334: Breaking Free From The Restrict, Binge, And Purge Cycle

Chris Sandel: Hey! If you want access to the transcripts and the show notes and the links talked about as part of this episode, you can head to www.seven-health.com/334.

Hey, everyone. Welcome back to another episode of Real Health Radio. I’m your host, Chris Sandel. I’m a nutritionist and a coach and an eating disorder expert, and I help people to fully recover.

Before we get on with today’s show, I just want to mention that I’m currently taking on new clients. If you are living with an eating disorder and would like to reach a place of full recovery, then I would love to help. And I know the idea of full recovery can feel very out of reach; it might feel like a complete pipe dream, it might feel like “that’s something for someone else, it’s just not for me because this has been going on for so long.” But irrespective of how long you’ve been living with an eating disorder, I believe that you can fully recover, and this is what I work on with people.

So if this is of interest to you, then please get in contact. You can send an email to info@seven-health.com and just put the word ‘coaching’ in the subject line, and I can get the details over to you.

So, let’s get on with today’s show. What I’m wanting to cover as part of this one is the restrict-binge cycle or the restrict-binge-purge cycle, depending on someone’s behaviours. It can be all three of those things or it can be just two of those things, and I want to talk about this and help people to understand this cycle and why it happens and what to do to stop perpetuating this cycle.

00:01:40

Why all eating disorders are restrictive eating disorders

A big reason for why I want to cover this as well is I think a lot of people have this misunderstanding of the clients that I work with. I think so often, when people contact me, there’s this idea of I must only work with people with anorexia because of the way that I talk about recovery. I think there’s this really incorrect notion that people have – and when I say ‘people’, this can be people struggling with eating disorders, but I think it’s still prevalent even within the eating disorder recovery world – where we talk about restrictive eating disorders, and these are things like anorexia or it could be things like ARFID or it could be orthorexia, where we see the problem with this eating disorder being the restriction piece of it, and we think that’s the thing that is driving this and is causing the problem.

And then there are other eating disorders, like binge eating disorder, where restriction’s not the issue. This isn’t a restrictive eating disorder, and the blame and the problems are seen as the binges, and that’s where we need to put our focus. This can even be the same with bulimia in terms of it’s the binges and the purges, that’s where the problem lies and that’s the bit we’ve got to deal with.

And really, from my perspective, all eating disorders are restrictive eating disorders. I work with many people with binge eating disorder, and in all circumstances, restriction was at the heart of this. I’ve said this before on the podcast, but I think it’s really important to recognise that someone’s weight is often at the heart of the diagnosis that they receive with eating disorders. I think this is highly incorrect. In a lot of ways I think of eating disorders as being the same thing, and they manifest slightly differently in terms of is there purging going on, what’s going on in terms of exercise, what’s happening in terms of the style that someone is eating, in terms of how they’re restricting and all of these different things. But really at the heart of it, they are all the same.

For example, you could have three people who are doing very similar things. We have someone who is in a stereotypically thin body who is restricting their food intake; at some points, there are some binges that occur, and a way of them dealing with that is to exercise and to compensate through exercise. So we have one person who’s doing that who is in a thin body – maybe it’s below the BMI cutoff for a healthy weight – and that person would then get diagnosed with having anorexia / anorexia binge-purge subtype, and that diagnosis is largely based on the behaviours they’re doing, but also the size of their body.

We then have another person, and their body size falls into the ‘normal’ side of the BMI, and they are also doing these behaviours. Here’s restriction going on, there’s binges going on, there’s purging that is going on, and this purging – again, it could be purging just from doing exercise and that’s their way of compensating. This person is then likely to get a diagnosis of bulimia, and they’re likely to get that diagnosis because their body is now not small enough for them to be deemed to have anorexia. Exact same thing is going on, but because of the size of their body, they get that as a diagnosis.

We then move on to someone who is in a larger body. Maybe they’re in the ‘overweight’ or ‘obese’ categories as deemed by the BMI scale. For this individual, despite doing the exact same things, they’re now deemed as having binge eating disorder.

I think that it’s a really useful, and sad, thing to recognise. But in each of these cases, despite these three people getting different diagnoses for their eating disorders, one, the exact same thing is going on with all of them in terms of their different behaviours, and two, restriction is the thing that is driving this.

