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A question from Dr Robin
In a nutshell, I have had the opportunity to briefly work with a 16 year old girl who had been suffering with anorexia. Her body mass index was only 13 when I first met her about six months ago. Thankfully something had switched in her mind and she had insight into her being unwell and realised that she was harming herself by not eating. I was able to give her the usual basic physiological advice and get her eating regularly and incorporating the right variety in her diet. I am pleased to say that her weight has slowly increased and yesterday her body mass index had reached 21. However, her main source of distress is that she still does not feel 'hungry' or 'satiated' and she is fearful that she will never feel those 'normal' sensations again. At first I wondered if much of those sensations would return when she restored much of her lean body tissue. I was wondering whether you could offer me any advice in order to further help my client.
Answer from Deanne
The issues of hunger and satiation are complex in anorexia and there may be some primary problems with appetite regulation. Appetite disruption tends anyway to persist long after dietary restriction. There are also issues of whether this person is confusing emotional experience with her experience of hunger.
Intero-receptive awareness is a term we use for sensitivity to body signals, which is one reason why people with eating disorders often say they are hungry when they are angry or sad, or otherwise fail to interpret the physical signals of emotion thereby being unable to name their feelings.
I could not predict that her appetite sensitivity will return because she is deflected from awareness of what is really going on somatically by the cognitive-emotional system which is activated by eating, which will be sensed as forbidden even long after apparent recovery. Thus, mindfulness training is also indicated so that she can calm down and pay attention to her body in a non judgmental way.
I hope this makes sense. Good consistent nutrition will also give her brain and body the best chance of working properly.