Recently I received feedback on the forums that some ideas I offered up for how to actually eat food in recovery were very helpful. So I promised I would transfer the information to the blog and here it is.
Hunger cues will return. But forcing down every bite is the way of early recovery. Why is that? It feels so monstrously wrong— as if you were trying to sleep when you are not tired.
As I have said before, researchers are in disagreement as to whether those with eating disorders are hungry or not, but I side with those who point out that the preoccupation and thoughts of those restricting food intake suggest levels of intense hunger that reflect their semi-starved states. No one is as preoccupied with food, dreams of food, flips through cook books as though they are reading riveting award-winning thrillers, or watches endless cooking shows quite the way those with eating disorders will do.
Yet the moment it’s you in the chair at the table with the plate of the food, suddenly you are thrust into an alternate reality. How can food be so all consuming as a thought and yet the reality ends up so perplexing? Or dull? Or a chore? Or irritating? Or, well, something other than a great thing that’s for sure!
I remember reading a description in Harriet Brown’s Brave Girl Eating where her daughter’s hand is shaking as she tries to get the spoon into her mouth and actually eat a mouthful of food. In that case it’s a bit easier to link the behavior with a fear of food. But much more commonly, there are no tears, shaking and visible distress.
Here are common behaviors seen with patients with eating disorders:
- Irritability: complaining about the food itself (temperature, texture, method of preparation); combative, argumentative and ready to pick a fight with a table mate (family meal). There are facial expressions and non-verbal expressions of disgust and anger: heavy sighing, eye rolling, harrumphing, sneering, drumming of fingers, clattering cutlery, pushing the food around, making shapes with the food.
- Distractibility/Hyperactivity: fidgeting, darting of eyes, wriggling in seat, sudden attention on distracting elements in the room (watching the family pet’s antics, swivelling around at a noise elsewhere in the place and taking an inordinate amount of time to return to the task at hand, suddenly remembering reasons to get something from another room or turn something off, turn something on elsewhere in the home…
- Boredom/Lassitude: lots of non-verbal queues and non-verbal expressions will be similar to what is seen with irritability and that’s because boredom is actually an aroused state— sighing, slumped in seat, eye-rolling, exaggerated chewing, prolonged time to chew each bite, pushing food around plate, and propping head up with hand and elbow on table. Playing with food, playing with hair, and eyes averted down and to the side.
- Exhaustion: the intensity of this response may sit on the narcoleptic spectrum. Boredom tends to have a theatrical playing at exhaustion, but a true sleepy response to food differs in the slackness of the facial expressions and non-verbal queues. The sighing will be a less forced exhalation of air. There will be no eye-rolling but rather half-lidded eyes. The key to differentiating exhaustion from boredom is to look for genuine slackness in the body, gestures and expressions.
And all of the above including Harriet Brown’s daughter’s reaction is the fight/flight/freeze response. To what? To the threat of food. Or, more accurately, the misidentification of food as a threat.
Irritable? Then you are going to fight the threat to the point where you might be flinging the plate of food across the room.
Distractible and hyperactive? Then you would actually like to get as far away from the threat as possible.
Boredom or lassitude? A bit more interesting as this is more of a hybrid fight/freeze response where you are dealing with conflicting drives to either fight the threat or perhaps freeze and it will leave you alone.
Exhaustion? Well a bit like a fainting goat you are feeling an overwhelming urge to freeze to the point of unconsciousness as a way to avoid the threat.
And all these powerful threat responses have one underlying outcome: you will be disconnected from your sense of hunger. No one looking at a coiled snake in the grass is going to take the time to go, “But wait, I have a chocolate bar in my pocket and I’m feeling quite peckish.” Those with an eating disorder have the nightmarish experience of actually reacting to the chocolate bar in the pocket as though it were a coiled snake.
In order to allow the hunger to dominate, you have to practice lowering that threat response. We experience our threat identification system power-up, no matter how we react to it, as anxiety.
What you can work on to help you connect to hunger is relaxation exercises, yogic breathing exercises, and using a notebook to constantly check in with your anxiety level.
Your hunger is there, but an eating disorder fires up the threat response so that hunger gets shoved to the side every time the food is in front of you.
The fight/flight/freeze response that the threat system fires up moves blood away from the gastrointestinal system towards major motor muscles (among a whole other set of physiological shifts to prepare you to address the threat).
Have a notebook handy when you are about to sit down to a meal. Jot down your anxiety level (1 being so relaxed that you’d call it peaceful and 10 being so anxious that you'd be quite happy to step out of your skin if it were possible) as you start the meal. Monitor it a few times throughout your meal.
If you are eating with family, then ask the family member to be the note-taker and ask you periodically where the anxiety is at.
If you notch up to a 6 or 7 in anxiety while eating, then take three minutes to apply slow breathing exercises.
Check out Yoga-Yak’s good introduction to yoga breathing exercises:
...or simply search for yoga breathing exercises on YouTube.
Whether that drops you down to below a 6 or not, you begin eating again (otherwise the eating disorder will manipulate the situation to create delays in eating), but now you either say this internally in your head or (better) have the family member read it out to you while you continue eating:
"I am experiencing the physical responses of misidentifying food as a threat.
Food is not a threat.
I am ok. I am going to be ok.
I can continue to eat and nothing bad will happen."
If you cannot get the anxiety below six in these ways, then you can cry or you can distract. Crying can often release the worst of the anxiety (yes, you still have to eat through the crying). Or, you can decide you need the distraction of the TV or a movie while you continue eating and you sit (and ideally a family member joins you) on the couch while you continue to finish the meal and watch TV.
Persevere with a) getting good at identifying how anxious you really are at any given time and b) using every technique in the book except delaying or avoiding food as a way to lower anxiety while continuing to eat.