Kathryn Hansen's Pioneering on Bulimia and the Primitive Brain

Kathryn Hansen is a leading voice in the field of eating disorders. She is the author of Brain Over Binge: Why I was Bulimic, Why Conventional Therapy Didn’t Work, and How I Recovered for Good and the Brain Over Binge Recovery Guide. Kathryn is also the host of her longstanding Brain Over Binge podcast. Known for sharing her personal story about struggling and recovering fully from bulimia at a time when others were silent, Kathryn’s book helped others to realize they were not alone. Publicly stating that conventional treatment did not help her also allowed other sufferers to recognize that eating disorder treatment is not a one-size fits all approach. She now offers her own alternative approach to ending the cycle of binge eating.

Your belief is that binge eating is not a result of underlying emotional or psychological issues. Will you please discuss what personally led you to believe this during your recovery from bulimia and what you believe is the sole cause of bingeing?

I never want to take away what may work for other people. So if thinking that your binge eating is caused by underlying issues and solving those issues works for you, then that's great. That was not the case for me—very far from it. I went to therapy after I had been bingeing a while and couldn't get control of it. And I was told that you're bingeing because of depression, anxiety, and problems in your past, and I really went down a path to try to solve those issues.  And of course, that had value, there's always value in improving yourself, but it literally did nothing when it came to my bingeing. In fact, in a lot of ways, I think it made it worse. I think it made me connect my bingeing to so many different things in my life. It made my bingeing seem to take on a deep meaning. It made my bingeing feel like something I needed to cope. And really, the bingeing was only harming me. It wasn't helping me cope with anything, it wasn't helping me deal with any of my problems. So it really took unlearning all of that to be able to let this behavior go. It took realizing that this is a habit that was created when I started dieting, which sent my body into a survival reaction. I binged as an adaptive response, it created a habit, and I continued to do it because the brain rewarded that behavior. It really took reframing it and realizing, okay, I'm not doing this for any sort of deep reason, and I can let it go.

Some people do have trauma, and maybe that does need to be addressed in order to be able to access your higher brain to say no to the binges and to really let the behavior go, but I don't think that should be the first line of treatment for everyone across the board. I think anyone who walks in with an eating disorder, it's automatically assumed there must be trauma, or there must be a deep reason, or there must be deep emotional problems. When a lot of the time, it's just because that person went on a diet, which is understandable in the culture that we live in and the pressure that we're under to have a specific body type.

Do you believe that emotional or psychological issues maintain the illness and that they still need to be addressed as part of holistic healing?

That's a great question too, and I think it all becomes intertwined. And some of that, as I alluded to before, is because of the ideas given by therapy. And a lot of these ideas that bingeing is a coping mechanism are perpetuated in the mainstream media. Even on WebMD, which is a popular medical website, it says that binge eating is a coping mechanism. These ideas are very, very common—to think that bingeing is a result of emotional problems. Because of the cultural messages, we can think that this behavior is something that means a lot to us, or is a symbolic behavior, or is a way of coping. That's a way that it gets connected to emotions, but then there also can be an element where we actually do crave a “pleasurable” behavior—and I say that in quotes because bingeing is the opposite of pleasure when we look at the result in our life—but in the moment, it can feel pleasurable. It can feel like you're giving yourself a reward, or a break, or an escape, and really, relief from starvation is pleasurable. And when do we want pleasure? Well, a lot of times we want pleasure when we feel pain, when we're stressed, when we're anxious. I don't think we have to give that a lot of meaning except that that's the connection that can be made: You crave pleasure more in times of pain. So, therefore, you might binge more in times of pain than in times of happiness, but that's not always the case. I mean, I definitely binged when I was happy, when things otherwise in my life seemed to be going well. So even though it is more common to perform this destructive behavior in relation to negative emotions, that's not always the case, and it can happen in connection to positive emotions as well.

In Brain over Binge, you wrote: “I knew my thoughts were not under my control but my actions were.” Will you please elaborate on the separation between the subconscious eating disorder thought leading someone to binge and the conscious act of doing it; and why this distinction is so important for recovery?

The thoughts are so powerful in both how the eating disorder develops and then how recovery eventually happens because anyone who's experienced bingeing and experienced the urges knows that there's a powerful craving, but then there are also thoughts. There are also justifications, a common one is "I'll just do this one last time," or "I already ate this junk food, so I might as well now eat everything." There are all these different reasons that come up that justify the behavior. 

And I talk about all of these thoughts as “neurological junk.” Neurological junk is basically thoughts that have come up over and over that have justified the behavior, that have caused you to act. And at first, they might have felt like your conscious thoughts, but over time, they become very automatic and you act on them without thinking. You really believe them. You really identify with them. And recovery is about stepping back and realizing that these are automatic thoughts, this is a primal force of your brain trying to maintain this habit. And once you see them as something separate from your true self and what you truly want, what you truly desire, you can start having the thoughts, but then not acting on them, and not reacting emotionally to them—realizing they don't signal any sort of deep meaning and they are not indicative of what you truly want or need. You can start creating an identity separate from those thoughts, and as you have the thoughts and don't act on them, then the thoughts slowly can go away.

Your website talks about the belief that “bulimia and binge eating are very natural” and are the brain’s “primitive” response to restrictive dieting and the repeated overconsumption of highly stimulating foods. Can you explain what you mean by the “primitive” brain?

