body to crave and tolerate larger and larger amounts of food, rather than learn to stop eating when you feel moderately full. "Your biology is not going to help you learn to prefer moderate fullness when you don't let it keep whatever food you eat ... You find it very hard to get satisfied. It seems like it takes a lot of food to feel full."

(3) Although the author mentioned 'research that suggest that repeated vomiting may result in delayed gastric emptying", I think that's a 'cause by correlation' suggestion. Repeated vomiting may be correlated with delayed gastric emptying, but not directly cause that. I learned from my personal experience that vomiting tends to cause more reflux by relaxing the lower esophageal valve (LEV) which, when closed, prevents reflux. Treating that reflux with acid blockers further reduces the amount of acid necessary to keep the LEV closed. Above all reduced stomach acid decreases the ability of the stomach to digest food. So less acid will cause the stomach to empty more slowly.

(4) Above all, purging to relieve discomfort after overeating or bingeing may mask gastrointestinal problems, caused by food intolerances or allergies. Only after I ignored my 'food rules' to eat whatever I craved and almost eliminated purging when I felt discomfort after eating, did I finally seek a diagnosis for excruciating gastrointestinal pain after eating. Then I was diagnosed with celiac disease (gluten intolerance) and 6 other (delayed reaction) food allergies. Did purging cause those diseases? Absolutely not! I inherited the celiac gene. So eating gluten, especially bingeing on gluten, caused reactions which damaged my gut and allowed other food allergies to develop. Nevertheless purging after overeating relieved discomfort that should have told me that certain foods caused problems.

GOOD NEWS ABOUT ABSTAINING FROM PURGING: "While you may not like how purging feels or its longterm effects on your health, you probably believe that purging is the only reason you have been able to lose weight or ... you are able to prevent weight gain." However, purging does NOT 'get rid of' all the calories you consume during binges. Above all, "treatment studies support the conclusion that few women gain weight when they stop purging". I would add that my weight stayed in a 3-5 pound range while I learned to eat normally (start when physically hungry and stop when physically full) but slowly decreased my binge/purge episodes from daily to once every 3-6 months. AAT teaches you to stop binges and overeating as well as reduce urges to compensate. "As your overeating decreases, you will have less motivation to purge, and as you resist purging, you will have more motivation to stop at moderate fullness."

RESIST THE URGE TO COMPENSATE:

(1) "Acknowledge that you have the urge to compensate ... (Remember) na urge is just a feeling ... you have a choice about how you want to respond to that feeling (or even) not to act on it.

(2) If the urge to compensate develops while you are still eating, "take action immediately to get away from any further opportunatiy to eat ... (with) the idea of purging in the back of your mind, it is much harder to resist eating more ... You think 'It doesn't really matter if I eat more, because I'm going to purge anyway.' ... if you (intend) to purge, it is better for you to (keep) the amount you eat small, (because) you are trying to become aware of your moderate fullness signal ... Every time you get stuffed, you are teaching your body to require larger amounts of food to feel satisfied ... If eating triggers a weak (purge) urge ... you will certainly feel even more likely to purge if you eat more. Above all resist the urge to (say) "what the heck and eat more ... (as well as) the urge to compensate (no matter what you have eaten."

(3) "Ride out the urge to compensate" with distraction, because "you do not want to focus on how uncomfortable your stomach feels." You can list distraction methods on an index card which you carry with you. You can put yourself in situations where purging is difficult, especially where you are with other people. Just as you can 'surf' urges to binge, notice that urges to compensate increase, plateau and diminish like waves. "Sometimes an urge will subside and return (repeatedly), but each time it crests and flattens out." Above all remind yourself that "compensation does not undo all the damage of binge eating ... purging makes you more likely to binge next time, because you still have permission to purge." When you refuse to compensate, you may retain a few more calories, but you will withdraw permission to binge, "so you will (take) far fewer calories in the long run."

