RECOGNIZE DANGER ZONES

The drive to starve, binge, purge, or graze often seems like it comes out of nowhere. People with eating disorders are actually triggered by cues in the environment, emotional pain and insecurities, and/or repeatedly engaging in their destructive habits. When the thought of food or losing weight enters their minds, they cannot stop themselves from taking some form of action. Then one behavior snowballs into another, starving leads to bingeing, bingeing leads to starving, bingeing leads to purging, grazing leads to starving. If they can recognize what sets them off, they can then decide what to do to prevent it. Triggers include the following (Price, 1999):

• Going to the grocery store when hungry and buying everything they crave
• Purchasing too much food to eat in one sitting and consuming all of it
• Weighing every day or multiple times a day
• Skipping meals to lose weight
• Eating only vegetables or salad for a meal
• Counting calories or calculating fat grams in foods
• Eating in the car
• Stashing food in drawers or sneak eating when no one is looking
• Limiting food choices
• Exercising excessively
• Having one last binge or purge and swearing to never do it again
• Bingeing today because they are going to start a diet tomorrow
• Spending hours planning a binge and/or purge
• Ignoring feelings
• Isolating themselves from others

 DELAY AND PREVENT EATING DISORDERED BEHAVIORS

Patients will need to learn to delay and eventually prevent eating disordered behaviors. The goal is to put time between the thought of starving, bingeing, purging, or grazing, and actually doing it. Have them start out slowly so that the first time they delay for 5 minutes, the next time10 minutes, then 20 minutes, and finally not engage in the behavior at all. During these time lags, patients will be working on building their internal capacity to cope. They will have to get comfortable in their physical and emotional skins, meaning that they’ll learn to accept their body’s size and shape as well as sit with feelings and tolerate them.

Every patient reverts to old eating disordered behaviors during the recovery process. Have your patients make a rule that they will try to get on track the very next meal. If they start over as soon as possible, it is less likely that the backward slide will last for days or weeks.

Anorexics: These patients have to delay and prevent themselves from starving, which means they must actively seek out food and make sure they eat. If they follow a schedule in which they eat three meals and snacks in between (even if the meal size is initially small), they will prevent starvation. They also have to delay and prevent overexercising

Bulimics and Binge-Eaters: When they get the urge to binge, it is because they are either physically hungry or wanting to numb out. Explain to them that if they’re hungry, eat. If they want to numb out, they will practice delaying the binge by doing something else to take care of their emotions. Physically removing themselves from, or not going to, a place where food is starts the process.