The other side of hunger cues: fullness cues

So my treatment team talks a lot about hunger cues and when the return and what they mean. I’m not saying I never had trouble with hunger cues because I did. But hunger cues aren’t the only game in town. Fullness cues are the flip side of hunger cues, and the generally receive the short stick. They were also something I found far more difficult to manage than hunger cues.

One of the most common myths about eating disorders is that people with EDs don’t feel hungry. It’s not hard to believe, especially when one of the most frequent phrases I uttered while ill was “No thanks, I’m not hungry.” And I said it All. The. Time.  Another fun fact about EDs is that many sufferers also report early feelings of fullness.

Given these experiences, along with brain imaging studies that suggest there is a neural basis for these feelings, it’s not surprising that many ED sufferers have a pretty serious disconnect with hunger and fullness. I was one of them.

Interestingly, my hunger cues came back relatively soon. Now, it’s true that I wasn’t able to respond to them for a really long time, but I started to actually feel hunger at least marginally normally fairly quickly. I might not have felt as hungry as others might have in my situation, and I very rarely actually did anything productive about what hunger I might have felt, but the hunger was, in fact, there.

Fullness was a different beast. I had those early feelings of satiety for a long time. Actually, I still have them somewhat. Part of my problem was that I figured that not actively feeling I was going to immediately starve meant that I was full. At least, that’s how I interpreted it. So I would eat a little bit of a meal or snack and feel full. Of course, I wasn’t actually full, I just got confused and thought that I was full.

Even thoughts of fullness, however, triggered extreme anxiety. So I stopped eating. Then I’d get frustrated when the little niggling hunger cues started to return an hour or so later. It made so sense. My mind immediately went to the place of “OMG I’m such a pig!” I wasn’t trying to undereat, but I would feel insanely full.

As time progressed, it wasn’t that I was eating ridiculously small amounts and being full as I was when I was actively ill or new in recovery. They were almost normal amounts. They didn’t look tiny or freakish. I looked like a light eater. I looked a lot like your standard dieting female, even though I wasn’t actively trying to alter my weight, shape, or appearance. But not long after I finished eating (certainly not long enough for the next eating time to be at hand), I would start to get hungry or antsy.

The problem was this: I felt like I was eating enough. In fact, I would have sworn up and down that I was eating enough. In the moment, it felt that way. But in the long run, I wasn’t.

This led to the really difficult bit of pushing myself to eat more and stick more closely to a meal plan (you eyeball it, you plate it, you eat it, regardless of how hungry or full you may be feeling. Seconds were always allowed, but what was on my plate was the absolute minimum I needed to eat) to get more used to how I should generally be expecting to feel after a meal. I still often feel overly full after eating. But since my weight is stable and my hunger feelings go away for longer, I know that I’m not eating too much. I do have to frequently talk myself down off the ledge, but I can do it.

I know intuitive eating is seen as the gold standard of ED recovery, but there are a lot of us who just can’t quite make it work. If I were left to my own devices, I would probably undereat. Not intentionally, but I probably would. I have to eat fairly mechanically and rigidly in order to stay well. I’m not saying that I eat the exact same things every day or measure my intake down to the grain of rice–not at all. But I have  number of meal and snack options that I know work well for me, and I stick pretty closely to those. I can be flexible when I need to be, but I’m a creature of habit as well.

There might not be an answer to this. Still, there’s much less emphasis (at least as far as I’ve seen) about noticing and responding to fullness cues vs. hunger cues, and I think they’re just as important and can just as easily be mucked up by an eating disorder.

Tell me: what sort of practical workarounds have you found to problems with hunger/fullness cues? Share your thoughts in the comments.

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21 Responses to “The other side of hunger cues: fullness cues”

  1. Interesting post. I don’t know what a “hunger pang” feels like- if I ever did feel one back when I was much younger, I do not remember it. I feel uncomfortably full almost all the time, even after years of being on a meal plan. I still have to measure and force myself to eat enough. After some decent weight gain, many of the ed-related feelings, like guilt, have become unassociated with this feeling of fullness.

    I have begun to recognize other signs of hunger- such as: shakiness, light-headedness, testiness. I know that these are signs of low blood sugar and a need to refuel. But I never feel it in my gut, and I’m not sure that I ever will.

    I am actually ok with this. I’m not “hungry” for my anxiety meds, and yet I take them. I don’t have to be hungry for food in order to eat it. I have accepted this, for the most part, and made peace with it. It’s not about feeling hungry or full- it’s a simple mathematical formula about how many calories I need to take in so that my body and brain can run efficiently.

