Anorexia and Bulimia

Upcoming ritual holidays – 5/21 full moon: 5/30 Memorial Day: 6/6 D-Day, the invasion of France in WW II (Nazi): 6/19 Fathers’ Day (US and Canada): 6/20 is both a full moon and the summer solstice

Prior posts on eating disorders – 4/10 Eating Disorders (Introduction): 4/20 Over-Eating: 5/10 Ritual Abuse Issues and Eating Disorders.

Let’s get oriented with some definitions:

Anorexia: “lack of appetite.” Modern Latin, from the Greek “anorexia:” the prefix “a,” without, and “orexis,” appetite, desire. First used in the 1590s. Anorexia nervosa was coined by William Gull in 1873 to mean “emaciation as a result of severe emotional disturbance.”
Paraphrased from the Online Etymology Dictionary, http://www.etymonline.com

Bulimia: “compulsive overeating usually followed by purging” Modern Latin, from the Greek “boulimia:” “ravenous hunger” (literally “ox-hunger”) from the prefix bou, (from “bous” ox) and “limos” hunger. The word entered English as bulimy in the medical sense in the late 14th century.
Paraphrased from the Online Etymology Dictionary, http://www.etymonline.com

Both these words are usually used to denote an eating disorder, but they can also be symptoms of other conditions. Anorexia can be a side effect of chemotherapy or extreme emotional distress. Prader-Willi disease is present at birth and makes children eat uncontrollably because they always feel hungry. Bulimia can be caused by poorly controlled blood sugar in diabetics.

Anorexia
Anorexia is the most dangerous of the eating disorders, with more fatalities than any other psychiatric condition. It is frightening for friends and family – and sometimes doctors and therapists – who feel helpless to do anything for the person with the condition and are panicked that the person may die.

Basically, it is an overwhelming obsession with food coupled with a distorted body image and an intense fear of becoming fat. The person believes they are fat when they actually are seriously underweight or emaciated. This misperception sets off a vicious cycle, increasing the resolve to diet stringently and strengthening the obsession.

Food is often categorized as “good” or “bad” and only very small amounts of “good” foods are allowed. Food may be weighed and charts of calories, grams of protein, carbohydrates, and fats logged meticulously. Some people attempt to manage their weight by depriving themselves of nourishment, while others turn to purging or excessive exercise. Either form of anorexia takes over the person’s life.

Anorexia is the most common cause of death among women aged 15 to 24, and affects between 0.5% and 3% of the general population. Men make up about 25% of anorexics. Some studies say that between 5% and 20% of anorexics will die of the condition, sometimes years after they have started eating normally.

Anorexia takes a huge toll on the body. Bone loss can occur after only six months from too much cortisol (the stress hormone), low levels of estrogen, and not getting enough calcium and vitamin D. Men experience bone loss from all the same factors, except that they have low testosterone, rather than low estrogen. Bone loss is irreversible without medications.

Heart damage occurs quickly, too. Starving yourself burns not only fat, but muscle tissue, and the heart is a muscle. The heart gets smaller and weaker, and, again, the harm is irreversible. The immune system is weaker, and so you are more apt to get infections, which are harder to fight off because you have a low white cell count.

And then there is lack of menstrual periods, thinning hair, feeling cold and tired, and messed up blood electrolytes.

Any deviation from the self-imposed dietary rules causes anxiety, shame, and guilt. There is also intense shame because of the misperception of being overweight or obese. Feeling fat may lead to wearing clothes that completely cover the body, avoiding social situations, and self-loathing.

Sometimes people can’t tolerate constant starvation and break down and binge. Sometimes binges occur periodically, sometimes anorexia is replaced by bulimia. Both disorders are horrible to live with, narrowing your world and sucking all pleasure out of life.

Bulimia
Bulimia is characterized by recurrent episodes of binge eating followed by efforts to eliminate the food eaten (vomiting, laxatives, fasting, etc.) This isn’t a now-and-then occurrence, like at Thanksgiving; it takes place on average twice weekly for three months or more.

There are two types of bulimia; purging and non-purging. With the purging kind, the person tries to eliminate all the calories by induced vomiting, laxatives, or enemas. Non-purging bulimics compensate for their binges by fasting or excessive exercise.

The prevalence of bulimia is said to be 2% to 3% of the general population and can be as high as 10% in certain groups, such as college-aged women. It occurs in 2.3% of white women but in only 0.4% of black women – probably because the studies are done on white middle-class women. Males have not been studied as much, but it appears that about a quarter of bulimics are men.

It is relatively easy to keep bulimia a secret. Many people are of normal weight, or even overweight or obese, so an eating disorder never crosses family or friends’ minds. Both binging and purging is done in private, as both are accompanied by intense guilt and shame at losing control. And the longer it goes on, the lower a person’s self-esteem, the greater the feelings of shame, and the more effort is put into keeping it a secret.

