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Eating Disorders- Do you Recognise Physiological Hunger?

Prompted by Eating Disorders Awareness Week 2015

Identifying the motivation behind our eating.

Part 1

An article on ‘Anorexia’ and ‘Bulimia’ this isn’t for me? Stop a minute. This is not about these conditions. Both Anorexia Nervosa (AN) and Bulimia Nervosa (BN) are familiar terms to describe mental distress that has manifested as an altered eating pattern. They tend to be diagnosed when the eating habits cause physical symptoms. Unfortunately this is often years after the illness first started. The symptoms associated with AN and BN can also be attributed to other conditions delaying accurate diagnosis still more. I want to make readers aware that unhelpful eating behaviours can be disordered before they manifest in a physical illness. If you want to know more about AN and BN visit Beat Eating Disorders  or Eating Disorder Help where some really useful information and support can be found.

6.4% of adults display signs of an eating disorder. I hope this blog raises awareness of eating habits and how they become unhelpful and the lack of trust we have in ourselves.

Many parents will be vigilant towards their children, especially daughters, watching for signs of dieting, over eating, missing meals and vomiting, some may be aware of over exercising too. When does this vigilance start? It’s interesting isn’t it? The vigilance regarding what you put into your child’s mouth will start the moment they are born. It happens partly as a result of the monitoring that is done by your well intentioned health visitor, who weighs and checks your baby to see that they are ‘normal’ to check for early signs of failure to grow, really key in spotting childhood illnesses. Do you remember how keen you were to know their opinion, and these results, and how they were interpreted? How much did you pay attention to this information, getting reassurance that little ‘Sammy’ was following the right ‘centile’? Or did you have confidence in yourself that you understood your baby’s needs? I imagine with each child you had your self-confidence grew.

Perhaps it even started earlier, the great debate to breast feed or to bottle feed?

The point I am making is that from our start in life there are external influences for example; societal, health, cultural, economic and fashion that detract us from our instinct, and heighten our anxiety about what we feed our children. For some this can have an influence on our relationship with food, body image and eating habits. For others it may manifest as ‘keeping up with the Jones’. Reassurance and a sense of belonging; being ‘normal’ is very important to us. Below I demonstrate that when we are children, dependent on others, food can be attributed qualities that are not real. It is these qualities that may contribute to an impaired ability, for us as adults to eat instinctively.

Two common examples that can become deeply imbedded in our unconscious are;

  1. Food as a prize

This emotional labelling of food may start very early, the weaning infant given a ‘treat’ for eating something we as the adult perceived as not nice. Little Sammy finished the browny-green looking sludge that was a ‘casserole’, carer smiles and looks happy, and then gives Sammy something that excites (or over stimulates) his taste buds. Sammy is stimulated emotionally, seeing his carer happy and this is rewarded by sensory stimulation, in this case taste (a fix).

In isolation this is quite normal, it’s when emotional stimulation are void in other situations. Seeing a carer happy when Sammy does other things, experimenting with touch, walking, playing, etc. will provide a balance. Sammy will get a sense that many things can please the people around him.

The lesson that is unconsciously learnt is ‘If I eat my food I get something really tasty and then those that look after me are happy’

The potential unhelpful lesson is ‘If I eat all my food, I get more nice things to eat and make the people I love happy and pay attention to me’ or ‘foods that are really tasty give me an emotional fix’. Emotional fulfilment over rides physiological need. Food can be eaten even when we are not hungry.

  1. Food as a weapon

Little Sammy is still being weaned. Carer is not able to focus on little Sammy, they have so much other stuff to do. Sammy isn’t sure what is expected. He might eat some sludgy casserole, he might feel it in his hands, rub it over everything, and spit it out, all such fun. Unfortunately all busy carer sees is a mess. The carer starts to engage with Sammy, they might be cross, or just chatting, but she is at least engaged, and not ‘busy’ elsewhere. Sammy responds to this engagement and it is good. The lesson Sammy learns is ‘at meal times my carer is busy, I need to do lots of stuff to get her attention’

Unconsciously this can manifest as ‘I can use food to manipulate people to pay attention to me’

These examples describe how food can be used, unconsciously, not as a fuel to keep our body nourished, but as an emotional tool to get something we want, to feed an emotion. Clearly we all were exposed to these types of scenarios as infants, and are not all affected by unhelpful eating habits as adults. But those that find themselves yoyo dieting, eating in times of stress, or happiness or during relationship breakdowns may well be drawing on childhood experiences that had historically been useful and provided emotional satisfaction.

