Bloating In Anorexia Recovery: Why It Happens And How To Cope

by | Apr 23, 2024 | Anorexia | 0 comments

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If you think you may have an eating disorder it is important to seek advice from your GP or health professional. The information in this blog post is intended for information purposes only and is not a substitute for personalised clinical advice. 

Woman holding stomach because of bloating and pain in eating disorder recovery

Are you struggling with bloating in anorexia recovery? Bloating and feeling very full can be one of the most difficult physical symptoms to cope with when you are recovering.

A lot of the time family and friends don’t believe their loved one when they say they are full. Eating when you feel full can also trigger feelings of extreme guilt as anorexia tries to convince you that you don’t need to eat.

We are told to listen to our bodies and tune into our hunger and fullness cues, but what happens when those signals aren’t working?

I’m Dr Jenny Davis, a clinical psychologist specialising in eating disorder recovery. I reviewed research on bloating in anorexia recovery to help answer your questions about why you feel so full.

Starvation syndrome

Our bodies don’t understand the difference between intentional food restriction and a famine. When someone develops anorexia, their caveman brain will treat this as a famine and therefore a threat to their survival.

In this ‘starvation mode’, the human body will prioritise only the bodily functions essential for survival. This means that non-essential bodily functions either stop or are significantly impaired.

This covers a wide range bodily processes. Heart rate can slow, blood pressure falls, and body temperature lowers leaving people feeling cold all the time. For women this can cause periods to stop. It can also cause our digestion to significantly slow down.  

Starvation also results in a number of changes to thinking styles, mood, and social relationships.

Bloating in anorexia recovery

Almost anyone who has rapidly lost a significant amount of weight will experience a slowing down of their digestive tract. The medical term for this is Gastroparesis.

Because food does not pass through the stomach at the normal rate, it can cause bloating, nausea, and lead to people feeling full after very small amounts of food.

Normal digestion speed is typically defined as the following:

  • 10% of food removed from the stomach after 1 hour.
  • 60% removed after 2 hours.
  • 90% removed after 4 hours.

Gastroparesis is diagnosed when food stays in the stomach for longer than this. Most people will not need physical investigations to diagnose gastroparesis. But if your symptoms of bloating and fullness persist after several months of eating reguarly, speak to your doctor to see if you need specialist health care.

As well as the effects of malnutrition, we know that emotions can have a significant impact on the digestive system. High levels of distress can negatively impact gastrointestinal symptoms. And these same symptoms can also negatively affect mood and anxiety!

Bloating can cause the stomach area to become distended. Not only is this uncomfortable, but it can be very difficult psychologically as anorexia tries to convince us that this is proof of being fat.

Constipation in anorexia recovery

Constipation is another common side-effect of starvation and may also be caused by laxative misuse for some people with anorexia. Constipation often makes bloating symptoms worse.

Constipation is correlated with weight, with people with lower BMI’s tending to have more difficulties with constipation. As with the other symptoms of starvation syndrome, the long-term solution is to focus on improving nutrition and reaching a healthy weight.

Treating excessive bloating and fullness

For bloating that is caused by malnutrition, the most effective treatment is nutritional rehabilitation. By eating regularly, and getting enough energy in, the body will slowly return to normal functioning and begin to prioritise non-essential functions once again.

Example balanced meal in eating disorder recovery

When you are starting recovery, it’s recommended that you eat ‘by the clock’, rather than try to listen to your hunger signals. Unfortunately, when you start eating regularly again it will almost certainly involve eating even you aren’t hungry.

Eating disorder therapists typically recommend eating 3 meals and 3 snacks a day to reverse the effects of starvation syndrome. Eating regularly also means you can follow the ‘little and often’ principle, which may be easier to tolerate than fewer, larger meals.

Always talk to your doctor before starting a new meal plan. If you have been significantly restricting your food, and/or have lost weight rapidly, you may be at risk of re-feeding syndrome.

How long does bloating in anorexia recovery last?

How long it takes for bloating to reduce in anorexia recovery will vary significantly. Some people find that it is a relatively short-term side effect lasting only a few weeks.

For most people, they will need eat regularly for a period of several months before their digestion returns to normal. For a few people, unfortunately gastroparesis can persist even after recovery and requires medical intervention.

Coping with bloating in anorexia recovery

Bloating and fullness can trigger some intensely difficult thoughts when you are recovering from anorexia. Try fact-checking some of the thoughts that anorexia brings up.

Does feeling bloated really mean that you are eating too much, or is it a symptom of starvation? Does feeling bloated mean you are greedy, or does it mean you are working really hard to get better?

Alternatively, you might find it easier to disengage from these thoughts. This can be especially helpful when you are ‘in the moment’, when battling with your thoughts can make them all the more powerful. Russ Harris explains the concept in this video about accepting our thoughts.

If you are finding bloating and fullness extremely difficult, you might find using distraction the simplest way to get through this stage. Try to plan your meals so that you will be doing an engaging activity afterwards.

Try making a list of readily accessible activities that will hold your attention. Examples include:

  • Reading
  • Studying
  • Crafts
  • Listen to music / podcast / audiobook
  • Calling a friend
  • Chatting with loved ones
  • Take dog for a gentle walk
  • Watch your favourite show
  • Play a video game
  • Painting or colouring
  • Light gardening
Paint brushes and paint to represent art as a distraction technique

Try to view this period as “food as medicine” and nutritional rehabilitation. It is incredibly difficult to tolerate, and it is also temporary. You can get through it, and you won’t always feel as bloated as uncomfortable as you do now.

References

Gaudiani, J. L. (2018). Sick enough: A guide to the medical complications of eating disorders. Routledge.

Waldholtz, B. D., & Andersen, A. E. (1990). Gastrointestinal symptoms in anorexia nervosa: a prospective study. Gastroenterology98(6), 1415-1419

West, M., McMaster, C. M., Staudacher, H. M., Hart, S., Jacka, F. N., Stewart, T., … & Ruusunen, A. (2021). Gastrointestinal symptoms following treatment for anorexia nervosa: A systematic literature review. International Journal of Eating Disorders54(6), 936-951.

Weterle-Smolińska, K., Banasiuk, M., Dziekiewicz, M., Ciastoń, M., Jagielska, G., & Banaszkiewicz, A. (2015). Gastrointestinal motility disorders in patients with anorexia nervosa–a reviewof the literature. Psychiatria polska49(4), 721-729.

About

Welcome. I'm Dr Jenny Davis, a Clinical Psychologist with a special interest in eating disorders. I'm passionate about helping people recover and build a healthy relationship with food. 

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