Bulimia may be an effort to contain PTSD, anxiety, or clinical depression, and the rate of substance abuse is high, especially of diet pills and stimulants. About 30% of bulimics are also alcoholic, and other forms of self-injury, such as cutting, are often seen.

Like anorexia, the damage bulimia can do is extensive. If ipacac, which is toxic to the heart, is used to induce vomiting, heart failure may result. Vomiting can erode enamel on the teeth, make the salivary glands swell visibly, and make small bleeding tears in the esophagus. About half of bulimics stop menstruating or have irregular periods.

Cognitive-Behavior Therapy, alone or with antidepressants, is recommended for treatment of bulimia. If the binging and purging has been going on for a long time or occurs frequently, it is harder to treat and there are more relapses. The Twelve Step program, Over-Eaters Anonymous, welcomes anorexics and bulimics as well as over-eaters – it should really be called Eating Disorders Anonymous.

Finally, the eating disorders bibliography at http://ra-info.org/for-researchers/bibliographies/eating-disorders/ lists resources. The website Something Fishy at http://www.something-fishy.org/ is especially helpful.

Ritual Abuse Issues and Eating Disorders

New Book! Jade Miller’s “Attachment and Dissociation: A Survivor’s Analysis” in e-book form. About intergenerational dysfunctional attachment and Jade’s healing process. (Jade is the author of “Dear Little Ones.”)  http://www.amazon.com/Attachment-Dissociation-Survivors-Jade-Miller-ebook/dp/B01DPX76YQ/ref=sr_1_3?s=books&ie=UTF8&qid=1460054531&sr=1-3&keywords=jade+miller

The eating disorders series started on 4/10, 2016 (Eating disorders and genetics,) and continued on 4/20, 2-16 (Over-eating.) The issues discussed in this section apply to anorexia and bulimia as well as over-eating.

Hard as these conditions are for people who were not abused as children, they are far harder for those of us who had to live through ritual abuse. Genetic factors and social pressure, of course, apply to all in our society.

Parents can set their kids up for eating disorders in lots of different ways. Many parents equate food with love, and since they love their kids, they over-feed them or give them candy and other goodies to make their children feel appreciated. Some cult parents act this way because they love as well as abuse their kids; others because they were raised this way and they continue the tradition without thinking. In any event, these children often grow up turning to childhood comfort foods whenever they are hurting. Which, if you are a ritual abuse survivor, is pretty much all the time.

Abusers also use food as a punishment or torture. Children can be deprived of food for a long time and then made to eat (even force-fed) rich foods, which will make them very sick. Most Satanic cults drink the blood or eat the bodies of sacrifices and often make children eat things which were never meant to be eaten, like excrement. They can also be starved for days because it is easier to program a child who is food-deprived and sleep-deprived.

Many adult survivors buy large amount of food or hoard food in reaction to having been deprived as children. Others are afraid of many foods, especially those that are unfamiliar or that remind them, consciously or unconsciously, of “bad” foods used in rituals, in training, or as torture.

It makes total sense that ritual abuse survivors often cannot eat meat, for example, and may even have trouble seeing others eat meat. Remember, though, that the opposite can occur, and some survivors will eat raw meat. This is a form of “acting out” – re-enacting a part of the repressed ritual, probably in an effort to trigger the memory and gain more information about the past. It’s not uncommon to swing between the two extremes, acting out and total avoidance. Being drawn to food can be the basis for over-eating and being repelled by food can be the basis for anorexia.

Then there is the issue of alters. Different alters may have very different attitudes, beliefs, and needs around food. If one alter wants to stop eating in an effort to disappear entirely and another alter wants to gain more and more weight in an effort to become sexually unattractive there is going to be chaos inside and out. And if one of those alters is out most of the time, the other will be seething in the background trying to figure out how to sabotage the alter in control.

Some therapists do not know a great deal about dissociation. They may believe that the eating disorder must be under control before dealing with the DID. That means that no communication between alters is established and no agreements are made inside before working on the eating disorder. This can easily lead to a battle for control between the survivor and the therapist and between the survivor’s inside people.

Even if therapists are familiar with working with alters, they may be frightened by the severity of the eating disorder, get flustered, and make mistakes. Or they may be working in a setting where they cannot make all their own decisions or where others higher up do not believe in RA, MC, or DID. There are all sorts of problems that can arise in therapy that have nothing to do with the client but which have great impact.

(There is another issue which I almost forgot because it is my issue. Survivors are often prescribed meds which cause weight gain which is very difficult to take off. I had eighty extra pounds thanks to various antidepressants. (With much effort, I have lost sixty of those pounds – hooray!) I can assure you that the meds did not increase my appetite because of the speed with which I gained weight. They wrecked havoc on my metabolism. This doesn’t belong in this post because it isn’t really an eating disorder but I thought I would mention it anyway.)