    Sometimes it depresses me- and sometimes I panic b/c I’m just so sick of feeling full- but I’d say the majority of my days I am at peace with having to measure out food and follow a meal plan. And that’s a HELL of a lot better place than I was in a year ago. 😀

  2. Do you think that when we swear we feel full we actually are? Or is that the distorted part of our brain talking, wanting us to believe we are full? I can see where the process of stretching the stomach back out to a normal size causes us to constantly feel full, but after our metabolism normalizes, do you think we ever gain a normal perception of what it means to be full? It’s still really hard for me to believe that ‘normal’ people eat until they are THAT full every single day, which makes me wonder if my brain is still highly distorted or if it’s just a time consuming process. Maybe both?

  3. I am so glad that you are writing about this! Fullness cues are something I have continued to struggle with throughout my recovery. And to be honest, I’m still trying to figure out how to make sure I get enough because I know I can’t trust my fullness cues.
    Currently, I have a few trusted people on my support team (including my therapist, my mom and my significant other) who I can turn to if I am unsure of how much I need. However, they are not always around or available, so I’m searching for other ways to deal with hunger/fullness cues. I look forward to hearing what others have to say on the subject 🙂

  4. I’ve recently been talking about this with my treatment team, as its the fullness cues that are really affecting me right now… My support worker worded it quite well I think: ‘are you feeling full or are you feeling food?’

    Turns out 90+% of the time, I wasn’t feeling full, but also wasn’t feeling empty, which to my brain meant I was full. I still find it difficult to know where one ends and the other begins but knowing this has made it a little easier to push through the initial ‘food’ feeling, and manage to complete more of the unsupervised meals

  5. Thomas Bradford July 7, 2013 at 8:23 am

    Wow…. it’s like you’re a fly on our wall Carrie – this is where we are and it’s a real challenge. As the parent of a YA I think it was easier when it was “you have to eat” than it is now with “you have to eat more”.

    Do you have any suggestions for parents/SOs to help with this?

  6. Yep, I know what you mean. When someone says “I’m still hungry” immediately after eating a meal or snack, it totally baffles me, since my feelings of hunger go away as soon as I start to eat. Interestingly, I also sometimes suddenly feel full before I even eat — my hunger will evaporate the moment I get up to fix a meal or snack. An anxiety response, perhaps? I deal with it, as you do, by reasoning with myself (my dinner was the right size so I need to finish it, I was hungry just a minute ago so I must still need to eat, I need a substantial snack today because xyz, etc.) and pretty much ignoring my fullness cues.

  7. This continues to be a big problem for me. When I was in reside trial treatment, I constantly felt so full of food, I could imagine it coming right up to my nose from my stomach. My anxiety levels rose as my hunger cues started to resurface and I was hungry when I felt I “shouldn’t” be. Now, three years later, (and 25 years of AN) feeling what I perceive as full usually means I’ve eaten what I “should” eat and to eat more would be immediate loss of all the structure I’ve built through years of restricting. My go-to these days is to hear ken back to an informal meal plan of three meals, and at least two snacks, and make sure those are spaced no more than four hours apart. As long as I can stick to the plan, I just shut down my mind and eat. It’s nowhere near intuitive eating, but I frankly wonder if that should be the standard we strive for. It’s just not reachable for so many of us.

  8. Wow! This so perfectly describes what I went through and what kept me stuck in periodic binging for much longer than I could have been. I have struggled with both anorexia and bulimia with periods of restricting. Years after I had stopped purging, I still couldn’t get my binging under control. I would go through periods of weeks trying to eat intuitively which often meant that I would slowly lose weight. I was trying to feel “more recovered” by never weighing myself, but didn’t realize that this so-called intuitive eating where I would stop when “full” was actually a form of restriction. After 2 or 3 weeks of “intuitive eating,” I would start to binge uncontrollably. It wasn’t until I started weighing myself again that I realized that I was overall maintaining my weight by losing then gaining the same 5 pounds over and over again. When I learned to eat more than I thought I needed at each meal, I nearly totally lost the urge to binge! Now, I use a combination of intuitive eating mixed with self-force-feeding when I know I am vulnerable for some reason; less hungry because of anxiety, excitement, busy days, falling in love, etc.
    I also used to feel so frustrated that I would eat until I thought I was “full” then be hungry an hour later. I would fill up on water thinking I couldn’t possibly be hungry so soon and that it must instead be a desire to eat emotionally. I have at times also had the opposite problem where I think I am hungry all the time, but the hunger is actually heartburn or anxiety! It is a difficult tightrope to walk but my brain is much better at reasoning through it than it was 3 years ago.