I think it’s a really important thing to understand because there are so many times when people do contact me and they say, “I’m living with binge eating disorder, and this is what’s going on, and I see your messaging and it doesn’t really make sense to me because I can’t possibly be restricting. I’m living in a larger body, so that can’t possibly be what’s going on. I eat ‘lots’ of food.” There’s all these reasons why this doesn’t fit – and every time when I’m then able to have conversations with these people, when we look at what’s going on, restriction is really at the heart of what is driving this thing.

00:06:48

The restrict-binge-purge cycle

So I want to go through what this cycle looks like and how people find themselves in this cycle because I think it is really important. For some people, they are able to consistently restrict, and it doesn’t then lead to a binge, it doesn’t lead to a purge – although I would say there is restriction and then there’s still a lot of compensation going on, and I’ll talk about this, that we could often think of the idea of a purge as compensation. And often, as people’s eating disorder goes on longer and longer, as a way of being able to keep in control of this thing or to be able to still ‘manage their weight’, they’re now having to ramp up the exercise and ramp up the compensation to deal with that.

So what I want to do is go through the restriction piece, the binge piece, and the purge piece just to understand this better.

As I said at the beginning, I think some people get into the restrict-binge cycle, so it goes restrict, binge, restrict, binge. There isn’t this purge piece, or not as obviously. And what I’ve also noticed is that for some people, it’s only when binges start to occur that they then begin to see what’s going on as a problem.

For lots of people, they could have a period of many years where they have been able to restrict and they’ve been able to keep it up, and it’s then at some point that the binges start to occur. This is then when the alarm bells go off. This is when there’s the recognition of “Oh my God, something’s not right here.” But when someone’s able to continue on with the restriction, it can often be harder for them to recognise that or reach that point. They reach that point only as the compensation starts to increase, and they find, “My God, I’m spending so much more time on exercise.” Or when there’s a decision “Actually, I want to do something different. I don’t want to be living in this way” and they then realise, “Oh, I can’t do something different. I feel so powerless to do something different.”

I often talk about the difference between control and being controlled, because so often when people talk about the eating disorder, they talk about “It’s just so important for me to be able to control, to have this sense of control”, and actually, it’s only when you start to deviate from that in terms of “I do want to take a day off exercise” or “I do want to go out and eat this meal” or “I do want to eat earlier” – it’s in those moments that you realise, “Oh, actually I’m not in control. I’m being controlled, because my ability to do these things is really impaired, and I’m really struggling to actually do something different.”

00:09:41

The restriction phase

In terms of the restriction piece, I think we have, again, this misconception about what restriction means. A lot of that is guided or created by, one, the stereotype of what we think someone with an eating disorder or someone suffering with anorexia is dealing with, but two, just because of the society we live in and how we have normalised dieting, how we talk about food and health and all of these different things.

For many people, the idea of restriction is “I didn’t eat anything.” That would be what would have to be going on for someone to feel like they’re restricting. “I clearly ate no food during the day. That’s really telling me that I’m restricting.” But that’s just not the case, and it’s very, very rare for me to work with someone where their eating has ever got to that place, where they’re having a day or multiple days where they’re not eating anything. That’s a very, very, very small subset of people who struggle with eating disorders. So that can’t be the bar for what is restriction.

Really, restriction is ways in which you are eating less than what your body truly needs to be able to function optimally. This can look like lots of different things. It could be you’re not eating enough total calories. This can be someone who is tracking their calories; “I’m not able to go over this specific amount of calories.” For some people, they’re not getting into the carbs and the proteins and the fats or the ‘unhealthy’ food or the ‘healthy’ food. It’s purely just “I can’t go over this calorie amount. I can work my way up to this calorie amount in whatever foods I want, but I’m just not allowed to go over this threshold.”

For someone else, it is about particular types of food. They’re low-carb or they’re low-fat or they’re making changes in terms of the macronutrients, or “There are particular types of foods that I’m not allowed to eat.” “No, that’s a processed food, so I’m not allowed to eat that. I only eat things that are whole foods.” Or “I have these lists of things that are ‘good’ foods or ‘bad’ foods, and I’m only eating things from the ‘good’ list.”

It could be something like intermittent fasting. “I’m now only eating during a 4-hour eating window or an 8-hour eating window” or whatever it may be in terms of “That’s how I’m doing my restriction.” And when someone is doing that, it can lead to them consuming less calories than they otherwise would, but even if it doesn’t, there is the restriction that is going on.

