ED Science Stuff

Eating Disorders in Couples: A Fish Story

Even Goby fish do it.

Dieting, that is.

Why, you may ask? You’d think that dieting would be a death sentence for a tiny osteichthyes, no bigger than a bloated paper clip. But some goby fish see slimming down as survival.

In essence, gobies lower on the ladder of piscine hierarchy starve themselves to minimize their threat to plumper, more powerful leaders. Starving is a way out of imminent confrontation.

This fish story doesn't just have import for our marine friends; it bears on human behavior as well and brings to mind several of the marriages I profiled in Lying in Weight: the Hidden Epidemic of Eating Disorders in Adult Women.

“Who partners up with a woman weighing 85 pounds?” I asked.

The answer: any one of five categories of men (or women if the male is the one with the eating disorder or the relationship is same-sex). The so-called, “Macho Man, Control and Conquer,” is like the superior goby acting in concert with his inferior, anorexic wife/girlfriend.

The husband/boyfriend could be an executive, doctor, attorney, military officer, or minister. He’s the man used to managing other people, assigning duties, and being aggressively IN CHARGE. He chooses a partner with an eating disorder because she will accept his alpha position, and by extension, her subordinate one. She starves to shrink into her Stepford role. As a bonus, she’s slender and trophy-like in appearance. All the more reason for him to stay with her.

This tragic dynamic and others have prompted psychologist Cynthia M. Bulik, PhD, Director of the University of North Carolina Eating Disorders Program, and her colleagues to pilot an intervention for couples in which one member is suffering from anorexia nervosa.

Called, Uniting Couples (in the treatment of) Anorexia Nervosa (UCAN), the intervention starts with the premise that adults develop anorexia, too. And when they do, they are often in relationships.

Intimacy is tough and tougher still when one partner has an eating disorder. Both partners feel the effects. Therefore, both might benefit from treatment, in this case cognitive-behavioral couple-based interventions that have been successfully employed for the treatment of depression, anxiety disorders, smoking cessation, and cancer.

Will it work?

We do have measured success stories with family-based therapy, traditionally with child, parents and siblings. So there is great hope for family therapy in marriages or partnerships.

The time has never been riper. Bulik’s group, in conjunction with Self Magazine, just published a survey of 4,000 American women aged 25 to 45. Nearly two-thirds (65 percent) of the women reported disordered eating behaviors, and 10 percent report symptoms of eating disorders such as anorexia and bulimia nervosa or binge eating disorder.

That’s a frightening number of adults, the majority involved in partnerships. Couples intervention might be a sorely needed option for those who are struggling.

 Back to the fish. Gobies find power imbalance in relationships the key to maintaining a stable, noncompetitive society. However, fish are fish and they can maintain smaller sizes without becoming mentally ill.

 Humans are a different story.

Take one common scenario: a woman in this situation shrinks down to “feel loved.” But she eventually realizes -- and admits -- that her partner does not love her for her. He loves her for what she can do for him. And as his dominance continues, she regresses into self-loathing. She does more of the eating- disordered behaviors such as starving, vomiting and/or exercising to excess. Finally, she becomes so sick that she is hospitalized and/or unable to fulfill her duties to him. He, then, dumps her for someone better able to do the job.

Another scenario -- and one I like so much better: the woman reaches her breaking point. She taps that strength buried inside her and fights back, not with food, but her voice. She swells up in her body, as well as personality. And the couple renegotiates their relationship. Or she, healthier, leaves him to look for a better partner. After all, there are more fish in the sea.

 

A Chocoholic? Not

Is chocolate addicting?  Common wisdom would say, yes. There are countless, self-professed “chocoholics” who swear the savory sensation of a square of Godiva, melting on their tongue, undeniably engenders an uncontrollable craving for more.

But is this craving an addiction? And, by the way, what’s the difference between craving and addiction anyway?

For help in answering these questions, I turned to psychologist Mary Boggiano, Ph.D., at the University of Alabama at Birmingham. She provided incredible knowledge and lab data about bingeing, bulimia and addiction, when I was writing Lying in Weight.

“No, chocolate is not truly addicting,” Boggiano says, “but it can sure as heck feel that way for some.”