    • Carrie Arnold July 7, 2013 at 10:53 pm

      Basically, you seem to have stumbled on the same solution as me: some of the flexibility of intuitive eating, but enough structure to keep you from falling back into ED. The exact combo of what works is going to vary from person to person, but finding it out is so important.

      Thanks for sharing!

  9. Like my pops said above, this really rings true with me! I can really relate with Joy about eating a LOT after a period of “intuitive eating” that was really skewed because of messed up hunger cues, and then eating less the next week thus “maintaining” weight by gaining and losing the same few pounds in a month. I think eating more than I think I need at each meal will be uncomfortable at first, but will help stabilize things. Thanks!

    • Carrie Arnold July 7, 2013 at 10:51 pm

      That was what I did- experiment a bit by eating more at mealtimes and seeing if it would impact when I got hungry next. The key was really increasing fats, which was really hard and really scary. BUT it really helped. The first time I did it, I felt stuffed but I also didn’t get hungry until the normal snack time and so over the course of the day, I didn’t have any actual increase in caloric intake. I just felt a lot less crazy.

      It really helped that my boyfriend doesn’t believe in diet foods and cooks a lot with cream and butter (I’m now waiting for all the FEAST moms to propose, LOL), so I had a natural exposure to some of that. When I could take a step back and view it as an experiment rather than a permanent change, I could be a lot more calm and objective. As a scientist, I’ve done lots of experiments and so I know the drill.

  10. I am experiencing many issues with hungry and full clues in my recovery from #BED as well. I’ve found the opposite from what you do works for me, Carrie. I put LESS food on the plate than I would like to eat since it is very hard for me to know when I’m full and I binged in the past. My issues were that I ate so much before recovery, I couldn’t tell how much was too much and had the miserable feeling totally turned off. If I am still hungry 10 minutes after my plate is empty (that VERY SELDOM HAPPENS), I get seconds. A small amount.

    • Carrie Arnold July 8, 2013 at 4:43 pm

      Thanks for sharing your perspective, Cindy. I think it’s interesting that we found similar ways to work around our issues with hunger/fullness. I’m glad you found something that is helping you.

  11. I have a major issue with my hunger and fullness cues. In the past, like you, I am used to saying “no thanks i am full” and eating just a little every meal was enough to make me feel full. in fact, when i have the thought that i am eating way too much (when am not), i would feel full for as long as 6 – 7 hours. now i am trying to recover, i eat normal portion (or so i think i am) but sometimes i feel like i am overeating. I dont exactly feel full after a meal and it puzzles me. I am still trying to figure out intuitive eating. and read many articles on how when you are recovering from anorexia nervosa, you will have this period of extreme eating.

  12. Ah, what a perfect description of the issue.

    I used to feel full after 3 crackers. I really did feel full. I was no longer hungry. But of course that wasn’t enough food.

    So now I eat more than that. But I still feel full after about half of a normal-sized meal. And I eat the rest of it either A. out of habit, or B. because it tastes so good. And that then leads me back to “I’m feel as though I’m overeating and I’m eating just because it tastes good and not because I’m actually hungry.” When you add weight gain to that thinking/feeling then the shame of eating can be overwhelming.

  13. This may sound weird coming from a now-210 pound woman, but ever since I can remember I had early satiety (I just didn’t know it was called that – just found out this minute, actually).

    As a child I simply couldn’t eat more than a few bites of food at a time. My mother would force-feed me (sometimes literally – I clearly remember my father gripping my hair back and forcing me to gulp down a glass of milk until I vomited, for example).

    Then I’d be hungry between mealtimes and I would be refused food so I could “save it up for dinner” – at which time I still couldn’t eat more than a few bites. I just starved in between, and starved overall. I didn’t grow (at all – height or weight) for two years in a row as a child, actually. I think I was malnourished.

    When I began eating “for pleasure” I would force more food in so that I could continue the feeling. I turned into a dieter/binger and was very thin until about 10 years ago, when I ballooned.

    I seem to have taught myself NOT to know what a feeling of fullness is…and now that I’m attempting intuitive eating I find I try to put more food in anyway (just like with binging) because I have a vague feeling that “I don’t know when I’ll get another bite.”

    Lightbulb moment.

  14. This post is just what I needed! I am desperately trying to intuitively eat but am dangerously underweight because I’m not getting proper fullness cues. How far past the “full” feeling do you push? My docs dont want me to count calories so its just hard to know how far to push, and if csnacks are really necessary or if I can just force in extra at meals. What’s a good motto to go by? How do yuou know if you’re truly full?

  15. I really like your blog.. very nice colors & theme.
    Did you design this website yourself or did you hire someone to do it for you?
    Plz reply as I’m looking to create my own blog and would like to
    find out where u got this from. cheers

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