And I do want to say, as part of this episode, I will make reference to other episodes or blog posts that I’ve done connected to these topics. I’ve done a whole podcast all about restriction, so I’ll put that in the show notes and it will go into this in a lot more detail.

00:12:51

The three types of restriction

The other thing with restriction – there are three types of restriction. There is physical restriction. That is “I’m not eating that particular food.” If I think rice is bad, for example, I’m not eating rice. There is the physical restriction of rice.

Then there is the impending physical restriction. That is the “Man, I’ve been really ‘bad’ today. Tomorrow I’m going to start my new diet” or “From Monday, I’m not eating these things anymore.” It’s this restriction that is just around the corner. I’m telling myself that this thing is going to be off limits in the future.

Then the final piece is the mental restriction piece. This can be that I’m actually eating something, and at the same time, I’m telling myself that I shouldn’t be eating this thing. So I’m having a cupcake or I’m having a piece of pizza or I’m having a sandwich or I’m having whatever, and while I’m eating it, there’s this telling to myself of “I shouldn’t be doing this. I’m not meant to be eating this kind of food. This is the wrong kind of food to be eating.”

All of these types of restriction are restriction. I think there can be this misunderstanding of “Yeah, but I ate that food, so I’m not restricting.” If you’re eating a food while at the same time telling yourself you shouldn’t be eating this thing or “Tomorrow we are not eating this thing. This is not something that we should be eating”, this is sending signals to your body, to your brain, to your nervous system that “What I’m doing is not right. This is a threat, and we need to stop doing this thing.”

If any of those kinds of restriction are going on, this is what can then continue to lead into other parts of this cycle – or to keep people stuck in the restriction phase of the eating disorder.

In terms of other episodes I’ve done, I’ve looked at how restriction affects the brain, so if you haven’t listened to that one, I highly recommend listening to it because I think it’s really important to see some research around the different stages as part of recovery and how that then affects someone’s brain and their perception. I think it’s an important thing to understand.

00:15:09

Why restriction can be happening even with weight gain

And then the next piece is I’ve done an article looking at weight gain even while restricting. I think this is another thing where people say, “I can’t possibly be restricting because my weight is steady” or “Actually, my weight has started to go up.” The reality is – and I’ve seen this happen for many people – especially as an eating disorder has gone on for a longer amount of time, someone could not change anything – they can be eating in the exact same way, they can be doing the same amount of compulsive movement, etc. – and yet suddenly they start to gain weight.

And this can be really terrifying for people because this is, in essence, someone’s absolute worst nightmare of “Now my body is malfunctioning. Now my body is starting to gain weight and it shouldn’t be doing this, and I have no idea why it’s doing this.” The reality is, as you keep restricting going on longer and longer, your body’s way of being able to deal with that is it has to turn things down and turn things off to be able to function. It’s having to run everything on less and less resources.

At some point, it can get to a place where nothing has changed in terms of what’s coming in, but from the body’s perspective, it’s got into more and more of a depleted state, so now it’s turning things down even more. So even though nothing has fundamentally changed with the amount coming in, your body’s now just using less of that and is starting to store more of it because it feels totally unsafe that “This thing is unsustainable. We can’t go on like this.” This is why someone can have a situation where nothing has actually changed coming in, but the body is now starting to gain weight.

If you want to understand more about that, there is an article that I’ve written connected to it.

00:17:01

How restriction leads to binges

What will often happen with restriction – and it doesn’t occur all the time, but it happens for I would say the vast majority of people – is that at some point, the body fights back. The body’s wisdom is “We can’t keep doing this. We can’t keep surviving on these small rations. We can’t keep surviving on this small eating window. It’s just not enough.” So what the body does is it turns on various hormones that lead to different cravings, different pulls toward bringing in more food.

Even though your mind may be thinking of this thing as this really terrible threat, “We shouldn’t be eating food, food’s bad, food leads to weight gain, food is just calories”, etc., etc., food is essential. It’s really important for us to be able to live. It’s important for us to be able to function. It’s important for the body to then be able to run all of the various systems and organs and everything within the body.

