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How Obsession Begets Obsession...With Anything

Hello, I am a 23 y/o female and I don't know what's wrong with me, l am a big time overeater. The only reason I am not obese is because I exercise. I'm always preoccupied with food. I'm always thinking of what I will eat next. After having my child I started taking phentermine and that has been the only time in my life that I did not obsess over food.

l don't know if I'm depressed, have Social anxiety or what my deal is. There is absolutely no time for me to be depressed. I do'nt feel sad. Mostly, I feel like a zombie going through daily routines while shoving processed food down my gullet.

1 also get this weird brain fog that happens when ' believe I'm possibly anxious, like around people. As a nursing student one instructor told me l needed to pay attention and the worst part is I do try but my head sometimes gets cloudy, and 1 will just feel this overwhelming fatigue.

I'm going to start a job as a RN soon and feel this foggy brain is going to make everything So much harder. I hate not being able to pay attention, always eating, Worrying I'm going to mess up.

I would like to ask my PCP about Wellbutrin but I feel embarrased asking.

Dr. Richard Schultz Says...

Hello, and thank you for addressing your question to me. 

I am truly sorry for the suffering you have experienced in regard to your relationship with food, and other troubling symptoms of symptoms of anxiety and depression.

Let me first tell you that you are so NOT alone in your struggles. In any given year, more than 25% of the U.S. population will meet criteria for a mental health diagnosis (anxiety being far and away the most common of these).  Although lifetime prevalence statistics are typically underestimated due to a variety of factors (treatment is not sought, diagnoses are not made, and mental health problems are simply under-reported), a great many of which stem from precisely the sense of embarrassment and shame you have described feeling, it is estimated that between 65% and 85% of the global population will experience at least one episode of mental illness during their lifetime. It is sadly puzzling that so many people continue to think of themselves as “defective” for experiencing what almost everybody else ALSO experiences. I suppose we must conclude that feeling strange is a very strong sign of normalcy.

Before writing further, I must advise you that a variety of medical conditions and syndromes can “masquerade” as mental health issues, and visa versa.  So please do get thoroughly checked out by your doc to rule out pharmacological, metabolic, hormonal, neurological, thyroid and other potential conditions that can impact mood, hunger and eating behavior.

So, it’s drill down time. I am now going to address your issues far more specifically. I will err on the side of directness, and I ask for your patience with this.

One can develop the cyclical pattern of preoccupation, obsession and compulsiveness you describe in regard to just about any other at least temporarily stimulating behavior (drinking, gambling, having sex, working, fighting, shopping, stealing, watching porn, etc.).  Regardless of the circumstances under which you developed such an uneasy attachment to this particular realm of behavior, however, let’s please be clear about the research which states that you were NOT born with this problem, but that you learned it.  And you have been practicing it diligently, daily and during almost all of your waking hours, for a very long time. Well, we get better at whatever we practice, and we are always practicing something.  So, sadly, you are now an expert.  But that need not define you beyond this moment.

With approximately 99% of human problems, overt, active and even aggressive solutions will yield success (getting out of a burning building, selling widgets, moving furniture, protecting yourself from an assailant, getting out of debt, etc.).  When applied to internally driven problems of thinking, feeling and behaving, however, such solutions typically fail, and usually cause these problems to persist and  worsen.  Thus, your attempts to zealously control your weight, via compulsive exercise, taking phentermine, or practicing periods of eating restriction, have all been associated with increasing distress and stuckness. This outcome is wholly consistent with the behavioral principle of negative reinforcement.

You wisely suggest that your own underlying tendencies toward insecurity, depression and anxiety, all of which you seem to want to suppress or negate versus address, are likely related to the eating issue, and to the layer of additional worries and pressures to which it gives rise. Well, I think you are right. You are treating yourself like someone that has no right (or time) to truly allow her painful feelings (no time to be depressed?), so you consequently feel as if you are walking through life like a zombie (which is, in fact, a clearer sign of depression than is crying and feeling sad), and the hungry, otherwise ignored part of you, is fighting back. That which is suppressed will be expressed.

Finally, experiences such as “brain fog” and other related neurologically located phenomena (lightheadnedness, dizziness, mind going blank) are common accompaniments to anxiety and are, in fact the direct result of your central nervous system’s fight or flight mechanism kicking in.  These symptoms typically occur within the context of social anxiety disorder and panic disorder, and generally respond well to empirically-supported psychological treatment when delivered by an appropriately skilled practitioner. 

So, most importantly you need, and will most likely derive significant benefit from, good solid treatment.

Most essential in this regard will be establishing a strong working alliance with a qualified therapist who can help you understand, disentangle and address these problems (which, again, do all appear to be related). I would therefore advise you to seek out a psychologist with a strong cognitive-behavioral perspective, who can demonstrate to you rather quickly (hopefully within the first meeting) that they have a solid conceptual and technical grasp of what has been going on with you, as well as a sound initial treatment protocol(s) to propose in response.  You also need to feel reasonably comfortable and connected to this therapist as the working alliance is a major mover in therapeutic success. 

With regard to psychopharmacological intervention, this is also likely to be at least somewhat helpful, and may give you some relief for your symptoms while you are on the medication.  This may also, in turn, give you greater resources for the work required in psychotherapy. I have worked with WAY too many people on psychotropic medications alone who have not made sufficient progress because they are not supplementing their meds with psychotherapy.  Meds can be great, but they don’t teach us new ways of thinking or feeling.  In summary, medication is not proven to be a sufficient standalone treatment for the condition you describe.

You may begin your search for a provider by consulting your PCP (please give yourself the opportunity to be honest about your struggles; your self will appreciate it!) about behavioral health professionals well-known to the PCP, or from trusted friends and family.  You may also elect to review popular therapist search engines such as those operated by Psychology Today, ABCT, ChooseHelp or the American Psychological Association. 

And to be clear, my advice is for you to begin with a psychologist or other professional trained in and practicing empirically supported cognitive and behavioral methods, and then consider the medication options, if desired and needed, after you have already begun to work with the therapist.  If you do find that medication consultation is indicated, the complexity of your combined symptoms do suggest that a psychiatrist could very likely be more useful than a PCP (as they are in almost every such case due to their knowledge of psychopharmacology that greatly eclipses that gleaned from the relatively brief training in such areas are received by internists or primary care physicians).  When and if it is time to identify appropriate psychiatric providers, you may request a referral from your new therapist, or your PCP.

The good news is that NOTHING in what you describe suggests that you cannot begin making change tomorrow. It doesn’t matter how long you have been suffering, enlightenment can still be yours. Psychological treatment is not rocket science, it doesn’t take forever, and the process is not even all that complicated. But I caution you; it will require very hard work (although not nearly so hard as the work you have already put into trying NOT to have the problems). Your personal motivation for liberation is key, and you will also have to be willing to accept the discomfort that comes from facing what you truly fear.  If you want anything else in your life more strongly than you want recovery, than your chances of healing are greatly reduced.  That’s the blessing and the curse of being free and of being human.

Finally, as a future health care provider yourself, you will be giving your patients a wonderful gift to the degree that you take the time to know and work on yourself, and you can then help others cope with their challenge in the ways that you will learn to cope with your own.

I wish you peace, luck and strength in your journey. Please do write back to update me on your progress or to ask any other related questions.  This may not only enlighten me, but may also provide support to the millions of others on behalf of whom you unwittingly write.

Thank you.

Richard E. Schultz, Ph.D.

www.mindsetdoc.com

www.drschultz.org

@mindsetdoc

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Page last updated Apr 07, 2014

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