Chapter 6 Exercises from "Anatomy of a Food Addiction" by Anne Katherine, MA

Chapter 6 is called "How Healing Happens". It discusses dealing with both chemical functioning and feelings, and goes into quite some detail. Again, I recommend anyone who thinks this book can help them to pick it up. This is the assignment for tomorrow's group, and it's a doozy:

6.2 Disease Inventory: Part III (p. 102)

Starting from your earliest memory of bingeing and/or starving, dieting, and/or purging, chronicle your relationship with food.

The Progression of Powerless Eating

1. When did you first turn to food?

2. Gradually, over the years, your relationship—your intimacy—with food progressed. Chronicle this progression.

3. Include, if relevant, the progression of addiction to sugar and/or alcohol.

4. What impact has the addiction and compulsion had on all parts of your life in the last five years?

5. Be very specific and honest about your present pattern of bingeing and/or purging and/or starving. How much and how often do you binge? What is your volume of food? How frequently do you purge? How often do you starve yourself?

Control Efforts

1. List attempts to control eating—starving, dieting, purging, laxatives, diet pills, prescription drugs, coffee, smoking.

2. Mark the control efforts that failed.

Unmanageability

1. Unmanageability is a part of this disease. Anyone with an addiction finds that her life gets frayed around the edges. What evidence of unmanageability exists in your life?

2. List evidence of unmanageability in:
(a) Emotional state—mood swings, depression, self-esteem
(b) Relationships, social life, sexual relationships
(c) Work. Have you been late or missed work due to a sugar low or due to drinking? Have you attacked coworkers because of sugar anger? Have you sabotaged your own success by not having a clear head when needed or by eating rather than studying or reading or learning?

Adverse Physical Consequences

1. Have you ever risked your life or the lives of others by eating or not eating?
2. Have you damaged your body as a result of your addiction?
3. Include food blackouts. How many times have you found yourself with an empty bowl or bag in your lap and no clear memory of a decision to eat? How many times have you stood in front of the open refrigerator without knowing you were going to walk there? When did you first start having food blackouts? Have these progressed?

Adverse Social Consequences

1. What harm has been done to your relationships?
2. How has your disease affected others? How have the people around you had to adapt because of your disease? In what ways have you abused others because of the influence of this disease?

Adverse Financial Consequences

1. Include adverse financial consequences. How has the addiction kept you poor? How has it deprived you of having money for other things you want to do? Include crazy thinking about money so you could spend it on food.

Adverse Moral Consequences

1. Has the disease made you violate your values? (stealing, concealing) How is your self-respect doing? Have you lost any as a result of this disease?
2. Have you manipulated others so you could satisfy a craving?
3. Include confused priorities—how is food the center of your life? Has it been the center of any of your relationships? What evidence is there that eating has been more important than relating?

Adverse Spiritual Consequences
1. Include evidence of how eating has been more important than your spiritual development, more important than your relationships, more important than your health, more important than your peace of mind.
2. How has this disease affected your choices, your decisions, the opportunities you’ve missed or aborted?

Group

I am *really* glad I joined the support group. I liked the therapist, I liked the other women (no men joined), I liked the vibe, and I feel that I can learn a lot from everyone and do some valuable, necessary therapeutic work. I felt like I didn't stop talking the whole time; I was just so glad to be with people that spoke my language, so to speak, that I couldn't shut up. The dread I was feeling was totally unfounded, but that is something I do--worry too much ahead of time, and let's face it, anything that has to do with a group of people is a total crapshoot. We actually touched on previous group experiences, and many of them were negative in nature. It seemed to really correspond on the specific mix of personalities, size of the group, etc.

One thing that is going to be interesting for me is that this group includes people who have already had bariatric surgery as well as those who have not--about a 50/50 split, actually. I am especially looking forward to the insights of those who have already had a procedure, but continued to struggle with their weight. I am so afraid of "blowing it" myself due to not having my mind right. I think the importance of getting the mind healthy during before, during, and after this process absolutely cannot be overstated--and in my opinion, it is far too often overlooked, not only by medical professionals, but by people who gauge a woman's worth by her dress size.