So when it’s not getting what it needs, it doesn’t understand why this is going on. It doesn’t understand “I’m trying to do this as my way of coping” or “I’m trying to do this because it’s important for me to lose weight to fit into a particular dress or to be bikini-ready” or whatever someone’s drive for this thing is. The body doesn’t understand that. All it knows is “We’re not getting the resources that we need. We need to change some things within someone’s physiology to help them start to go out and get this food.”

00:18:47

Defining a binge

What this then can lead to is a binge. I think there can be lots of different definitions around this, and I’ve done a whole podcast looking at binge eating and binge eating disorder, so I will make reference to them in the show notes and you can go and check them out. But if I’m using a fairly lay definition of a binge, it is an episode of uncontrolled eating in which a person rapidly consumes an excess quantity of food.

What I think is useful to start to explore here is the idea of ‘excessive’ and what constitutes excessive, because really this is often fairly arbitrary and is often defined by the individual.

I’ve had clients where they tell me that they’ve had a binge, and then when we talk about what they had as part of that binge, it’s the equivalent of a small snack. To them it feels like a binge because “I’m not even used to having something to eat at that point of the day” or “That’s way bigger than what I would normally eat at a meal”, so from a relative term, it feels like a much bigger eating experience, so for them it is a ‘binge’. But for lots of other people, like myself or an outsider, actually that doesn’t constitute a ‘binge’.

In essence, it doesn’t matter what other people think; if this person is defining this as a binge, that’s what we’re going to work with, at least from my perspective, if I’m going to then have a conversation around that. But I think what is useful to recognise is that we have our own definition of what constitutes ‘excessive’. So for people where they’re describing a binge, it’s that there is some threshold that is being crossed, and then there is some story of why this means this thing is a binge. It could be that “I felt different in terms of my speed of eating.” There could be different symptoms connected to it. “I noticed my heart was beating more.” But this experience gets categorised as someone having a binge.

What’s interesting here is – I often think about myself in that I don’t suffer with binge eating disorder. I have a very healthy relationship with food, thankfully. And there are lots of things that I will do that I know that if a client was doing this, it could very easily be considered a binge.

For example, I could finish my dinner and then I may walk over to the pan because there’s still some of the risotto left over, for example, and I’m just eating out of that pan with the ladle. And I could be eating it kind of messily. It’s probably not what I want to record a video of and put up on Instagram. But I’m just doing that in that moment. For me, I think nothing of it. I think, okay, maybe I should’ve put it on a plate and this isn’t the greatest viewing experience if someone is watching me, but in the whole scheme of things, it’s not a big deal. It means absolutely nothing. I’m just eating some extra food over this pan.

Versus someone else could be having a very similar experience, but there’s all this story or meaning that is attributed to this experience. “I’m noticing that I finished my meal, but yet I’m still hungry, and I’m now having this experience where I’m standing up, I’m eating, and I’m not really present” and all of these things then get added on.

Or I was recently on holiday, and as part of that, I was eating differently – because when you’re away, you often eat differently. I remember having chocolate donut as part of breakfast. I remember going out to a café and had a couple of croissants for breakfast. I had a cheese and ham croissant and then I had an almond croissant as part of breakfast. And again, I didn’t think anything of this. It was just a very normal, natural experience. And I know for someone else, that could’ve been thought about as a binge because “I don’t normally have breakfast, and now I’ve had this thing” or “My normal breakfast is X and now I’m having this other thing Y, and that thing is much more calorie-dense than my normal breakfast, so now this is a binge.”

I’m saying all this because I think it’s useful to reflect on “What are the stories that are coming up connected to this thing?” Because I do think so much of it is around some arbitrary threshold being crossed and then the story that we’re making up to describe why this thing is happening or why this thing is important or what is the meaning behind this thing.

I also think with the word ‘excessive’, I would suggest thinking about this in more than just this moment. For example, someone could actually sit down and eat a large amount of food that lots of people would consider excessive, and for that single meal, it is a large amount of food. And yet if I think about, what’s happened over the last week? What’s happened over the last month? What’s happened over the last multiple years?

When we think about it in that way, actually there’s been so much restriction that has occurred over that time, so this bigger eating that is going on – yes, someone may feel that it is a binge, but in comparison to what is actually needed as part of the body, this is your body behaving and responding in a totally normal way, and where there is food available, saying, “Great, we really need to get some of that food in.”

