ARFID Treatment: Improving Hunger Cues

Low hunger cues is one of the 3 common factors underlying ARFID, the goal is increasing awareness and reinterpreting sense of fullness in early-recovery.

Introduction

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Low hunger cures mean it can be hard to motivate change with eating. This is a sensory experience that might be innate for some people, while for others, it develops over time.

Psychology under the hood

People who have low hunger cues without a specific cause or trigger might be what we call "super sensors," who are highly aware of bodily sensations. We can think of this almost like a superpower with obvious and sometimes significant consequences. This trait seems to co-occur with people who are "OC," which stands for over-controlled or having obsessive-compulsive coping styles (whether or not they meet criteria for OCD or OCPD). It can also occur with people who have an autism spectrum disorder - people with autism are also frequently OC either as a trait, a coping mechanism or a symptom such as rigid schedules and routines, and are often highly aware of sensory and unfamiliar stimuli.

For these individuals, when something is off, it might be alarming. Perception might be somewhat black-and-white: it is normal or aweful. In terms of eating, I am hungry or completely full.

Working with low-hunger cues: using scales

Black-and-white experience of hunger means the person doesn't perceive gradients of satiety between hungry and full. How do we help someone expand their healthy hunger cues if their cues are binary? One aspect of treatment is to use a 1-10 scale. This may seem foreign at first to someone with low hunger cues, and kids may need visual rather than numeric designations for these gradients.

We might first ask a few questions. "Do you notice a difference between when you first feel hungry and, say, if you don't get a chance to eat and you get hungrier - sometimes we say 'I feel starving!'?" Now ask a question about fullness: "Do you notice a difference between when you could stop eating and say 'I feel full enough,' and eating more to the point it might be uncomfortable?" Let's think about this on a scale, from 1 to 10:

• 1 being "I'm famished, If I don't eat, I will become lightheaded" getting near a health concern.

• 2-3 is a normal range of hunger, but not feeling unwell.

• 4-6 is not having any hunger cues currently or, if having just eaten, feeling full enough

• 7-8 is the target intervention point for treating low hunger cues. A little more full than comfortable.

• 9-10 designates eating to the point of discomfort, 10 including feeling physically ill or actually having an emesis (vomiting), not by choice but physiology.

The more frequently we rate our hunger, the more aware we become of these gradients. At first, it may feel odd, like a blind person trying to describe sight, but it becomes more tangible with time.

You can stomach it!

As we hold ourselves accountable to eating to the 7-8 range, our stomach starts expanding - not just when eating, but staying larger over time. This means we feel full less quickly.

When we don't eat enough, our stomach shrinks. Less food is required to fill it. When it is filled, it releases chemicals that signal to our brain: "hey bud, all full down here - stop running that mouth machine of yours." If our stomach has shrunk due to low intake, the black-and-white, binary experience of either hunger or fullness is actually physiologically backed: we have a very low ceiling between our stomach being empty and full, so we do literally go from empty to full quickly. Consequently, it is normal to feel uncomfortably full in this stage of treatment when we are using food to stretch our stomach to a normal capacity, building a physically broader and healthy range of hunger cues.

For many people, the change in stomach capacity occurs more quickly than you'd expect. People are excited that they feel "right" eating a "normal" portion size meal like those around them. To define a "normal" portion size, consult a dietician or nutritionist, trust yourself and supports if unless there is a reason to second guess that intuition, and use trusted resources like My Plate.

Note, if you are significantly low weight, you should already be connected with a medical provider such as an MD, dietician or nutritionist. Increasing eating too quickly can cause a serious medical concern called refeeding syndrome. Make sure that changing your diet is safe before doing so.

Think before you (speak) eat!

Ok, that might not sound like good advice for ARFID, but hear me out. When I say "think," I mean be mindful. Don't eat mindlessly just to push yourself to get to the 7-8 out of 10 goal for this interventions. Think about how you feel, "where am I right now on a scale of 1-10?" This continual, mindful gauging can help us build that self-awareness of gradients of fullness, and language for those sensations that may have been overshadowed by the black-and-white experiences from prior to working on broadening your hunger cues.

When preparing food, try to engage your hunger cues:

• What does it smell like?

• Does it smell good?

• What scents or ingredients can I smell and name?

• How do it look? Tasty?

After eating

For some people with AFRID, there is a strong desire to avoid the uncomfortable sensations that go along with fullness. I use sensations plurally for for a reason. It could be the stomach, a feeling of needing the restroom, movement or excessive activity could worsen it. Plan an after-meal activity or routine around this. Don't ignore it and push yourself to do too much, worsening the sensation, but also don't just blind yourself too much it with excessive distraction. Try to learn to tolerate it with just enough distraction to make the experience ok. Remind yourself these sensations are normal and will get better with time, and usually quickly. Engage in conversation, reading, TV or music. Some movement can help with digestion. See other blog articles regarding tolerance and coping skills!