To help understand the concerns you might have with your own eating behaviours it is useful to take a step back and focus on becoming attuned to what is going on for you when you eat both emotionally and physically.

If you have practiced mindfulness or other relaxation techniques, you may find them helpful.

For a day or 2 each week, or more if you find it really useful, try to focus on these questions EVERY time you eat.

On these days, before you eat spend a minute or two deep breathing and focusing on something simple, such as your breath going in and out.

Ask yourself

  • Where you are on the Hunger Scale?

Hunger scale

  •   Why am I eating?
    • Because I am at an appropriate place on the hunger scale, and feel physiological symptoms of hunger
    • And/or Because it is a meal time/ a meal is to be eaten
      • If you are eating because it is a meal time, and not because you are hungry reflect on whether you can eat at a different time. Or how necessary is it for you to fit in to meal time.
    • I don’t know, I know I want this particular food.
      • If this is the case, try identifying where the need comes from. An emptiness somewhere? A desire for a sensation in your mouth which will give you pleasure (a fix) it could be anything.

Having answered these questions, eat and enjoy.

Establishing your motive for eating is useful and the first steps to changing eating habits that you know are not helpful to you.

In part 2 I will describe how this can be developed to help you become attuned to food types and self acceptance.

You may find it interesting to look into Mindful Eating, or Intuitive Eating and the organisation Health at Every Size (HAES)

Some of these ideas evolved from Judith Matz and Ellen Frankel’s book Beyond a Shadow of a Diet.

The Johari Window and Improving our Understanding of our Patients

Joseph Luft and Harrington Ingham in 1955 created this ‘Window’ concept to understand how individuals work  within teams and to improve productivity, communication and collaborative working. It is frequently used within counselling to explore self awareness.

It is a metaphor for displaying ourselves, drawing on ideas of visibility and transparency as well as curtaining off areas to keep them protected from on lookers who may mean harm.

I wonder if this tool can also be used to understand the complexity of the patient presenting to their doctor or Health Care Professional (HCP)?

The Open Quadrant

The transparent two way picture.

This is what the patient is willing and able to show to their doctor. But what is it that the doctor believes they are being shown? And what are they willing to see? The picture is quite a simple discrete one, I believe that too often the view for the doctor and HCP is the illness and  treatment for which their patient has been diagnosed. This is not necessarily so for the patient, their presenting picture; what they make visible, may be quite different, not even on the radar of the doctor or HCP. For example they may be showing as an anxious parent unsure of their ability to provide for their children, a highly paid business man who is in denial  ‘not very ill at all’. So  despite this quadrant being ‘open’, and that our patient willing to disclose some of them self, is the same picture being seen by the doctor? Is the doctor, only looking to see a patient with an illness, not a person?

The Blind Quadrant

This area is designed to represent what the other person can see but the patient themselves cannot see. I have  interpreted this slightly differently to emphasise the knowledge the HCP or doctor has about the patient because of their illness.

This area is saturated by the doctor’s knowledge about the patient’s diagnosis, prognosis, and expected complications. So they see, or focus on their own intelligence and ‘dump’ it on the patient. Whether they are able to tune into other aspects of the patient ( not their illness) such as their bravado, courage, or fear,  would provide potential for an improved empathic relationship. Do the blind and open quadrants merge, the patient becoming the illness, detached from the person?

Perhaps the doctor too is being blind?

The Secret Quadrant

This is describing the things the patient is keeping well guarded and hidden from the HCP or doctor who will be completely unaware of them.

An acknowledgement by HCP’s that they in fact are not being presented with the whole of their patient and the patient is concealing aspects of themselves may be useful. It may be relevant to reflect: what is my patient hiding from me?Is this related to their illness?  The situation, environment? Am I being presented with the whole person? How can I facilitate openness? What impact will this have on concordance? Self management?

The Hidden Quadrant

Neither the HCP nor the patient knows what is hidden. But by providing space to explore the potential for understanding how the patient’s illness is impacting on relationships, behaviours and emotions will only serve to increase the potential for our patient to modify their behaviour  to help them reach the potential they hope for themselves. So facilitating the exploration of anxiety, poor sleep patterns, bad dreams and other negative characteristics may prove beneficial for physical health and the relationship between patient and HCP/ doctor,  and patient and their illness.

Johari-Window-Medical-Model

I would just like to conclude that there are missed opportunities within the NHS care settings that deny the patient the opportunity to be truly known by health care professionals such as doctors, who claim to wish to do patients no harm and yet understand very little about the patient they wish to avoid harming.