Next will be a discussion of anorexia and bulimia and then on ways of dealing with the external –  the actual eating disorder – and the internal – the relationships between alters who experienced the parts of the abuse that led to the eating disorder. As always, I could use all the help I can get, so if you have ideas, please be generous and leave a comment.

Eating Disorders: Over-Eating

New Book! Jade Miller’s “Attachment and Dissociation: A Survivor’s Analysis” in e-book form. About intergenerational dysfunctional attachment and Jade’s healing process. (Jade is the author of “Dear Little Ones.”)  http://www.amazon.com/Attachment-Dissociation-Survivors-Jade-Miller-ebook/dp/B01DPX76YQ/ref=sr_1_3?s=books&ie=UTF8&qid=1460054531&sr=1-3&keywords=jade+miller

In my mind, I should be writing about anorexia at the beginning of the series on eating disorders and over-eating at the end, but I am arranging it according to the way my interest is flowing.

The other day, I was waiting for my mechanic to tell me where the oil was coming from (good news: he found out where the leak is – more good news: it can be fixed – bad news: it will be expensive – even more good news: I don’t have to fix it until next year.) I picked up the January 2016 issue of the Scientific American and found an article called “That Craving for Dessert” by Ferris Jabr. http://www.scientificamerican.com/article/how-sugar-and-fat-trick-the-brain-into-wanting-more-food/ (The title has been changed, but the article itself is the same.)

And then, just today, I came across an article by David Ludwig, Professor of Nutrition at the Harvard School of Public Health called “Are All Calories Equal?” harvardmagazine.com/2016/05/are-all-calories-equal. Ludwig points out that excess insulin causes weight gain and insufficient insulin causes weight loss. Refined sugars and processed carbohydrates make insulin levels spike, causing more calories to be stored in fat cells and fewer in the blood. And low blood sugar makes the brain think that the body is hungry and the process repeats itself.

The other article is a bit more complicated, but I feel it is worth trying to follow the chemistry.

Until fairly recently, it was assumed that all hunger came from a need to keep the body in equilibrium. When we burn more calories than we eat, we get hungry and when we are below our normal body weight, we get hungry. When we eat enough calories to equal the calories expended, we stop eating. So calories in = calories out.

This is the way it works. When the stomach is empty, it sends out ghrelin, which tells the brain that the body should feel hungry and seek out food. When the stomach is full, it sends out hormones that tell the hypothalamus, where the control center is, to stop the feelings of hunger. When there are an excess of calories, they get stored in fat cells for a time they may be needed. As the fat cells expand, they send out the hormone leptin, which tells the brain to reduce appetite and rev up the metabolism. It’s a really nice mechanism to keep everything in equilibrium.

But that doesn’t seem to be the whole story. There is another process going on at the same time: eating for pleasure, regardless of hunger. There is a part of the brain called the reward center, which releases dopamine and creates an intense feeling of pleasure. Sweet and fatty foods (along with cocaine and cigarettes and lots of other addictive things) are triggers that activate the reward system. The brain learned thousands of years ago that some foods were calorie-dense and that gorging on them when they were available could ward off starvation later on, when people were living on the edge of starvation. Having a reward center that encouraged eating these foods was a survival mechanism.

These days sweet and fatty foods are plentiful. They remain pleasurable, but if eaten often enough, the brain adapts by shutting down some of the dopamine receptors. Then larger quantities of calorie-dense food are required to give the same feelings of pleasure. It’s the same as a heroin addict “chasing the high” –  taking more and more of the drug in an effort to regain the initial rush.

There is an off-switch to pleasure-eating. Ghrelin (the hunger hormone) increases the level of dopamine and leptin (the satiation hormone) and insulin decrease it. This way, the first few bites of something yummy are pleasurable, but as the pleasure fades, the brain says, “Okay, that’s enough for now.”

The problem is that, as the amount of fatty tissue increases, the brain stops responding to leptin and the off-switch no longer works. So the more fat there is, the more the hormones tell us to eat. Not fair.

There is another problem — there always is, it seems. The reward center can be activated by seeing a sugary, fatty food, or talking about it, or even seeing a photo of it. This is the source of the cravings that we know all too well. But how do we avoid seeing those addictive foods, when they are in every supermarket,  every fast food restaurant, every fancy restaurant, every coffee shop? It is so easy to make money off of addictions!

I need to write a section specific to multiples and ritual abuse survivors. And I need to write a section on how to handle this horrible, complicated problem.

Use the comments section to share what has and hasn’t helped you and we will go from there.