Technically, chocolate does not induce a drug-like effect on the brain – at least not in the same way that, say, cocaine and heroin do. If you doubt, know this: scientists have even taken apart the ingredients of chocolate i.e. cocoa, cocoa butter etc. and found that no subjects craved the components when they were presented in different food sources. 

The sum of a candy bar is definitely better than its parts.

There’s more. Historically, doctors have used the word, “addiction” to refer to a recurring compulsion by an individual to engage in some specific activity. He or she does this despite harmful consequences to health, mental state or social life. Addictive substances or behaviors (i.e. gambling) breed a tolerance, meaning that greater dosages are needed to produce an identical effect over time. And taking away the addictive substance evokes noticeable, if not extreme, physical withdrawal symptoms.

Chocolate does not produce the classic responses that defines real addiction. 

“It's not like you need more and more chocolate each time,” Boggiano says.  “And any feeling of "withdrawal" is probably more psychological (a habit) vs. physiological.”

Speaking of physiology, there’s a slew of medical research on what happens in the brain in response to addictive drugs. Simplifying the research, an addictive substance is one that produces a specific effect on a specific neurotransmitter (dopamine) in a specific region of the brain called the nucleus accumbens, a seat of reward -- and ironically, fear.

Chocolate does not do this. Or it at least it does not do it in the same way as cocaine and heroin. Studies show that drugs of abuse stimulate the production of dopamine in the nucleus accumbens. These drugs also keep the stimulation going when the brain is repeatedly exposed to them. Chocolate, too, stimulates dopamine. But the brain eventually down-regulates this dopamine response after repeated exposure to chocolate.

So, what looks like a duck, isn’t a duck – that is, if it's a chocolate duck.

However, no one can deny the pure pleasure and pick-me-up feeling of a nice hunk of a Dove Bar. If this is not addiction, than what is it?

Researchers suggest that chocolate induces a delicious mood state that is so vastly different from the PMS-depressed-like mood state you were in when you bought the Dove Bar in the supermarket. Thus, it is this contrast in states of mind (blah versus ahh) that provides the 'hook' or belief that chocolate is addictive.

Of course, there is the caveat that when an eating disorder involving bingeing is present, this dopamine response in the brain can go awry.  But that’s a whole different story; a study by British researchers showed that for those who consider their intake of chocolate excessive, any pleasure experienced is short-lived and accompanied by deep feelings of guilt.

Indeed, chocolate is bittersweet.

A Diabolic Reckoning

Last week, the Boston Globe ran an article about diabulimia, a practice in which individuals with diabetes skip or underdose their insulin in a misguided attempt to stay thin.

The article cited in the work of psychologist Ann Goebel-Fabbri, at the Joslin Diabetes center in Boston. She published a shocking study last year showing that diabulimia tripled the risk of death from diabetes or its complications. Those who restricted their insulin died on average 13 years younger -- at 45, compared to 58.

Raisin Bran and Disordered Eating

They skip it because they want to lose weight. Breakfast, that is.

In a study published this month in Pediatrics, Dianne Neumark-Sztainer’s group at the University of Minnesota reported that adolescents who regularly skip breakfast end up heavier than their counterparts, who spoon their cereal and nibble their toast regularly. Because the skippers tended to be trying to --or thinking about trying to -- lose weight, the authors concluded that breakfast-skipping may be a misguided attempt at weight loss.

 

Can Dieting Be a Drug?

Explain this: Most people abhor dieting – it’s just too hard to eat less than the body naturally craves. But a person with anorexia nervosa diets, loses weight and actually feels better. It’s almost like dieting becomes the ultimate accomplishment, a fix that a certain kind of dieter learns to crave.

Sound like an addiction? Maybe, says biologist Valerie Compan at the Centre National de la Recherche Scientifique, Montpellier, France. Last October, she and her colleagues found that starvation in mice activated some of the same brain pathways as the highly-addictive club-drug Ecstasy.

To Sleep, Perchance to Binge

There’s long been a consensus that what you eat influences how you sleep. But can how you sleep dictate how you eat?

The answer is yes. At least at the extreme.

Hal Droogleever Fortuyn, M.D., of Radboud University Nijmegen Medical Center in the Netherlands, and colleagues just published a study uncovering severe binge eating problems in people with narcolepsy, a sleep disorder. Half reported runaway cravings for food and binge eating. More extreme, almost a quarter (23.3 percent) met the criteria for a clinical eating disorder.