The book the group is using is called "Anatomy of a Food Addiction: The Brain Chemistry of Overeating, An Effective Program to Overcome Compulsive Eating" by Anne Katherine, M. A. It is in its third edition and originally came out in 1991. It is a very interactive book that has many writing exercises, self-assessments, etc. I already like it because I feel it has a real-world, comprehensive approach. It classifies food as an addiction and serves to help find the roots of the addiction so that the behavior can then be modified.

The therapist talked a bit about food serving as a painkiller or sedative, how it is thought to be linked to the opioid receptors in the brain, boosting serotonin levels, and having a calming, soothing effect on those who use food in an addictive way. The genesis cannot be known for certain, but there is speculation that some people are just genetically more sensitive, having predisposition to addiction, depression, etc. In many cases, a food addiction begins as an attempt at self-care, usually quite early in life. The therapist posed the question: "If food is the bandage, what is the wound underneath?" The goal is essentially to determine what our individual wound or wounds are, also touching on what will take the place of food, so that we do not replace it with another self-destructive, addictive behavior.

I know this is going to be difficult, but I feel more hopeful than I have in a long time. I already know I am my own worst enemy (as are most people). I also know how hard I am willing to work and how far I have already come working through and against incredible obstacles. I am so lucky to have support and love in my life--leagues more than I have ever had. I know that without it, I would not even be attempting this journey.

Next week is my second wedding anniversary, and we are going away for a couple of days. When we come back, we plan to submit applications for private student loan funding, in the event we can qualify for some as a couple and I can pursue further education in the fall. I'm crossing my fingers!

Day 86, Part Two: This Time, It's Personal

Phone appointment this morning with regular doctor went well. She is upping my Seroquel (sleep med) to 75 mg with optional 5 mg Ambien chaser if I wake up and can't go back to sleep during the night.

"Has it changed your mood?" she wanted to know.

"To what?" I answered. No, my mood pretty much stays at half-mast, Doc; I just want to sleep. I am having one of those puffy-eyed, flat-affect kind of days as it is. We debated about eventually changing the Lexapro, but when she consulted my chart notes she discovered I have already tried every freakin' antidepressant that was ever so much as a glimmer in Eli Lilly or GlaxoSmithKline's eye.

We talked about the sleep apnea, and she wants me to see the specialty dentist to get the mouth guard made ASAP. I have to see if I can get it covered first; they are not cheap. If I have to have another sleep study, I will straight-up plotz. She is willing to write me authorization letters for everything. I heart my doctor.

(A side note/update about Fun With Insurance Coverage--insurance still has not settled on my psych eval charges. They continue to debate back and forth with the provider's office as of 11:30 this morning. The date of service was January 16.)

*****

Next up: the nutritionist.

I weigh in. I have gained a couple of pounds. I am two pounds less than I was on the first appointment. This is not a shock. I am rather grateful I didn't gain more.

We procceed to Talk Seriously about What I Think Happened. What I think happened is as follows: I am not feeling motivated, I am sick of the BS, I have a hitch in my gitalong, I am discouraged. I have gone out to eat and I wanted a cocktail. I have gone out to eat and split dessert with Mr. Salted. I have gone out to eat and felt like crying because I'm not going to be able to enjoy food as I once did. I have eaten chocolate because it remains the most reliable source of pleasure on the planet. So sue me. I am still writing every blessed thing I eat down (give or take a Hershey's Kiss here and there), complete with calorie counts and protein content. I am exercising roughly half the time. I am not a complete and total screw-up; if it was Pass/Fail, I'd get a Pass. (I think. If I smiled a lot. Probably.)

I tell her I'm looking into getting counseling authorized by insurance and--DA DA DUM!!!!! turns out the wellness center is hosting a support group. It isn't free, but the cost isn't outrageous. It starts tomorrow night, goes until June 3. The flyers says, "help break the cycle of food addiction and emotional eating." It's facilitated by a nutritionist/counselor and there will be no more than eight members, which sounds like a good size. Support, therapy, reading, assignments, etc. I bit the bullet and took the money out of the tax-return/pipe-dream-of-further-education fund, which is flying out of the bank to pay this bill and that anyway. I really need to talk to some other people who are dealing with the same stuff; I think it could really benefit me. (Since I coughed up the actual cash, I know that I will not run screaming into the night; once I part with any money, to run screaming ceases to be my way. My way is, "I will get everything out of this that I possibly can, dammit.") I participated in a similar group fifteen years ago, and although it was not about food issues, it was extremely helpful. The book they are going to use in this group is called "Anatomy of a Food Addiction". It discusses brain chemistry and other contributing factors.

