First of all I want to thank you for this site. After reading Life in the Thin Cage, over a year ago, I have been a regular on this site. Even though I am still in the grips of Binging/purging, I still feel I have taken a few steps forward and I believe this site is the reason. I have also finally sought the help of a therapist, so I am very hopeful and I am on my way to beating this disorder. My question is since I have been binging nearly everyday for the past 2 years, is my stomach stretched to the point were I need too much food to feel satisfied? I know from the book Constance shared that women who undereat may have stomachs that have shrunk so they may need to force themselves to eat a little past fullness. Shouldn’t I need to restrict my eating because my stomach is stretched out? Also, do you think having a daily food/eating plan is helpful? I have a plan nearly every day but never end up sticking to it, I am wondering if maybe I am not ready for this stage, or if it is not recommended at all because it would make me feel like I’m being restrictive, and then giving me more urges to overeat/binge. My food plan is nutritious, using the food pyramid guidelines. Thanks Again and God Bless you for helping myself and others. – Anonymous
First, I want to commend you for the positive steps you’ve taken towards recovery. We’re glad that you found Constance’s book helpful and you find encouragement from our site. It’s also wonderful that you are now working with a therapist. Hang in there and be patient—you will overcome this!
It really can be difficult to eat intuitively—based on hunger and fullness—in the early stages of recovery from bulimia. But I would also agree with you that purposely restricting your intake and following a rigid meal plan on your own can trigger the diet-binge-purge cycle. At this point, it’s really important that you strive to eat three balanced meals per day, with healthy snacks as needed. The food pyramid guidelines are healthy recommendations, but can easily feel like a diet if you try to follow them too closely. Read the article “What Is Healthy Eating?” for a balanced perspective.
In general, bingeing and purging takes its toll on the digestive system in several ways, which means the impact on appetite, hunger, and fullness can vary for different people. These variations are due in part to the extent and frequency of the binges, as well as the method of purging. In addition to the gastric dilation you asked about (expansion of the stomach), you can develop reflux esophagitis (inflamed esophagus; heartburn) and/or a hiatal hernia. If you abused laxatives, you may have lost muscle tone in your large intestine resulting in pain, gas, and constipation. With most of these conditions, smaller, more frequent feedings are better tolerated while the body heals. With time and improved nutrition, you will once again be able to respond to the body’s natural hunger and fullness signals. I think you would get a lot out of the book Intuitive Eating by Evelyn Tribole.
I would highly recommend that you work with a nutritionist (who is an RD), to help guide you in your physical recovery. She/he would give you some eating guidelines to follow as you work your way towards being able to listen to and respond to your body again. You need assistance in learning to eat healthfully—without obsession. It’s a process that will take some time, but will be well worth the effort. Ask your therapist for a referral, or check out “Finding a Nutritionist.”