PURGING AFTER EATING SMALL AMOUNTS OF FOOD: If you purge continue to purge when you are no longer bingeing ... you (may be) using purging ... to maintain a low weight ... you are not wiling to take the risk to see that ou can maintain your weight simply by eating normally ... To overcome your fear of weight gain, commit to not purge for 4 weeks without allowing yourself to weigh. Give your body a chance to show you that purging is doing nothing for you. You need ... (to give your body) this much time to restabilize its weight (and resolve) water retention problems.

PLANNED BINGE-PURGE EPISODES: "When you first started binge eating, you most likely idd not intend to purge (but) you just got so upset when you ate toomuch that you had to do something to feel less anxious ... (So) You started planning to purge whenver you binged." When you believe you can 'undo the binge by purging', you lose the motivation to limit what you eat. "Some women find it much easier to purge after eating large amounts, so once they decide they are going to purge, they eat more on purpose ... Some women experience the 'what the heck' response after purging ... (So) they may as well binge and purge some more ... often several times in sequence ... Once that pattern gets establish you may have to plan the whole episode ahead of time, because it may take several hours." There are 2 types of planned binge/purge episodes:

(1) In the first type, "you have strong urges to binge but you kep putting them off ... (however) you evenging get frustrated (by) trying to get those thoughts out of your mind. Since you have permission to purge, it starts to seem ... reasonable to just get it over with ... (and) you plan a binge/purge episode (hoping to) get some relief (or release) ... Planning this release actually helps you restrict prior to that time. IN ORDER TO REDUCE THIS TYPE OF PLANNED BINGE/PURGE EPISODE, PRACTICE MORE REGULAR ANTIDEPRIVATION EATING. "You must honor strong cravings to eat certain foods so your urges to binge does not build up to the point that you feel such intense pressure to give in."

(2) The second type of planned binge is a 'learned coping strategy ... (in which) you have learned to use bingeing as a way to numb or change negaive feelings and you also have permission to purge ... (So) this type of episode is a form of emotional eating." TO REDUCE THIS EMOTIONAL EATING PLANNED BINGES "find alternative ways to manage your negative emotions" in order to give up those episodes. "Planned episodes will be the most difficult to eliminate ... Start with (eliminating) the unplanned episodes that are triggered by excessive restriction or ignoring fullness ... (Then) you will be able to see more clearly when bingeing and purging is triggred by negative emotions.

WITHDRAW PERMISSION TO PURGE: "You will be less prone to relapse (when) you completely withdraw permission to purge ... Say to yourself: "Purging is simply no longer an option. No matter what, I will just sit with my uncomfortable feelings. Even though I feel like purgine I know intellectually that no singe episode of eating has that much effect on my weight. (So) I can't use weight as an excuse to purge ... Allowing myself even one episode of purging will put me back into (thinking) that I can get away with overeating ... That mindset is much morel ikely to undermine my ability to manage my weight than whatever calories I retain by not purging ... In treatment studies, women who stop purging are more likely to remain recoverd a year following the end of treatment than women who cut back but still occasionally purge."

MY OWN RECOVERY EXPERIENCE SHOWS THAT WITHDRAWING PERMISSION TO PURGE WILL GREATLY FACILITATE RECOVERY. As long as I knew I would let myself purge, I continued for years to binge about once a month. After I withdrew permission, I binged much less often and learned to stop eating when I felt moderately full whether I 'broke rules' about what or when I ate or even ate to cope with fatigue or emotional distress. However I also recommend that anyone who has difficulty with withdrawing permission to purge should consider whether they have gastrointestinal issues which make distracting themselves after overeating or eating small amounts very difficult. After I was diagnosed with celiac disease and food allergies, so I identified and abstained from foods which caused excruciating gut pain, I could more easily distract myself from urges to purge after overeating. Enduring discomfort from overeating is much easier than enduring excruciating gastrointestinal reactions from food intolerances or allergies. I also realized that I could EASILY abstain from foods which I knew causes painful reactions, even though I usually felt 'deprived' when I restricted foods which were 'less healthy' or contained 'more calories' but were otherwise safe for me to eat.