00:24:39

Finding a term to replace ‘binge’

When we talk about binges, I think another thing I would say connected to this is ‘binge’ has such a negative connotation for so many people. I will often have conversations with clients about, what does that word mean to you? Does it have a negative valance to it? Is it a pejorative word in your mind? And if the answer to that question is yes, is there another word that we can come up with that describes what’s happened here, but it doesn’t have those negative connotations connected to it? If we describe this as “I had a bigger meal” or “There was more feast eating that went on there” – can we find a descriptor that describes what happened, but it doesn’t have this negative connotation?

And the reason why this is important, again, comes back to this idea of we’re telling a story connected to this thing. We’ve gone over some particular threshold or we’ve had this experience that we’re now creating meaning with. So using a different word from ‘binge’ can help relate to that differently.

Why this is important is because typically, the knee-jerk reaction when this happens is either to, one, run back to the restriction piece, or two, do some kind of purge compensation. So if someone’s able to recognise “I had a moment where I’ve eaten more food here, and I now don’t need to be going back to restriction, and I now don’t need to be compensating in any way”, I think that’s a really helpful thing to start to break this cycle.

Again, I’ve done a whole article looking at what to do after binge eating that goes through lots and lots of different ideas connected to this. So if this is something that is happening in your life, then I would highly recommend checking out that article.

00:26:39

The purge phase

So then the final piece is the purge. I would say the final piece depends on what someone’s cycle is. It could be restrict, then binge, and then straight back to restriction; in that scenario, the binge was the final piece and we just keep going back between those two things. Or the purge can then be someone’s final piece with this.

I think what often happens – again, because of stereotypes – when people hear the word ‘purge’, they think of vomiting or they think of laxatives. So I want to suggest that maybe a better word for this would just be ‘compensating’. Because even with people who are diagnosed with bulimia, the purging piece doesn’t have to be vomiting or laxatives. The purging piece can be exercise, or it can be other ways of compensating for this. I would say that for a lot of people, this is how they purge. “I had this eating that occurred and now I need to increase my exercise.”

I would say that this also can then lead to other things that feel like they’re more aligned with restriction, but may just happen after someone has had a binge. So it’s not their everyday go-to form of restriction, but this is one of the things that they do after that as their way of compensating.

For example, chewing and spitting can be something that happens. I also want to add, this is something that happens a lot more frequently than people imagine. Every time that I have a consult with someone where I’m having either the initial consult with them or when we’re starting to work together and they mention about the chewing and spitting piece, they feel like they are the only person who ever does this.

And I know that that is somewhat common with many of the aspects connected to eating disorders, but I feel like this one in particular, for whatever reason, hasn’t got the airtime. It’s not listed on lots of things in terms of particular symptoms or behaviours or whatever. But this is something that I do see fairly commonly, where people are using this as a way of restricting. Chewing and spitting can be going on all the time or it can happen after a binge.

There can be high water consumption. “Okay, I’m not eating for the rest of the day. I’m just going to have lots of water.” And these notions of “If I use the water, that’s a way of cleansing or detoxifying” or all this orthorexic language around it, when really it’s just someone’s attempt to “How do I stop eating, how do I do restriction?”

There could be not eating for a specified time. Normally, someone’s eating between these hours of the day or they’re pretty rigid in terms of their meals and meal timings and all of that, but after this binge episode, that’s when “For the rest of the day I’m not eating” or “I’m not eating until this thing happens.” Again, it’s a form of restriction, but often it can be specific to “This is what I do after a binge.”

And this cycle just continues. After we’ve done our day of drinking water as our way of trying to make amends for what just happened, we then go right back into our usual default of restriction. We do that until at some point it becomes too much, and we end up having a binge. And then once that’s over, we go back into this purge cycle. It just becomes this real loop.

00:30:28

Calling the cycle a binge problem is not the right approach

As I said at the beginning, depending on the size of someone’s body will depend on, one, the diagnosis that they get, but two, what gets suggested as how to deal with this thing. If someone is in a smaller body, we are more likely to suggest “This is about restriction. We need to stop doing the restriction, and the restriction is part of what’s leading to the binges. If we can start to deal with the restriction and get out of that depleted state, that’s going to help the binges.”

