So, it seems I've written a book...
Actually, I've written two books. The second is still in the editing stages but my first book, which is called, Addicted to Energy Deficit, Your Neuroscience Based Guide to Restrictive Eating Disorders, is about to be published!
I had no idea I was going to write a book. None whatsoever. In fact, whenever people had suggested to me that I might write a book, I'd pushed it aside as a crazy idea.
Then, a conversation with a client at the end of last year led me on a journey. I started to question eating disorders more deeply than I ever had before in relation to what they are, what drives them and makes them so powerful. And the research I did took me to some Aha! moments that I knew I couldn't keep to myself and that I had to write about them. There was so much to unpack that a blog post wasn't going to be enough and so the book writing began.
Before embarking on this research and writing process, I considered myself knowledgeable about restrictive eating disorders—I knew how they make a person feel and think and what it's like to live with one. But I never really understood why. Why they make people behave in this way. What's happening in the brain to drive these semi-starvation behaviours that despite someone's life falling apart, they are so powerless to stop?
And I'll admit that in the past I fell on the fear of weight gain bandwagon as an explanation for why people behave the way they do with restrictive eating disorders but that explanation never really rang true to my experience or that of others I know.
I understand now that restrictive eating disorders are not driven by a fear of weight gain as is so commonly believed, although yes, fear of weight gain can be a precipitating and maintaining factor.
So then, what are they?
I'd always been struck by the fact that eating disorders and addictions have some very strong similarities in relation to how they manifest, their impact and how it feels to live with one. Exploring this concept in depth has left me with no doubt that eating disorders are a powerful form of addiction for which there's a credible evolutionary explanation. This new understanding has given me an insight into restrictive eating disorders that fits with everything in relation to my own experience and what I've witnessed in others.
But what is a person with a restrictive eating disorder addicted to?
My belief is that restrictive eating disorders are a powerful brain based addiction to the state of energy deficit. In this way, any behaviours that you engage in that lead to a state of energy deficit, will become addictive and compulsive to a brain whose ultimate 'drug' is this energy deficit state. Eating less, exercising, purging or using other compensatory methods all lead to energy deficit which is your brain's drug. Energy deficit (like any addictive drug or habit) creates a surge in your dopamine levels, which your brain seeks more of.
I won't get into the neuroscience in this blog post but suffice to say, it does all make sense on a brain based level as to why this would happen and ties into the evolutionary theory for eating disorders too (all this and more is covered in depth in the book!).
Perhaps though for this first post about the book and this concept of restrictive eating disorders as a form of addiction, let's explore the parallels between an addiction and a restrictive eating disorder in terms of the signs and symptoms they create.
Comparing the Presenting Signs and Symptoms of Addictions with Restrictive Eating Disorders
An addiction starts when someone either consumes an addictive substance or engages in a habit-forming behaviour and it makes them feel great. Their brain’s reward system creates a large pleasure response making them want to repeat the same experience. At first, the substance or behaviour continues to make them feel good, creating intense internal rewards. However, over time, the person's brain perceives less reward and develops a rise in their anxiety and emotion circuits, which go into overdrive whenever they are not engaging in the addiction. It's then this agitative state that compels the person to continue to pursue their drug, no longer for pleasure, but to escape how highly anxious or depressed they feel if they don't.
Compare this now to a restrictive eating disorder. It's likely that when you first engaged in behaviours, such as restriction, exercise or purging, which created an energy deficit, you felt good. You very likely experienced feelings of pleasure or even highs from a surge of dopamine and other reward chemicals in your brain. This might have been reinforced by praise from others for some initial weight loss or a self-satisfaction at seeing the numbers on the scales go down. This resulted in your brain seeking out more of what led to this internal sense of reward.
