Mixing it up–The role of food concoctions in EDs

Spend time in an eating disorder treatment center, and you will see some pretty strange stuff go down. Mealtimes, due to the stress-inducing nature of the situation and the presence of food, can bring out some of the most bizarre. We all probably have some amount of unusual food habits, most of which fall into the category of quirky rather than disordered. In people with eating disorders, however, quirky doesn’t even begin to describe what’s going on.

When I was deep into the anorexia, I ate some pretty weird stuff. I made salad dressing of salsa and mustard that I would use to drench lettuce. I ate sugar free maple syrup on rice cakes. Carrot sticks and mustard. Sugar free jelly in rice or used as a pretzel dip. And so on. I generally did this in secret. For one, eating in front of others was fairly anxiety-provoking (although I tried to do it regularly enough, and make a huge show out of it, so that people wouldn’t get suspicious). For another, as much as some of the concoctions might have seemed appetizing at the time, I knew they were pretty gross to the average person. The last thing I wanted was to draw attention to myself.

Food concocting, as it’s called, is very common in eating disorders. It’s also very common in famines. Mary Boggiano and colleagues, who recently published a study on the subject in the International Journal of Eating Disorders, noted that:

They have been described as making nauseating and poisonous concoctions of weeds, bark, clay, and manure; grinding acorns and weeds to mix with grain and chaff; eating hard woody roots soaked and swallowed in a green mush substance of pounded leaves, banana skins and mango pits; mixing glycerin or Artic willow with hot water; making watery stews from dirty potatoes and vegetables or with grits and stones; pounding cattle hide into a glue-like substance; mixing old shoes in with shreds of burnt deer skin and bones; thickening soup by mixing sawdust into it; or even when food was more available, thickening food with flour or oatmeal. Clearly, extreme hunger and the uncontrolled unavailability of food motivated the creative mixing of food and non-food substances in these individuals. Concocting was a means of survival.

If food gets extremely scarce, we will even eat each other. As a result of your ED, you may (like me) have gone on a few nasty ice cream benders or whipped up some pretty messed up combinations of food, but I’m guessing you haven’t gnawed on your neighbor. Hunger is a very powerful force.

Not surprisingly, similar behavior has also been noted in EDs, both in the clinical literature and in media reports. It even occurs in binge eating disorder, which is generally not characterized by prolonged starvation. Typically, food concocting in BED generally occurs during a binge, rather than in the course of everyday life. Given this behavior’s similarity to what is found in the famine literature, as well as the malnutrition and erratic eating habits that accompany ALL EDs, NOT just AN, the general assumption is that this behavior is generally driven by hunger. What no one has formally examined is whether there is any evidence to support this hypothesis.

A strange recipe

Baggiano and colleagues recruited 552 students taking an introductory psychology course, as well as 45 people seeking outpatient ED treatment for BED or compulsive overeating (Baggiano et al., 2013). The researchers hypothesized that food concocting would be associated in people with binge eating with a particular facet of ED psychopathology known as dietary restraint.

Definition: Dietary Restraint

Psychologists formally define dietary restraint as “intention to restrict food intake in order to control body weight.” (Williamson et al., 2007).

In a series of questionnaires, the authors asked a variety of questions about frequency of food concocting, whether they did so during eating binges or episodes of overeating, frequency of binge eating/overeating behaviors, as well as measures of dieting and dietary restraint. Participants who said they concocted were also asked to provide examples of their “recipes.” They also asked the study participants from the intro psychology class whether they had a current or past ED or whether they suspected they had an ED. If they answered yes, they were asked to inform the researchers what that was.

One-quarter of the group said they made concoctions at least occasionally. Apart from being slightly older than the non-concocting group, there were no significant demographic differences in the concocting group. Significantly, people who made concoctions scored significantly higher on levels of dietary restraint and reported a higher dieting frequency in the past. This group also scored higher on measures of binge eating and were more likely to have an ED diagnosis or suspect they might have an ED.

Examples of different concoctions:

  • A paste of hot chocolate mix, powder coffee creamer or powdered skim milk, and sweetener.
  • Sugar on scrambled eggs; peanut butter and chocolate chip sandwiches; condensed milk on bread.
  • Flour or Bisquick® with eggs, oil, sugar, cinnamon and milk eaten raw.
  • Peanuts and raisins in a cup mixed with cereal and honey or syrup.
  • Mashed potatoes w/ Oreos®; Oreo® cookies with peanut butter, pickles, and chocolate.
  • Bananas with peanut butter wrapped in cheddar cheese.
  • Tortilla chips and peanut butter.
  • Peanut butter, mayonnaise, banana, and potato chip sandwiches.
  • Butterbeans, mayo, cornbread and onions mix.
  • Mayonnaise with cheese, beans, ketchup, and beef.
  • Chips in grits, potatoes, and milk mixed together.
  • Cheese with eggs, marinara sauce, pasta and cut-up Slim Jims.

