One patient stated it succinctly: "I think there is a
little gizmo in my brain gone crazy...if you can only get in there and fix it, I'll be OK
again."
We postulate a biological cause; an infectious agent, an environmental agent,
food allergy, or other problems in the food supply. If a similar endemic involved more
explicit physical symptoms, an epidemiological approach would search for a physical or
infectious agent as the cause of the malady. A good biological theory would postulate "Agent
X" in the food supply, which disorders appetite regulation in a predictable
manner. Agent X need not be a single substance, but may be a collection of operators in
the food supply, affecting susceptible individuals. Agent X has the property of triggering
compulsive eating associated with aversion to the effects of overeating.
The gratification or reward of eating is unmistakable. The model of all want and desire
is hunger. Pleasure has a great deal to do with satisfying hunger. Our basic drives for
food, comfort, love, warmth, and security merge as we try to establish and maintain
relationships and a home environment. Eating patterns are important social determinants.
Eating together indicates social acceptance and tends to cement social relationships.
Intimate relationships often begin with dinner invitations; "the way to a man's heart
is through his stomach." Many complex food-related transactions emerge in family
groups. Implicit food contracts often reflect reward and punishment strategies. Shared
food preferences and eating rituals are important to the pleasure bond that keeps couples
and families together.
Bulimia refers to aberrant eating patterns
Bulimia is an addictive eating disorder. The essential features of bulimia are
binge-eating, interrupted by deliberate efforts to avoid the consequences of over-eating
by vigorous exercise, fasting, self-induced vomiting, and purging with laxatives. Bulimics
report foods cravings and loss of control during food binges; they are
overwhelmed by short-term gratification and are often ambivalent about treatment
attempts. This is an addictive disorder. Bulimics often use and abuse drugs and have high
rates of alcoholism. Between 33 and 83 percent of bulimics may have a first-degree
relative suffering from alcohol abuse or alcoholism.
The bulimic pattern is associated with guilt feelings, secrecy, and overt depression.
Binge-eaters sometimes report extravagant food intake with prolonged feasts of many foods
in bizarre combinations - the Roman banquet effect. The basic technique is to eat until
your stomach is full, retreat to the nearest bathroom, and then induce vomiting by putting
your index finger down your throat. For those of us who find vomiting an unpleasant
experience, the idea of voluntary vomiting is a little hard to grasp. But an experienced
regurgitator can induce vomiting with little effort, and thinks nothing of several
vomiting sessions a day.
The effect on body weight varies with each person. Many bulimics have a history of
weight fluctuations, usually within a range they attempt to control by vomiting. Some are
overweight, but most are within a normal weight range. Some bulimics lose weight
progressively, alternating between binges and food restriction.
The Addictive Model with Food Triggers
There are many theories of causation and a variety of treatment strategies.
"Eating disorders" are often interpreted as personal and social problems and not
related to food choices. Self-induced vomiting in the bulimic patient is a rather complex behavior that involves
a rational component - avoiding the consequences of eating the wrong food and an
irrational, compulsive component. If you eat compulsively, you know you have lost control;
one way to regain control is to induce vomiting and get rid of the food that you did not
want to eat in the first place.
The idea of a recursive feeding loop, running amok, helps us to locate the irrational
behavior at a primitive, addictive level. The rational concern is not just avoiding weight
gain, but also avoiding the awful feelings and the depression that follows bingeing. Many
bulimics with food allergy, initially vomited spontaneously after eating offending foods,
only to feel much relieved; they then learned self-induced vomiting as a method of
avoiding food- related symptoms.
Many bulimics have a split personality or different
eigenstates. Foods act as molecular
switches, often changing the eigenstate abruptly. Here are three typical
eigenstates:
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One eigenstate (part of their personality) craves and compulsively eats foods.
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A second state methodically gets rid of the problem.
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A third state acts as if neither the bingeing nor the purging are happening at all.
Most bulimics are focused on weight control - this is often a ruse, a convenient and
widely accepted explanation. Many fail to recognize their food addiction, and do not admit
that they are ill. They will seem surprised when it is suggested that food allergy may be
involved and resist advice that "favorite" foods such as bread and cheese may be
a problem. They are involved in typical addictive denial. heir denial that food makes them
ill is often reinforced by treatment programs that fail to recognize food allergy symptoms
and discourage efforts to change food choices. Some bulimics are also alcoholics; the
patterns are similar in any case since compulsive drinking of alcoholic beverages is just
another type food addiction.
Biological Determinants
The practical biological questions are:
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If I hunger excessively for food, what procedure in my brain is activated by what
circumstances?
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Am I experiencing an error in the appetite system or has a molecular message gone
astray?
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What corrective action is likely to diminish or remove the drive-state?
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What responses to my hunger are likely to compound the error and lead to repetition of
the unsuccessful eating behaviors?
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What do the craving-compulsion experiences for all substances have in common?
Hunger is the monitor image of appetite, the drive to get food. Appetites create
ready-for-action states known as "drives". Drives produce seeking behaviors,
which get results. If the drive for food produces wrong results, further drives emerge to
renew the opportunity to get what is needed. An automatic brain system regulates
food-seeking behavior and food intake. If we move into this system, toward the molecular
level of function, our description will have to account for the effect of incoming food
molecules on the brain. We would recognize that the systems which determine appetite and
eating behavior monitor chemicals in the blood and receive information from diverse body
systems about their chemical environments. The same system projects an image of body
states into consciousness.