Internal vrs. External Cues of Hunger

Eating disorders almost uniformly involve a broken thermostat-like mechanism that governs internal cues [symptoms] of hunger and fullness. In other words, unlike our “normal eating” contemporaries, we are often confused when to eat, what to eat, how much to eat, and/ or when to stop eating. Whether suffering with anorexia, bulimia, or compulsive overeating, there is a tendency to be more governed by external stimuli - such as the sight of food,, smells, time of day, stressful events, body image, etc. These influence our behavior around food more than the internal cues such as blood sugar levels, stomach contractions, an empty stomach, and so on. Just how much do these factors mediate our eating behaviors?

We seem more susceptible to being conditioned to associate certain emotions or external events with turning on or off our appetite. Again, another way to look at this may be that our circumstances and psyche tend to “trump” our physical needs or internal signals when it comes to our eating. To date, science has yet to figure out whether this is a learned behavior or one some of us prone to eating disorders are born with.

Given both the effect certain foods exert on our brain chemistry and this external orientation regulating our appetite, we need to have a plan to take both factors into consideration. Again, there is the nature of the person and the nature of the substance interacting here.

The “plan” needed begins with some structure and realistic boundaries around our eating. In my humble opinion, it is why an “intuitive eating” approach is not the best route to take with food planning and eating in general. There is a need for limits around the types of foods we eat, a reasonably consistent schedule of when we eat, and an acceptance of some of the physical and psychological differences that separate us from our “normal eating” peers. The same can be said for people suffering with a variety of other substance and process addictions. Although the differences may unique to their particular problem, they too differ from their non-dependent peers.

The Restricting Side of the ED Coin

Then again, you may be at the other end of the eating disorder spectrum. With more of an anorexic pattern, there is either a denial or misinterpretation of our physical needs or, more typically, a phobia of what will happen to us if we “give in” to our hunger and feed ourselves. The “phobic” response to eating and the never ending pursuit being “thin enough” seems to come with the territory. Fact is, there is a general mistrust of what the body is telling us internally and an over reliance on external perceptions and stimuli that further our “Dis-Ease.” Even when “listening” to your body you’re likely to continue to mistrust both the message and the messenger.

In sum, over feeding and under feeding are simply different sides of the same coin. Both are perpetuated by a chaotic array of mixed messages from our internal selves and what we perceive on the outside. All this makes for a relentless battle between our bodies and our minds. Not a fun place to be.

One of the positive outcomes of recovery comes when we accept we are not as internally oriented as as non-eating disordered peers. With acceptance of our reality, the adoption of a reasonable food plan becomes a preferred place to be rather than a prison sentence. *Clean eating, along with the other components accompanying a recovery life-style become a matter of preference and not something we do because “we have to.” You’ll find the same experiences among people enjoying long-term recovery from alcohol, drugs, and other dependencies-namely their “recovery” has become a blessing and not a curse. I’d further the analogy to someone with any chronic disease. If we we’re discussing diabetes treatment then eating within the bounds of a healthy whole-food plan, moderate exercise, managing stress, and developing a personal sense of spirituality would be the exact prescribed program called for. If you think about it, this formula would serve anyone with a chronic disease and go a long way to restoring someone’s health and quality of living.

[*] It’s important to remind the reader our reference to “abstinent food plans” and “clean eating” are about healthy and adequate nutrition and not in the service of further restricting calories.

Author's Bio: 

Dr. Lerner is the founder and executive director of the Milestones in Recovery Eating Disorders Program located in Cooper City, Florida. A graduate of Nova Southeastern University, Dr. Lerner is a licensed and board certified clinical psychologist who has specialized in the treatment of eating disorders since 1980. He has appeared on numerous national television and radio programs that include The NPR Report, 20/20, Discovery Health, and ABC’s Nightline as well authored several publications related to eating disorders in the professional literature, national magazines, and newspapers including USA Today, The Wall Street Journal, New York Times, Miami Herald, Orlando and Hollywood Sun Sentinels. An active member of the professional community here in South Florida since finishing his training, Dr. Lerner makes his home in Davie with his wife Michele and daughters Janelle and Danielle and their dog, Reggie.

Professional Memberships:

- American Psychological Association [APA]
- Florida Psychological Association [FPA]
- National Eating Disorders Association [NEDA]
- National Association for Anorexia and Associated
Disorders [ANAD]
- Binge Eating Disorders Association [BEDA]
- National Association for Anorexia and Bulimia [ABA]
- Florida Medical Professional Group [FMPG]
- National Association of Cognitive Therapists
- International Association of Eating Disorder
Therapists [IADEP]

Prior and Current Affiliations:

- Founder and director of Pathways Eating Disorders
Program [1987-1994]
- Clinical Director, Eating Disorders Unit at
- Clinical Director, Eating Disorders Unit at Humana
Hospital Biscayne, Miami, Fla. [1982-1987]
- Founder and CEO, Milestones In Recovery’s Eating
Disorders Program, Cooper City, Fla.1999-
- Florida Physicians Resource Network 2005-