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If it Makes Me Miserable, Why Can’t I Stop?

Posted Apr 24 2012 12:00am

When I was a clinical intern in the last year of my doctoral program, I worked in a hospital outpatient clinic that specialized in the treatment of eating disorders. Among the patients I had treated in that program were many young women who suffered from bulimia. Each had unique issues and different histories leading up to the problem, but when they described how they experienced their episodes of compulsive bingeing and purging, they did so in almost identical terms. I wasn’t surprised to hear them describe purging as a very negative experience, but if I was asked to guess how they would describe the food binges that preceded them, I would have expected them to say that they were in some way positive or enjoyable. But that was rarely if ever the case.

Instead, they depicted their emotional state during a binge as, at best, emotional numbness. They would turn off the thinking and feeling parts of the experience, and almost mechanically, would proceed to stuff themselves with a large amount of food. They described a sense of disconnection from the behavior, not enjoying it and barely even tasting it. It was as if the outcome was so inevitable they might as well just turn on the autopilot and quickly get it over with. If they were aware of any feelings at all they were negative: self-loathing, guilt, disgust. When I heard this same theme repeated by many of these young women, I recalled something I had learned in one of my undergraduate psychology classes that should have contradicted their accounts, and I couldn’t make sense of it.

In 1905, one of the earliest American psychologists, Edward Thorndike , discovered a principle of behavior that he called the law of effect . We now consider the idea so basic and intuitive that it seems surprising anyone even had to “discover” it. In simple terms, the law of effect states that if a behavior produces a satisfying effect in a particular situation it is more likely to occur again under similar circumstances, and if it produces a negative or uncomfortable effect it is less likely to be repeated.

The problem that bothered me may by now be obvious to you. According to Thorndike, even a puppy can be trained to be housebroken if  some negative experience follows the behavior. So why did my patients with bulimia continue to engage in a behavior that left them feeling physically ill, depressed, guilty, and out of control? Not only were they willing to repeat the behavior in spite of the known consequences, but they felt compelled to do it! This was troubling to me, and I was given a variety of unsatisfying explanations by people more experienced than I. But as a trainee I figured I must be missing something that was obvious to everyone else so I put the question aside.

A few years later, I began a clinical practice treating patients with a wide range of psychological problems. After about ten years in practice, I became interested in the area of health psychology, and narrowed the focus of my practice to work with people who wished to improve their health behaviors and lower their risk of chronic illness. Since obesity is the primary preventable cause of heart disease and diabetes, I began to specialize in helping people who had difficulty managing their weight and eating behavior. Most of these patients struggled with emotional eating.

As I have always done when I meet and evaluate patients with a behavioral problem, I would ask them to describe their thoughts and feelings while they engaged in the unwanted behavior. Almost all of them conveyed their experience in negative terms, or like the bulimic patients I had treated as an intern, as emotional numbness. It wasn’t long before I recalled the puzzle I had set aside years before: Why would anyone repeat a behavior that makes them feel worse? This time, however, I was not going to let go of it. If there was one thing I had learned by then, it was that many experienced people tend to take things for granted and fail to ask the most obvious questions. And often, it is the obvious questions that are most important. The answer to my question took a while longer to find, but I finally solved it with the unintentional help one of my patients.

Lauren was a very successful and driven sales manager. She was able to lose more than 15 pounds over a six month period. Around the time that she lost the weight, she was in the process of changing jobs in a very high pressure industry because she was feeling under utilized. She had started a new job, but with less time flexibility and increased responsibility, she became quite busy and was soon no longer able to continue coming in for therapy. Although she had not yet reached her desired weight, she was happy with her progress and felt she had a good sense of what she needed to do to continue on her own.

After about eight months without hearing from Lauren, I received a call from her asking to set up an appointment. She explained that she had gained back all of the weight she had lost, plus six more pounds. Although she loved her new job, she was very stressed, traveling four days a week. With a husband and two young children, along with many social and volunteer responsibilities, Lauren was pulled in so many directions that she felt she was not fully meeting any of her obligations, especially in her personal and family relationships.

She knew that her overeating was not about enjoying the food itself. As with virtually all of the other patients I was seeing for binge eating, she did not enjoy any part of the eating itself. This behavior was also not directly a result of her frequent travel and lunch meetings in restaurants. In fact, she was always very careful about what she ate when she was with other people because she was self-conscious about what they would think.

She explained that several times a week she would binge when she was alone in her hotel room and needed to take a break from her tightly-packed schedule and responsibilities and just let go. As she described it, “Eating without thinking about it is like taking a mini-vacation or going to a spa whenever I need it. I’m not enjoying what I eat; I just need to let go every once in a while.”

As I listened to her describe her experience, I realized that I had the answer to my question about what triggered her behavior and what maintained it. The reinforcement was powerful; it was just not as obvious a reward as enjoying a snack or giving a treat to a puppy. Call it defiance, rebellion, or self-determination; people have a need to abandon restraint when they feel controlled. Even though the experience was always brief and had a bad outcome, it allowed her to satisfy a much stronger need: to feel free. Thorndike’s law of effect had not, after all, been repealed.

My approach to treating emotional eating had shifted from that point forward. I realized that it was not about food, eating, or even loss of control; it was about gaining autonomy. Instead of viewing it as a passive breakdown of resistance, I see it as an active need to let go by abandoning control and relieving the pressure of restraint.

Why do we have such a strong need to be free of control? Coming up.

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