As the eating disorder took hold however, you stopped getting the same buzz from engaging in the behaviours. Despite this, you felt powerless to stop them because attempting to do so led to agitation, anxiety or even panic and low mood. Your brain quickly learnt that the agitation and anxiety at not engaging in the behaviours were instantly overcome by continuing to pursue them. This became so efficient that you now engage in the behaviours automatically before any discomfort even enters your conscious awareness. In this way, the automatic pursuit of these now compulsive eating disordered behaviours gives you an ongoing sense of calming numbness and an ability to function somewhat normally.
Let's now take this a bit deeper. The following signs are typical of an addiction. For each of these signs, a comparison is made to the experience of an eating disorder:
TOLERANCE
A need to engage in an increasing level of the drug to feel the same positive effects. With an eating disorder, many people find that the level of restrictive eating or amount of exercise they engage in increases over time. If you have one or two days of increased restriction or exercise, you can find it incredibly hard to reduce it back to the level it was previously. This is because the feel-good effects from the behaviours are now linked to that higher level of engagement.
COPING MECHANISM
Over time the drug becomes a way to cope with emotions and to feel normal to such an extent that you develop a dependence on it. People with eating disorders quickly learn to use the behaviours to manage difficult emotions or stress. When this incredibly effective coping mechanism is not available, levels of distress can build quickly.
WITHDRAWAL
If someone is unable to pursue their usual drug fix, they are likely to feel anxious, irritable, restless and/or depressed, with possible sleep problems. If you are attempting to overcome an eating disorder, you will very likely experience these withdrawal symptoms when you stop engaging in the disordered behaviours.
LACK OF CONTROL OVER THE DRUG
This is reflected in unsuccessful attempts to cut back on or stop engaging altogether with the drug despite wanting to. Perhaps you have tried to stop exercising but within an hour found yourself pounding the streets before you realised what had happened. Or maybe you can relate to situations such as saying to yourself, Today I will eat a brownie with my lunch, only to find that the discomfort became overpowering, and you resorted to your usual low-fat yoghurt instead.
TIME
The drug consumes a huge amount of time, from planning for it, engaging in it or recovering from it. Many people with eating disorders spend a lot of time engaging in habitual lower-level movement and more formal exercise. Time is also commonly taken up on planning out restrictive food intake and consumed by engaging in ritualistic eating behaviours.
REDUCTION OR NEGLECT OF OTHER AREAS OF LIFE
An increasing preoccupation with the drug leaves other life areas and relationships neglected, even those of high value to you. Perhaps you stopped engaging socially, neglected relationships or allowed your career choices to be impacted so that you could devote more attention to the pursuit of energy deficit.
CONTINUING DESPITE NEGATIVE LIFE CONSEQUENCES
Eating disorder behaviours cause physical, psychological, social and interpersonal problems, and yet even when you can recognise this, it can be incredibly hard to stop. It's likely that you continue to eat restrictive amounts and engage in compensatory behaviours despite clear indications from your body or even warnings from health professionals that continuing to do so could lead to significant physical harm.
MINIMISING THE EXTENT OF THE PROBLEM
This can be hiding how great an impact your dependence on the drug has or how often you are engaging in the behaviours. Perhaps you have attempted to reassure your family or friends that you are eating sufficiently by leading them to believe you are eating more than you are. Or you might have experienced self-denial in relation to physical symptoms caused by the eating disorder.
I think you will agree, that comparing the typical signs and symptoms of an addiction to any substance or behaviour and those of a restrictive eating disorder shows parallels that are more than just striking. Their manifestation and impact are the same. It's only the drug that differs. But once you can begin to appreciate that the eating disorder is an addiction, you can find ways to overcome it.
In upcoming posts I will tell you more about what energy deficit is as part of the addiction model to a restrictive eating disorder, cover more of the neuroscience and of course, how to address overcoming a restrictive eating disorder.
In the meantime, the book covers more than I ever can in these blog posts and I hope it will help you in so many ways, so please consider picking up a copy for yourself. It will be published later this week on Amazon and other online book stores around the globe!
If you like to listen, as well as (or instead of read!) then this blog post is the transcript of a podcast episode which you will find on my podcast series,
available on this website, on all mainstream podcast platforms and on YouTube!