Personal observation: There seemed to be a large Oreo theme in the reports

In the ED group (those that had a past or current diagnosis, or suspicion of diagnosis), the researchers found higher levels of food concocting than among those without EDs (45%-52% in ED groups vs. 15.7% in non-ED group).

concocting by dx

Important to our “famine hypothesis of concocting,” the pattern of increasing concocting scores per ED group: AN > BN > BED > noED (p < .001 all EDs vs. noED group), paralleled that of dietary restraint scores for these groups: AN > BN > BED > noED (p < .001 AN and BN vs. noED and p < .001 BED vs. noED).

{{For those of you without a stats background, a brief intro to the p values. It’s basically a measurement of the likelihood the results obtained could have happened by chance. A high p value means that any differences between the groups were likely just the vagaries of how they were selected and didn’t indicate true differences. A low p value (the magic number in biosciences is p<0.05) means that it wasn’t just chance. In this case, p=0.05 means there’s only a 5% likelihood that these groups are different based on chance, which means that researchers say they are significantly different.}}

The patients also reported a variety of different emotions (see below).

emotions after concocting

Given the shame associated with food concocting, it’s probably not surprising that many sufferers don’t bring it up during treatment. Whether it generally goes away with treatment or needs to be targeted more specifically is less clear. The authors conclude that

Assessment of concocting in patients may speed recovery by serving as an indicator of persistent dieting that is a common relapse trigger, and by helping to break through the wall of secrecy and shame that plague so many with binge-eating disorders. Hippocrates advised, “Let food be thy medicine ….” We would add that food and feeding must first be free of any association with shame for it to heal.

Twitter Digg Delicious Stumbleupon Technorati Facebook Email

16 Responses to “Mixing it up–The role of food concoctions in EDs”

  1. Hence – broccoli and sweet and sour sauce. My favorite for several years. Recovery means giving this up!

  2. Carrie, I don’t really understand the difference between eating interesting foods and food concocting? Is it that a concoction that only happens during a binge? Because broccoli and sweet/sour sauce sounds quite sensible…

    • Carrie Arnold May 12, 2013 at 10:16 am

      To me, no, broccoli with sweet and sour sauce doesn’t sound that strange but it could be a concoction depending on the person, as well as (perhaps) how much sauce is used, whether it’s an actual dish or just something you eat.

      I think the key is whether you would eat these things in front of other people and/or be embarrassed to be seen/known to eat them (above and beyond any anxiety about eating food in general).

      The “strangeness” of a food is also based on family culture and culture at large. My mom is from Pennsylvania, and there, it’s really common to salt your watermelon or cantaloupe. Which sounds totally vile to me but in that population, totally normal. So it’s not a totally defined thing.

  3. I’ve done some pretty weird stuff with ketchup–on vegetables, on canned tuna, on bread as a sandwich. Plus hot chocolate mix in fat-free yogurt that I froze. Still sometimes get those urges.

  4. Think of my old food concoctions actually makes me a little nauseous now. I have always wondered why ED patients have such strange food combos and this post definitely helps explain the survival mechanisms behind it.
    I love this… “We would add that food and feeding must first be free of any association with shame for it to heal.”

    • Carrie Arnold May 12, 2013 at 10:18 am

      I didn’t have a chance to get into potential motivations for concocting. For me, it was

      1) My taste buds were shot and most of the foods I would let myself eat were very bland. Concocting was a way to get some flavor.

      2) It was also a way to make food less palatable so I wouldn’t overeat.

      The sweet combos were generally #1. The savory combos were more #2, at least for me.

  5. I wrote out a description of some of the concocting I’ve gotten up to… and erased it. I don’t think it’s fair to subject anyone to that. Let’s just say, in response to C above, it’s not ‘interesting food’… it’s ‘bizarre food’ and in many cases ‘disgusting, sick-making food’.

    I think the degree of concocting(for me anyway) is proportional to the amount of anxiety I’m experiencing, and the degree of starvation I’m at. Part of it was that the concocting served to form elaborate rituals that kept the amount of time that it took for me to prepare and eat my food extremely drawn out. When I wasn’t allowed on table meals with the ED unit I was in, my meal times blew out to over an hour and a half because of all the things I ‘had’ to do in certain orders to my food to make it the way ‘I liked it’. It stopped me from having to think as much too, about the fact that I was being made to eat that food. The concocting went away very quickly when I was back on tables – where if you didn’t finish your meal in 20 mins you were supplemented as well as whatever you had eaten!

    In relation to how starved I was, a lot of my concoctions come from trying to make the inedible edible, either because it was parts of the fruit and veggies we don’t normally eat (for example, I felt like I was wasting food and heinously sinful if I had watermelon and didn’t eat all of the white part of the rind too because it was edible – at a pinch!!) or because my allowed food was SO BLAND that I had to do something to it.

    Maybe our taste buds are screwed up by perceived deprivation, because I can’t explain the weird combinations as easily as the rest of it. Vegemite and banana sandwiches for example? (Actually they aren’t bad!)

    I do know that the more WELL I am, the more I am satisfied with my food eaten the way ‘normal’ people eat ie in line with serving suggestions etc.

