Eating Disorders: Techniques for Treating Binging & Purging

On the last track, we discussed three different levels of overeating.  These three different levels of overeating included:  food users; food abusers; and food addicts.

Have you, like I, found that those clients who are compulsive eaters do not quite know the feeling of hunger? They have been subject to their emotions for so many years that they have become more prone to listen to their emotions as a trigger for eating.

On this track we will examine four Cognitive Behavior Therapy techniques for redefining hunger for overeating clients.  These four techniques of redefined hunger include: Recognizing Mouth Hunger Phrases; Hunger Log; Demand Feeding; and Responding to Hunger.

4 CBT Techniques of Redefined Hunger

CBT Technique #1 - Recognizing Mouth Hunger Phrases
The first technique for redefining hunger is Recognizing Mouth Hunger Phrases. While stomach hunger is connected to the physiological need to refuel, mouth hunger is related to the psychological need to feel satisfied. Many of the reasons behind eating because of mouth hunger include the following phrases I have heard from clients. Listen to these and see if any of these sound familiar:
5 Reasons behind Eating because of Mouth Hunger
           --1. "Because it’s there."
           --2. "Because I have to put something in my mouth."
           --3. "Because it tastes good."
           --4. "Because it’s time for breakfast/lunch/dinner."
           --5. "Because it would be a shame to throw it away."

Most clients try to control mouth hunger while on a diet, while in fact they were only instigating more stomach hunger. Corey, age 23, internalized the phrase, "I need to eat to celebrate."  Corey would binge during a social gathering or during the holidays. I asked her to write down the thoughts and phrases that pass through her head during one of these binges. She wrote, "Eh, what the heck," "It’s just one day!" and "Everyone else is stuffing their faces!" 

Think of your Corey. What Mouth Hunger Phrases is he or she using as an excuse to eat?

CBT Technique #2 - Hunger Log, 3 Steps
The second technique for redefining hunger is the "Hunger Log."  Kim, age 27, had difficulty distinguishing between the two types of hunger. Kim stated, "Whenever something smells good or looks like it will taste good, I have to put it in my mouth right away, regardless of diet restrictions or if I actually need it." 

To help Kim distinguish and analyze between stomach and mouth hunger, I suggested she keep a "Hunger Log."    
Step 1 - I asked Kim to write down two columns, one labeled "stomach" and the other labeled "mouth." 
Step 2 - I asked that each time she had anything to eat to write down what she ate, when, and whether it was from stomach or mouth hunger. 
Step 3 - I also asked that she remember that it is the purpose of this exercise to analyze and track data, not to judge or intervene. 

A couple of weeks later, I asked Kim if she noticed any patterns.  She stated, "I seemed to eat a lot after dinner. All the night snacks I had are under ‘mouth’ hunger! I think I’m depriving myself too much during the day and my body wants to make up for it at night."  Think of your Kim.  Would he or she be better aware of his or her eating habits with the help of a "Hunger Log"?

CBT Technique #3 - Demand Feeding
The third technique of redefining hunger is "Demand Feeding." Because clients have been responding to outside stimuli in regards to their eating, it is obviously important that they learn how to recognize their internal cues which have been subdued. Whenever a compulsive eating client is asked, "Are you hungry?" they don’t know how to respond. Some have responded to mouth hunger for so many years that they don’t remember what stomach hunger feels like nor how to respond to it. 

Jim, age 39, worked at a high pressure job and as a result only ate when he felt stressed or self-conscious. I asked Jim to try and "Demand Feeding." To do this, first I asked him to regularly ask himself if he was hungry prior to a meal or snack. I asked Jim to start allowing himself to be hungry. Once the hunger hits, I ask him to satisfy it, not overcome it. This may involve Jim eating three, six or even eight times a day. However, by eating on demand rather than mouth, Jim can more fully recognize "need" signals rather than "want" signals.

CBT Technique #4 - Responding to Hunger
In addition to Recognizing Mouth Hunger Phrases, The Hunger Log, and Demand Feeding, the fourth technique for redefining hunger is Responding to Hunger. Clients who have become bingers and purgers have adopted a mindset in which it is acceptable and prudent to suppress any type of physical hunger that may occur. Through their constant dieting and binging, they have taught themselves that responding to hunger, even stomach hunger, is bad and can lead to unnecessary binging.  Catherine, age 26, had serious fears about allowing her body any say in what she ate. 

Catherine stated, "If I let my stomach control me, I’m going to go over the edge!" I stated, "You aren’t letting your hunger control you, rather you are responding to a perfectly legitimate need to sustain yourself." I asked Catherine to try the "Responding to Hunger" exercise.

2-Step "Responding to Hunger" Exercise
Step 1 - Each time she felt herself become physically hungry, I asked that she say to herself such phrases as "Great! I’m hungry! I can eat now!"  
Step 2 - Then I asked her to eat, even if it was not the appropriate time to eat.

Instead of framing hunger as an object to overcome and rather as an opportunity to fulfill a need, Catherine can not only avoid the negative feelings that trigger her binging, but also can learn to recognize and respond to her hunger appropriately. 

Think of your Catherine. Could she use some help responding to his or her hunger?

On this track, we discussed four techniques for redefining hunger for overeating clients. These four techniques of redefined hunger included:  Recognizing Mouth Hunger Phrases; Hunger Log; Demand Feeding; and Responding to Hunger.

On the next track, we will examine three concepts related to binge regression.  These three concepts related to binge regression include:  self-criticism during a binge; panic; and guilt.