But if someone is not in that body and if they’re in a ‘normal’ body or they’re in a larger body, what is often the advice is “We need to figure out how to stop you having these binges” and not “Let’s address the restriction that’s going on”, but more about “How do we get more willpower, how do we do things to trick the mind so that when those cravings come up, we’re doing something else and we’re focusing somewhere else.” We just basically ignore that restriction is going on and we put the problem solely on the shoulders of “This is a binge problem.”

I really want to say that irrespective of the size of body that someone is living in, that is not the right approach. Restriction is at the heart of what is going on, whether that is actual physical restriction, whether that’s impending physical restriction, whether that’s mental restriction, or all of the above. It’s important to understand this because otherwise it can feel like it’s just a binge-purge cycle, and actually it’s the restrict-binge-purge cycle.

I really want to get that message across, because I just don’t see that being what is told to many people. Or “We started focusing a little bit on the restriction in the beginning, but now you’re at a ‘healthy’ weight, so that’s not the problem anymore. Maybe we should be cutting back on those snacks, and no, you don’t need the full fat version anymore” and all of this kind of advice that really keeps someone stuck in this quasi state of recovery – or not even quasi-recovery. It’s this version of passing for not having an eating disorder, and that’s just not what I want for people.

As I said at the top, I work with people to help them fully recover from an eating disorder, not to be able to pass as not having an eating disorder because most people aren’t going to notice that this is what’s going on. I want to genuinely improve the quality of your life by “I’m no longer engaging in these behaviours”, and I truly believe that everyone can get to that place. And for many people, the way to get there is first having the awareness around how much of the restriction piece is doing the heavy lifting in creating so much of this.

00:33:32

Variations in the cycle + recognising the pattern

What I would also say as a final piece connected to this is this cycle can be longer or shorter depending on the individual. It can change with an individual depending on how depleted they get, depending on what level of restriction is going on. So someone could be going through this cycle on a daily basis where “I’m restricting really heavily in the morning, I’m binging in the evening time and purging in the evening time, and then rinse/repeat” and this is happening every single day.

Or it could be “It’s normally by the end of the week, I’ve been restricting so much that” – and again, someone might not use this language because they don’t even recognise that this is what’s going on – they’ll say, “I’m so good for so much of the week, and then come the weekend or this thing happened on Friday, and it just feels like everything falls apart and that’s when I get into that place.” So it could be much more this weekly cycle where weekdays are ‘good’ and weekends are ‘not so good’.

It could be a much longer cycle than just that. Over a couple of weeks, things start to build up and then it starts to happen. For some people, there can be this pattern where “I restricted for quite a while and there was no problem, and then the binges started to happen and I had this number of days or couple of weeks where I was doing the binging and binge-purging really hard, and then I wrestled the reins back and I was able to get back to just the restriction piece. And then I was able to keep that up for a period”, and then it goes again in that pattern.

It’s not just the food piece that is driving this as well. Obviously, you getting into a more depleted state and the restriction going on is a really big part of it. But it also then connects to challenges within life. As things become more difficult, whether that be because “I stepped on a scale and I noticed my weight had changed” or “I’ve got this dinner coming up and I don’t know how to handle it” or it could be “I had a review at work and they weren’t particularly happy with my performance and I don’t know how to handle that” – there can be these other life things that happen that then have an impact on when the restriction increases because “That’s my way of coping” or when the binge occurs because “Now it’s become all too much and this is the result of what happens when I’m in this restricted state and these things occur.”

So I think so much of this – I said it’s the awareness of the restriction piece, but also the awareness of the pattern and how this plays out, because it is so cyclical. I can have a conversation with someone in a fairly short amount of time and be able to start to notice all those patterns, and even when I’m working with someone, when someone is able to tell me “This thing happened”, I’m able to predict pretty accurately what could be the outcome of that based on where someone’s at in their recovery, the state they’re in, etc., because it follows this real obvious pattern.

So that is it for this week’s episode. I hope that this has been useful to you to really understand this more and why there is this pattern.

As I’ve said a number of times, I do really believe that everyone can fully recover, so if this is a pattern that you find yourself in and you don’t want to be in this pattern anymore, you want to break out of this, I would love to help you to do so. You can send an email to info@seven-health.com, and if you just put ‘coaching’ in the subject line, then I can send over the details.

So that is it for this week’s episode. I will be back next week with another new show. Until then, take care of yourself and I will see you soon!

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