    Thank you, Carrie, your blogs always make me think and reflect.

    • Understanding the watermelon rind thing…the feeling of “not wasting” that comes from a mind in deep malnutrition. I actually scraped the inner peel of my husband’s discarded banana peel (retrieved from the bin!) to “not waste” …Harissa paste smothered on every, usually raw, protein (meat/egg/fish)..dousing pure shallot, wine or apple cider vinegar over every single salad…eating spices by the teaspoon (parsley, dried garlic …cinnamon…anything…All of these being feeble attempts to make my “meals” actually “look” like something to me..if not to the rest of my family. I actually believe that this concocting mentality has, along with the starvation component, much to do with a hidden desire to “separate” our eating …ourselves …from the “others”. It is quite isolating and decisive, and thank you Carrie for addressing this very real occurrence in ED’s.

  6. Did I miss the hot sauce? Lots of patients seem to report adding spicy items–like you stated above, to make bland food less so. It seems to me that it helps slow things down and makes food last–in the case of the hot sauce combos. I wonder how much of it helps create ritual. I’ve had patients who would mix cereal with things and needed to wait until it reached a certain texture to consume it, also helping to slow things down and prevent overconsumption.

  7. Hi I’m so glad I’m not alone I thought it was only me! I don’t have solids but have done concocting of fluids this time mostly salty things like marmite stock cubes or spices and hot sauce in hot water! These promote guilt too I can’t imagine what it will be like without these. So reassuring to read others posts xx

  8. Love this post. But the problem would be differing food concocting from what’s the norm for someone’s background/ personal taste! Half the “concoctions” listed up there don’t sound strange to me, especially the peanut butter/choc chip sandwiches, condense milk on bread ( in fact, we have condense milk with a lot of things- garlic cheese naan bread dipped in condense milk or french toast smothered in condense milk), paste of cocoa/milk powder and condense milk is a shortcut for fudge…etc. The big issue in the eating disorder unit was we were told what was “normal” and what wasn’t based on very rigid rules. A lot of thing that was “normal” to where I’m originally from was considered ” eating disordered” in the unit. SUch as peanut butter and banana sandwiches. Yoghurt with cereal rather than milk. Tuna and cheese melt sandwiches ( apparently you can’t toast tuna sandwiches with cheese. or toast any sandwiches that have cucumber in them). Baked beans have to be heated up and POURED on toast, and eaten with knife and fork not how I was accustomed to having it ( toast separately to keep it from getting soggy, scooping on the baked beans onto the toast as you eat it). YOu had to have half a portion of butter with a single portion of peanut butter on toast- you couldn’t have a whole portion of butter on one, and use the 2 portions of peanut butter on the other even if in the end if it meant that u ate the same thing in the end anyway… I was quite happy to have the butter as a base for the peanut butter sandwiches if they’d let me have extra peanut butter on the toast so you could actually taste it, but that was deemed “bingeing”). At the end of it all, I was left with a very warped view of what was ” normal” and “abnormal” and was very very very confused indeed. Yet what was horrifying to me and seemed very very abnormal to me was allowed- DROWNING plain white rice with soy sauce?!?!! and staff eating peanut butter sandwiches (ironically, THEY could have 2 portions of peanut butter on a single slice without the butter) with sweet chilli sauce??? EDU’s really need to cater for the range of “normality” especially between different cultures, which may understandably be difficult sometimes having different standards for different patients, but still.. being told you’re “disordered” for something that’s quite normal for you… does nothing for your mental health…

  9. It’s going to be ending of mine day, except before finish I am reading this impressive post to improve my experience.

  10. I have anorexia and tend to eat like Buddy the Elf – putting maple syrup, ketchup, and chocolate syrup on everything. It’s gotten pretty bad.

  11. I completely agree with you about the notions of what is ‘normal’ that are imposed on people in treatment. I understand where they are coming from with trying to ‘normalise’ eating behaviours and cut down on things like drawing out the eating time, punishing one’s self by making things unpleasant etc or getting some sort of comfort from the ritual, but what is normal changes in families, in cultures, geographically and over time… surely it’s not that hard to distinguish between reasonable personal preference and ED behaviour. Being forbidden to eat food in a way you find pleasing or you are accustomed to because it’s how your family has eaten it, takes even more of the enjoyment out of food, when many of us struggle to find any enjoyment in it in the first place. When food and eating has become alien because of the ED, sometimes things that are familiar from a time before ED was so strong eg eating an egg the way you did when you were a child, can provide an anchor to hang on to and reestablish some semblance of personal normality with food.

  12. I’ve been reading through this site for a bit now, and have found so many posts to be incredibly helpful – but today this one really struck a chord with me! I’ve been diagnosed with AN and/or ED-NOS (because of EXTREME weight fluctuations and shifts in behaviors) for the past ten years, but literally had no idea that there were other people who did things like this! OMG. Thank you for helping me feel a little less alone for the past few days, reading through your blog has been a huge inspiration. xoxo

  13. Orange juice with Dr pepper and sprite. Love it but not in front of others though.