I got the below email and decided that I would answer it in blog post because I think that these are questions that many adults in Anorexia recovery will have from time to time.
Other than removing the writer’s name I have posted the email in it’s entirety. My responses are in purple.
I REALLY appreciated your posts on extreme hunger. Being aware of this phenomenon (if you can call it that) and understanding it a bit better is without a doubt reassuring for anyone experiencing it. During past recovery attempts, I now recognise feelings of extreme hunger, but at the time I considered it to be binge eating or out of control eating- I was sticking to my meal plan, and eventually ended up exercising more for any “extra” food I ate. If only I had known the truth, that relapse might have been prevented.
Anyway, fast forward a few years to where I am now ; Actively pushing for recovery, but really hung up on the fact that I am not hungry. I don’t feel hunger. I don’t know if I have an appetite. If I give myself permission to eat anything and everything, I have no idea what I want to eat. I have been on the same meal plan for 2 years (oh dear god, how dull and ridiculous, I know!) but those meals and snacks are maintaining my weight and keeping me going I guess. I have increased daily intake by XXX calories for the past 3 weeks, and I feel fuller. I am thinking more about food than previously, probably because it’s anxiety provoking. What on earth does one eat if it is not part of a calculated meal plan?!
I really had to question this.
I challenged myself, Why am I not hungry?
What does hungry even mean? automatic response: Stomach growling.
BUT maybe the fact that I am thinking about food all the time is a sign of hunger?
maybe hunger is less dramatic than I think it has to be? feeling tired or suddenly colder? Feeling just a bit empty?
Stomach growing might be what most people define to be hunger. But you are right. For those of us in recovery from a restrictive eating disorder it is often not that. That might come later, in the meantime what you have is the mental hunger.
Mental hunger counts in anorexia recovery. And by mental hunger, I mean any will or desire to eat that is not based in a physical stomach growl or traditional hunger signal. Mental hunger for a person in recovery from Anorexia expresses itself most commonly in the obsessing over food. Initially most of us discount this, but what I learned was that this mental hunger was my brain telling me “you need to eat” regardless of how full my stomach felt. Mental hunger asks us to eat in the absence of physical hunger. If you are thinking about food you should be eating food.
2. I have ignored or manipulated hunger signals for 15 years. Hunger was an alert signal: hungry? NO, go and exercise more. Hungry? NO, have another mug of coffee. Hungry? NO! NO! NO!
Maybe my body gave up asking?
I do think that when we continually ignore hunger signals over years, that the body will cease putting effort into generating them. I think that a bigger piece here is that when the body is in starvation mode, it reduces, and in many cases ceases, hunger signals. Mine certainly were absent for a long time, and I had to force myself to eat when I didn’t want to. But, I did find that when I got over a threshold of around 3,500 calories my appetite picked up— and shortly after that I experienced extreme hunger. But, even within that, there were days and times when I did not want to eat. Being able to force oneself to eat when not hungry is a skill that I think all people with Anorexia and other restrictive eating disorders need to master.
If someone ignores your calls or texts for years you’ll ultimately stop trying to contact them. Yes, maybe your body gave up asking you to eat. That’s okay, you trained it not to ask, and you can retrain it to indicate hunger again. You start by eating more food. Also, regardless of time of day or whatever your Anorexia brain tells you about it, if you get an inkling of a hunger signal you have to respond immediately by eating. Even if you are not sure if it was a hunger signal or not you have to eat. This is usually very hard, as ironically (but biologically understandably) we tend to get hunger signals after we have eaten a meal, so then it is very difficult to mentally justify eating more to your Anorexia brain. You have to do it anyway.
3. All of this stress around being hungry or not is enough to kill my appetite.
Stress does that. It’s a standard evolutionary response to not feel hungry when stressed. It doesn’t matter — you get to eat anyway. Hunger is a bonus in eating disorder recovery. It is a nice to have but not a need to have.
Think of this lack of appetite as a gift; you get to practice that skill of eating when you are not hungry! Part of recovery and sustaining recovery is about being able to eat regardless of how hungry or not hungry you are. Stress is part of life and it will still be part of life when you are recovered. How we deal with stress is crucial. If I allowed the lack of hunger that accompanies stress to cause me to eat less, I would relapse every time I got a parking ticket.
You eat if you are not hungry. You eat if you are stressed. You eat if you are feeling bloated. You eat if you don’t feel like eating. Recovery and sustaining recovery is largely dependent on your ability to make yourself eat when you do not want to eat.
