[adapted from Mindful Emotional Eating (Somov, 2014)]
Differentiating a binge from emotional eating or emotional overeating is both hard and simple. Hard if you go a quantitative route, if you count calories. Easy if you go a qualitative route, if you factor in the emotional mandate of these two types of eating. I’ll take the easy path here. The subjective goal of emotional eating is to feel better. The subjective goal of binge eating is not to feel at all (i.e. to numb out, to disassociate somewhat or entirely). What this means is that binge-eating cannot be made mindful. Binge eating is a desire for mindlessness.
Another aspect of binge-eating that might or might not be generally true, but usually is, is that binge eaters are at least partial restrictors. What this means is that they try to compensate for overeating by undereating. In this they begin to approximate the dynamics of bulimia, minus such explicit compensatory behaviors such as purging, over-exercising, or using laxatives. This compensatory tendency of binge-eaters will come in handy when we try to sublimate this eating roller-coaster. You’ll just have to read on to get a better sense of what I mean by “handy.”
Three Approaches to Managing Binge-Eating
As I clinically see it, there are three approaches to managing binge-eating. One is common but impotent – that is an advice of abstinence.
The second one is much less common – it’s an approach of harm reduction. Think of it as down-shifting a binge to plain ol’ emotional overeating. (I have described this approach in my 2008 book Eating the Moment; Linda Craighead, in her 2006 book Appetite Awareness Workbook, offers a similar approach).
The third approach is essentially unknown – it’s a path of sublimation. (This approach, to my knowledge, is unique to my clinical practice and I have described it step by step in my recent book, Mindful Emotional Eating, in Chapter 9.)
Clinical Non-Doing & Attitudinal Harm Reduction
Sometimes clients are ready to change and sometimes they are not. When clients are ready to change, you help them change. When clients are not ready to change, you try to see if you can help them become ready to change and if they do become ready to change, then you help with the change. But sometimes, and not infrequently, you have a client who is not interested in change. Period. Despite your best motivational enhancement efforts. As the wise minds of Motivational Interviewing tell us, we have to meet clients where they are. And sometimes we have to stay and work with clients where they are. So, if the behavioral change is out of the question, the only thing left to do is to help the client change how they feel about their behavioral patterns. And that is the art of clinical non-doing – it’s attitudinal harm reduction.
Attitudinal harm reduction without a corresponding behavior change scares clinicians. Clinicians, particularly in this day and age of behavioral outcomes, have come to equate their clinical potency with behavioral changes. That is myopic: A change of attitude, while invisible, is an entirely acceptable existential outcome of psychotherapy. If your binge-eating client can shift from feeling ashamed and embarrassed about her eating pattern, she is now psychologically healthier even if she continues to remain at risk physiologically. Self- acceptance, as I see it, is not just a “good enough” outcome but an essential outcome of a successful clinical intervention. And there is nothing like humanistic harm reduction to leverage self-acceptance, particularly, with the binge eating population.
Chemical Alchemy of Sublimation
But we are not going to stop at helping our clients accept what is, as strategically useful as it may be. We can offer them a blasphemous solution – a solution that involves a permission to binge. That’s right, not the kind of gear-downing, harm-reduction permission that Linda Craighead talks about when she talks about a conscious decision to overeat instead of bingeing. I am talking about an actual permission to binge eat. “On what basis?” you might ask. “On the basis of sublimation,” would be my answer. Let me explain.
An old mentor of mine once defined sublimation as “turning s*!# into gold.” If this strikes you as mildly pathologizing it’s because it is. I prefer to define sublimation as “clinical alchemy” – as a process of turning something that is problematic into something that is less problematic. Viewed as such, sublimation is quintessential harm reduction. Sublimation as a clinical direction scares the clinician because, once again, it seems like clinical non- doing. As a clinician, you are not fostering any behavioral outcomes, just attitudinal changes. And somehow it just doesn’t seem enough to you. But to your client, it’s plenty. An attitudinal change makes all the difference for your client; not judging themselves, not feeling irrational, or not having to hide feels great. And this gain of self-acceptance, of course paves the way for an eventual behavioral change down the line. But sometimes it doesn’t. Sometimes clients stay behaviorally exactly where they are for a very long time, if not for good. In such cases, attitude change is as good as it gets and to my clinical mind, that is plenty.
Two Sublimation Vectors
Recall that sublimation is not behavioral change but attitudinal change (that may or may not lead to behavioral changes). The goal of humanistic sublimation is attitude change and, thus, a change in self-view. I use two sublimation vectors when working with binge eaters who don’t want to stop binge-eating. The first is by now all too familiar for you, it’s the idea of self-care. I reframe binge eating just like I reframe emotional eating, as a form of self-care, as a means of emotional self-regulation.
The second sublimation vector is the idea of intermittent fasting. I reframe the binge-eating-self-restricting roller coaster as a form of intuitive intermittent fasting. In doing so, my client and I take the pseudo-sin of self- destructiveness out of binge eating and self-restricting. This positions the client to shift from self-loathing to self-acceptance and to also see the serendipitous method behind the apparent binge-eating/self-restricting madness. Suddenly, the client who felt chronically stuck finds oneself at the cutting edge of nutritional science on extending health span via calorie restriction. The shame is gone in a flash. The defensive bracing for social judgment has vanished. Instead, the client experiences a moment of righteous vindication: She feels that all along she must have been onto something, onto something intuitive, onto something that not only makes emotionally pragmatic sense but might even be physiologically healthy. It’s a pleasant shock, a whopper of good news, a major glimpse of hope. The client feels smart and encouraged and suddenly open to fine-tune their binge-eating behavior to transform it into the cutting edge paradigm shift of health maintenance.
To pull off this sublimation vector you need to do some homework on calorie restriction (CR) and intermittent fasting (IF).
Caveat: my clinical ideas are time-specific, reflecting the current realities of what we know, the current state of CR literature. If the paradigm shifts again and we discover that calorie restriction and intermittent fasting are bunk, I’ll be the first one to slam on the brakes and go back to my clinical drawing board in search of another sublimation vector. But as the facts stand right now, sublimating binge-eating and self-restricting into calorie restriction and intermittent fasting makes good clinical sense.
[adapted from Mindful Emotional Eating (Somov, 2014)]
Pavel Somov, Ph.D., is the author of 7 self-help mindfulness-based books, 3 of which are on mindful eating: Mindful Emotional Eating (2014), Reinventing the Meal (2010) and Eating the Moment (2008). He is on the Board of Advisors for the Mindfulness Project (London, UK). Pavel Somov is in private practice in Pittsburgh, PA.