Feeling Fat: Working Through Sensations and beliefs in Anorexia REcovery
Understanding "Feeling Fat" in Recovery Through CBT-E
Many individuals with anorexia enter recovery seeking relief from the mental anguish of obsessive thoughts about food, weight, and body image. However, one of the most distressing and confusing experiences in this process is the sensation of "feeling fat." This feeling can be overwhelming, but it does not necessarily reflect actual body changes. CBT-E (Enhanced Cognitive Behavioral Therapy), one of the leading evidence-based treatments for eating disorders, offers a framework to help individuals understand and manage this experience.
The Reinforcing Cycle of Anorexia
Anorexia is uniquely challenging to treat because its symptoms are often self-reinforcing. In the early stages, weight loss and restriction can feel rewarding, both internally and externally. A person might receive compliments about their appearance or disciplined eating habits. Others may ask for weight-loss advice, reinforcing a sense of accomplishment. However, these behaviors are unsustainable and often lead to a steep decline in physical and mental health. Over time, what once felt like control turns into an all-consuming cycle of food preoccupation, exhaustion, and isolation.
At Columbus Park, we work with many individuals who are deeply weary of the relentless mental chatter about food and eating. Though they may feel conflicted about recovery, they recognize that restoring their health requires eating consistently and allowing their body to heal. Still, the fear of weight gain—both the reality and perception of it—remains one of the most significant hurdles in recovery.
What does it really mean to "Feel Fat?"
CBT-E teaches that "feeling fat" is not an accurate reflection of body size but rather a label for other emotional and physical experiences. Let’s break down the key contributors:
1. Body Fat Redistribution
When the body has been deprived of adequate nutrition, it prioritizes protecting essential organs. Upon refeeding, fat cells first accumulate around the midsection before redistributing evenly over time. This means that, initially, individuals may notice changes in their stomach area, which can be distressing. However, this is a temporary and necessary phase of healing. Over time, fat distribution evens out as the body stabilizes.
2. Delayed Gastric Emptying and Digestive Distress
Prolonged restriction slows down the function of the stomach muscles, making digestion sluggish. This delay means food sits in the stomach longer than usual, leading to bloating, nausea, gas, and discomfort. CBT-E helps individuals recognize that these sensations are not signs of weight gain but rather indicators of a healing digestive system. With consistent nourishment, these symptoms gradually subside over several weeks.
3. Cognitive Distortions and Body Image
A core concept in CBT-E is understanding how thoughts influence emotions and behaviors. Individuals with anorexia often have deeply ingrained negative beliefs about weight and shape. These beliefs can cause them to perceive their body as larger than it truly is—a phenomenon known as body image distortion. This misperception is not just psychological but also neurological; prolonged malnutrition alters how the brain processes body image.
How To Cope During Anorexia Recovery
CBT-E interventions help individuals challenge these distortions by:
Recognizing that "feeling fat" is often a proxy for distressing emotions, such as anxiety, fear, or loss of control.
Practicing body image exposures to reduce avoidance and distress.
Developing alternative responses to body image concerns, such as focusing on function over appearance.
Knowing that Feelings aren’t facts
If you’re in recovery and struggling with "feeling fat," know that you’re not alone. CBT-E teaches that these sensations, while deeply distressing, are not reflections of reality but rather cognitive and physiological responses to the recovery process. Practical strategies, such as identifying and reframing distorted thoughts, using distress tolerance techniques, and building body acceptance, can help manage these feelings.
Healing is not linear, but it is possible. Trust the process, and give your body the care it deserves.
Enjoy Columbus Park’s Guide to CBT-E so you can learn about this potent treatment and how it might help you in your recovery.