4. I am still defaulting to foods that give a false impression of fullness. Porridge for breakfast is great, but maybe those oat flakes are so swelled up with water after the laborious cooking process to get it just right that I feel fuller than if I just had a bowl of cereal? Eating lots of vegetables and eating beans everyday might slow down digestion?
Sounds like you know what to do here. Your safe foods are fine … sure. But it sounds as if you know that you can move on from here. The next step for you is dense foods. Foods that are not filling as much as highly nutritious. I’m talking butter, cheese, etc. You want porridge for breakfast — cool … add a couple of tablespoons of peanut butter and make it with full fat milk rather than water. Not only will your taste buds dance, but you will get more recovery bang for your buck.
Vegetables offer you the least beneficial form of nutrition if you are in weight restoration phase. I know that this is hard to get your head around due to the “healthy eating” messages piped out everywhere. Foods that are high in fat are the most nutritious for you. I doubt that you lie awake at night fascinating about broccoli. Your head is probably full of fatty and delicious foods. There is a very good reason for this.
5. The foods I am eating are not appetizing. It’s pretty much the same sorts of things day in day out and that’s probably really rather boring. My body knows what to expect : the meal plan. No point pestering for more. Nothing to get excited about.
Same as the answer above. Anorexia recovery is about staying consistently a step or so outside of your comfort zone. If foods have become boring, they are sitting inside the comfort zone and the work to do now is to step outside again. You probably know your meal plan by heart, so use that as a base and start to substitute out safe foods for more exciting and nerve-racking ones. If the thought of eating something scares you than you know you are on the right track. It is important to find that sweet spot that lies between “safe” and “paralyzing fear.” Only you really know where that boundary lies, but I will say this: the bigger mistake is playing it too safe for too long. Nothing bad will come of you pushing too hard to overcome the bigger fear foods, but if you play it too safe for too long the results are devastating — you’ll be in this same spot this time next year.
Stagnancy should scare you more than anything else. Be very afraid of treading water. Eating disorders are so tricky with this and it will lull you into a false sense of security. Don’t settle for a half life.
I’m not sure if this list is accurate or conclusive. I know that half of me feels I have to ignore my “lack of hunger” and eat. Eat differently.
However there is still that nagging other half me that dictates : You are not hungry. you are eating enough already. Eating more means eating too much. 3000 calories is a lot of food and no one eats more than that.
The second voice is so powerful because eating more feels more stressful, and physically uncomfortable.
Yes, that second voice is powerful. I know it. If you were eating enough already you would not be writing me this email. I don’t care what number of calories you are eating, if you want to eat more you are not eating enough.
Anyway, I was just wondering if something like “not feeling hungry” could be a topic that you address on a podcast or a blog post (as if you don’t do enough already!). Writing this message out to you has helped me think about hunger from a more rational recovery point of view. In order to recover, I am going to have to override the “not hungry, no need for food” mindset. Maybe other readers might find it helpful too.
It could well be that you have already dedicated a blog post to this subject, in which case, sorry for missing it & ignore the suggestion!
p.s, even now, as I am about to hit send, there is that voice: “You are sending a bloody email about not being hungry ?! trying to invent reasons that you are hungry when you are NOT?! everyone is going to think you are an idiot, Tabitha will think you are wasting her time, clearly someone who is not hungry has no business thinking about “recovery”….etc, etc….
You are not an idiot; you have an eating disorder. Not being hungry is a very normal and irritating side effect of Anorexia. I had to eat in excess of 3500 cals in order to start feeling hungry, and it was only after about 4000 cals that I went into extreme hunger. Some of us need to keep adding to intake until hunger hits at all — and doing this is excruciatingly difficult as you have the Anorexia brain very strongly telling you not to.
Not everyone experiences extreme hunger in recovery. So people do and in a way if it happens it is like a golden ticket because that bottomless pit feeling helps us to want to eat a lot. Just like we need to. However, you cannot wait for hunger to come because there is no guarantee that it will.
One of the greatest skills I leaned in recovery was forcing myself to eat when I didn’t want to. Forcing yourself to eat is different than going to IP and having someone else force you to eat. It is way harder! But, think of it as a superpower. If you know how to make yourself eat when you don’t want to, you have the skills to sustain your recovery no matter what else life throws at you.