I've alluded to that a little bit here as far as when I talk about survival instincts when you diet. We all have a primitive brain within our brain in our heads. The primitive brain lies deep within our brain under that wrinkled outer layer of the brain. And the primitive brain is in charge of our survival, it’s also in charge of our habits, it’s in charge of our motivation toward pleasure. It is said that there are three goals of the lower brain or the primitive brain (which I call the lower brain in my books), and those three goals are to survive, to seek pleasure, and to avoid pain. So when we diet, the primitive brain gets activated because it thinks we need to eat as much as possible to survive. That's why bingeing is that adaptive response because the primitive brain gets activated because it's trying to help us. And I think that even though we may not need to binge to survive—we just need to eat normally—but if we don't eat normally, the brain takes action to try to keep the body alive. That's why bingeing really stems from that more primal force of the brain. And then also, once you repeat the behavior, it's rewarded. Like I talked about earlier, it is pleasurable in the moment you're eating foods that stimulate some pleasurable brain chemicals, and that becomes very reinforcing. And that again is through that primitive brain, which contains the reward center or the pleasure center. This is typically referred to as the limbic system, which is in charge of our motivation toward pleasure. All of this operates beyond our conscious, more human brain, which is in charge of our identity, our true wants and desires, our goals, thinking about our future, and things like that—what we consider our more human qualities. That is separate from the primitive brain. Of course, all of the brain works together, but that’s what I mean by the primitive brain and the human brain.

How does restrictive dieting and/or the repeated overconsumption of highly stimulating foods lead to bulimia or binge eating?

I've talked a lot about the dieting aspect, and the biggest study on starvation is the Minnesota Starvation Experiment, and I think that's a really important one for anyone struggling with this to look into because it was really the only study on human starvation, because for ethical reasons, a study like this can't be repeated. But it was done to test refeeding strategies for people returning from World War II who were literally starved from the atrocities of war. So the men in the study agreed to go on a calorie-restricted diet to test refeeding strategies, and they developed all of the symptoms of eating disorders. They binged, they became obsessed with food. It really showed the effect that starvation has. And the fact that now, sitting in therapy, we say, "Oh, it must be because of this terrible thing in your childhood or it must be a depression"…yeah, maybe that's a factor, but if you just look at this Minnesota Starvation Experiment, they basically recreated all the symptoms of eating disorders in healthy males that went through the study, and that’s important to see.

And then the second piece of this that you asked about is the repeated overconsumption of highly stimulating foods. So, dieting doesn't always have to be the path. Some people, for whatever reason, start overeating, and a lot of times it starts in childhood and can be linked to emotions. Based on what I said earlier about when you have pain or any sort of negative emotion, your brain can crave pleasure. If it's craving pleasure and you eat to get pleasure, that can become a habit as well that increases over time, and you become very pleasure-seeking around food and that can be in response to pain that you're having. You just go back to the food and eventually you need more and more of the food to achieve the same result. It creates some changes in that reward center, it's almost like tolerance—you need more and more over time. So eventually overeating or emotional eating can lead to binge eating. That same habit, based on whether or not you took the dieting path there or the overeating path there, you end up in the same predicament where you have a brain that is programmed to think you need to binge to survive. I mean, that's what it feels like. Anyone who's had this issue, it can feel like it's a life or death situation to binge and that's what your brain has been trained to do, regardless of the path that you took to develop that habit.

What do you feel are the biggest contributing factors to the rising numbers of people diagnosed with eating disorders?

I do think social media is a big one. There is a cultural standard of body image, and that has always been the case—different time periods bring different standards, but I think now it's just so visible and there's so much pressure and there's so many people posting perfect pictures, and people use filters, and AI. There's just so much that creates an unrealistic standard for young people and it's tempting to think that dieting is a solution. It's tempting to start restricting your food intake, and we still have the same brain with this primitive survival response. And people don't know when they start dieting that that's what's going to happen. They think, "oh, I just need to look a certain way." So, I think that more cultural pressure is contributing to that increase in the number of people with eating disorders.

What is the one takeaway you want people who are struggling or those who love them to know about bulimia recovery?

People have stopped habits and addictions for as long as addictions have existed, and you can get back to leading a normal life. You're totally capable of that. And it's so important to eat enough food. Some people will think, "Oh, I can stop bingeing once I lose the weight," or "I'll go on this last diet, and then I'll stop bingeing." But you're not the exception, and as long as you’re dieting, you're not going to be able to stop bingeing. You have to eat enough food in order to stop this habit. So those are the two things that I would want people to take away.

Is there anything you would like to say that I didn't ask you?

We talked about therapy and how bingeing is seen as a coping mechanism. And what I try to teach is that when you binge, you're coping with the urges to binge. Those urges to binge are the direct cause. The reason some people binge and other people don't binge is because the people who don't binge are not having binge urges. These urges are such a strong force. They create desire which is from the primitive brain, and it includes all of those thoughts we talked about—the justifications, those binge-encouraging thoughts that we talked about before—and these urges are the direct cause. So it's really about learning to recognize these urges and learning to what I call “dismiss” these urges and really seeing that you are separate. When you zone in on the urges as the cause, it makes recovery a lot more simple. You're no longer trying to fix the rest of your life or fix all of your emotions. You're trying to dismiss these urges. And when you do that—along with eating enough—you decondition the habit, you change your brain and then you can just be free of this.

Author: Merrit Elizabeth

Certified Eating Disorder Recovery Coach, CCIEDC 

Struggling with Bulimia?

Download our new, FREE 25-minute video where we take you through our Top Ways to Stop Purging. CLICK HERE