I have never talked about my food issues in a group of people I didn't know. I barely talk about them with people I do know. I wonder if I will be the fattest (SHALLOW!), and I wonder if there will be any men there. (It would be really interesting to talk to an acknowledged male food addict.)

I am feeling some (inevitable) dread, but also that this is a positive step in the right direction.

Chocolate and the brain

I was surfing the Web the other night, just playing around, looking at food addiction treatment-type things--I was curious what was out there. There is actually quite a famous center that treats food addiction close where I live--they have been included in TV documentaries I've seen--so I went to their website and discovered (a) there were no prices listed anywhere, which is never a good sign; and (b) they threw the word "God" around an awful lot as it related to treatment. Salted don't play that; even if I was into that, and I'm not, I think God has bigger fish to fry than my fat ass.

I went to the Food Addicts Anonymous website and it looks as though they use the old Overeaters Anonymous model, which was attended by a close family member back in the day, so I have some familiarity with it. I also read about it in Betsy Lerner's memoir "Food and Loathing". It's a 12-step program. No sugar, no flour, no nothing. I will continue to look for post-op support groups. Though it has worked for many and I respect that, I don't see myself being able to embrace the 12-step model. I will continue to research post-op support groups.

So, I started looking up chocolate addiction, and when Googling the words "chocolate rehab", lo and behold, a British woman is writing a book called "Chocolate Rehab". It sounds like genius to me; I can't believe no one else has written it before. I hope it comes out soon. I found other websites of many different stripes, some claiming that chocolate was more addictive to the brain than cocaine and marijuana and may have similar effects (!).

I found an academic paper from the Journal of Affective Disorders that was fascinating--it was debating whether or not chocolate had antidepressant effects. The writers argued that chocolate craving and chocolate emotional eating were two entirely different things, although they could both exist in the same person. Some studies have shown that seasonal affective disorder and atypical depression sufferers who tend to self-medicate are able to achieve some elevation in their serotonin levels by ingesting chocolate, but the writers of this paper argued that chocolate would not be as effective as other foods or chemicals in achieving this result, yet chocolate is the specific substance craved. The paper's writers ultimately come to a similar conclusion regarding the possibility of chocolate cravings as the result of a magnesium deficiency, providing evidence that other foods would be more effective in making up the difference there, but would not satisfy a chocolate craving, possibly because of the uniquely appealing texture, aroma and taste of chocolate.

The paper went on to define emotional eating and conclude that it failed to produce any real or lasting benefit to a psychological or mood state, and that continued or elevated emotional eating could actually contribute negatively to mood. (I think anyone who's ever been a binge eater would be able to vouch for that.)

Though food craving shares some of the same features of drug addiction, the writers of the paper point out, they found no consensus that food craving qualifies as an actual addiction. They cite the possible reason for this as different reasons for craving drugs vs. craving chocolate--craving drugs is related to a physiological requirement by the body to put it into a certain altered state that alleviates a negative state of "low", where craving chocolate is related to the sheer "hedonic experience" or pleasurable sensation of smelling, tasting, and consuming it.

I found this paragraph interesting: "Chocolate was not greatly preferred over other sweets for self-medication, even among chocoholics. Self-medication occurred most commonly in response to depression, tension and irritability, less often in response to anxiety, and least often to anger." (Indeed! How can one be angry while savoring a Ghirardelli creation? Nom nom nom...) "Anecdotal evidence indicates that chocoholics who are also emotional eaters only crave chocolate, but when stressed, they will crave any other carbohydrate." The paper ultimately concludes that chocolate is an indulgence that invokes pleasure and it may provide some comfort in emotional eaters, but that it is more likely to prolong depressive mood and so cannot be called an antidepressant.

So, basically, according to this paper, I am not an addict, I'm simply a hedonist. Do they have a Hedonists Anonymous?