Myth: People Who Have Anorexia Don’t Get Hungry

By B, AKA The No Nonsense Guide Guy

People who have anorexia nervosa are generally the ones who spread this myth. “No thanks, I’m not hungry” is something I surely said thousands of times during the years when I was ill.

I wasn’t lying, at least not usually. I really didn’t think I was hungry, even if I’d not eaten in recent memory. If I waited all day before eating a meal, sometimes I could get a faint signal I could recognise as hunger. But I was more likely to get a headache or become irritable than to feel traditional hunger pangs.

Did that mean it was easy for me to starve myself? That I could just forget to eat because I didn’t have a physical reminder? No, not at all. It was a struggle every day: even though I wasn’t feeling ‘hungry’, I was constantly preoccupied with food.

There was always a thought loop running in my head. What have I eaten today? How many calories have I burned off with exercise? When can I eat again? Can I delay that? Over and over, all day. I would try to ignore it by getting absorbed in work, or by drinking coffee, or by chewing gum. But it would keep going.

What I didn’t realise was that for me, this was hunger. ‘Mental hunger’ is a symptom of chronic starvation. Starving people are obsessed with food. This phenomenon is well-known to bodybuilders, wrestlers, and boxers, who often fantasise about food when they’re ‘cutting weight’ for a competition. And it’s been studied by scientists—here is one description of what happened to participants in the oft-cited Minnesota Starvation Experiment:

Food and eating became focal points in conversations, reading, dreams, and even daydreams. For example, when they watched movies, the study’s participants were recorded commenting on the frequency of food and eating mentioned. Some volunteers developed concentration issues due to their preoccupation with food. 

(from Chantal Gil’s post, The Starvation Experiment, at the DukeHealth Center for Eating Disorders blog)

Mental hunger manifests in a number of ways. Some have a pretty obvious connection to food: Some people spend hours grocery shopping. Others scroll endlessly through recipes online. One woman I know was constantly calculating the costs of what she’d eaten that day: the energetic cost (how many calories her dry toast had) and the financial cost (how many cents worth of milk she’d consumed).

Other mental loops are more mysterious. For example, I was constantly thinking about exercise: How many miles did I run today? This week? This month? This year? Will I be able to run tomorrow? What about later in the week when it might rain? These exercise-related thoughts were sublimated hunger: I could only allow myself to eat if I’d exercised a certain amount. So I was very focused on getting plenty of exercise—in a way, I was afraid that I would starve myself if I didn’t do ‘enough’.

Sometimes the preoccupation with food focuses on others: many people who have anorexia report being hyper-aware of what everyone around them is eating, or are constantly noticing when people around them gain or lose small amounts of weight. Other times it causes anxiety about scarcity: lots of people who have anorexia are irrationally reluctant to spend money, or get paranoid when their phone’s battery charge drops below 85 per cent.

Why this happens isn’t really clear. Some researchers propose neural circuitry malfunctions, but are still mostly puzzled (for example, Kaye et al. 2009 suggest that the mental symptoms associated with AN are perhaps related to altered serotonin and dopamine metabolism, which is not exactly going out on a limb). Eating disorder recovery specialist Tabitha Farrar conjectures that mental hunger is less energetically expensive than physical hunger, and chronically starved people need to save every calorie. My pet explanation is that the body switches strategies when it finds that the hunger signals aren’t having the usual effect.

I always thought my anorexia was incurable: I didn’t really have a negative body image, I couldn’t point to anything my parents did wrong, I didn’t even really have a low BMI, I didn’t feel like my life was out of control, etc. But learning about mental hunger shifted my thinking: if my intrusive thoughts were just a symptom of starvation and not some intractable mental condition, maybe I could banish them by… not starving myself?

That turned out to be the case! Treating mental hunger as a cue to eat was a key component of my recovery. After a while I started feeling actual hunger, too. Really intensely, in fact—for a while I would wake up at 4:00 in the morning, absolutely ravenous for breakfast. This is apparently pretty typical. In early recovery, people with anorexia nervosa often have ‘extreme’ hunger. It’s almost like they have to make up for all the times they ignored their appetite. It scares some people, who think that they might always be insatiable. But it’s a transitory thing, and eventually normalises—it did for me within a few weeks.

It seems a little ridiculous when I look back on it now.

“Sure, my every waking thought is about food. I’m always working to justify a meal. But I don’t have a grumbly feeling in my stomach, so I guess I’m not hungry.”

I both believed and perpetuated the myth that mental hunger isn’t hunger.