How To Explain Symptoms Of Starvation To Clients

Disordered patterns of eating play a central role in the maintenance of eating disorders such as anorexia nervosa, bulimia nervosa, binge-eating disorder, and other specified feeding and eating disorders (OSFED). For this reason, psychoeducation regarding the consequences of abnormal patterns of eating is an important aspect of treatment.

When the human body is deprived of energy from food, individuals experience a range of problematic symptoms that can contribute to eating disorders. The Minnesota Starvation Experiment (Keys et al., 1950) provides a vivid account of how food restriction affects people. Most notably, it highlights common symptoms of semi-starvation and the ways in which this “starvation syndrome” can establish and reinforce key features of disordered eating.

The Minnesota Starvation Experiment

Food gives the body the energy it needs to function normally. If people limit their food intake for extended periods of time, they experience specific side-effects. These symptoms of food restriction are sometimes called “starvation syndrome” or “semi-starvation.”

The Minnesota Starvation Experiment is a well-known research study which explored the effects of starvation between 1944 and 1945. The project took place against the backdrop of World War II: hunger and starvation were commonplace around the globe, but relatively little was known about the effects of starvation or the process of rehabilitation following extended periods of malnutrition.

Led by the physiologist Ancel Keys, the Minnesota study began in November 1944 and ended in October 1945. The participants were 36 healthy young men who were conscientious objectors to military service. Recruitment into the project was rigorous: participants needed to be in good physical and mental health and demonstrate an ability to work well with others in difficult circumstances.

During the first phase, lasting three months, the participants ate a normal diet while their eating patterns, behavior, and psychology were closely monitored. During the second phase, lasting six months, the participants’ food intake was roughly halved, which caused most of them to lose around 25% of their body weight. During the third phase, the men underwent a period of rehabilitation during which they were re-fed and restored weight.

The changes observed in the participants during the semi-starvation phase of the experiment were variable but nonetheless dramatic. Importantly, some of these changes persisted after the participants had restored weight and resumed normal eating. They included:

• Biological changes, such as increased hunger and cravings, reduced strength, gastrointestinal pain, reduced need for sleep, headaches and dizziness, sensitivity to cold, and hair loss.

• Psychological changes, such as preoccupation with food, impaired concentration, reduced alertness, impaired judgment and decision-making, as well as rigid and obsessional thinking.

• Behavioral changes, such as changes in the speed of eating (e.g., prolonging meals), urges to binge, occasional loss of control over food intake, highly ritualized patterns of eating, increased interest in food (e.g., collecting recipes), desire to hoard, use of hunger-relief behaviors (e.g., chewing gum), and disinterest in other activities.

• Emotional changes, such as depression, anxiety, irritability, impatience, apathy, and brief periods of elation.

• Social changes, such as withdrawing from others, feeling socially inadequate, strained relationships and conflict, disinterest in sex, and loss of sense of humor.

For some participants, the effects of semi-starvation were extreme: two were briefly admitted to a local psychiatric facility and one admitted to eating scraps of food out of garbage cans (Kalm & Semba, 2005).

Implications for eating disorder conceptualization, psychoeducation, and treatment

The findings of the Minnesota Starvation Experiments have important implications:

• Symptoms of starvation and symptoms of eating disorders overlap. All the participants in the study began the experiment in physically and psychologically healthy states, but this changed due to food restriction. This suggests that many disordered eating behaviors that might at first seem unusual or shameful actually stem from universal effects of starvation, rather than reflecting anything deeper about the person carrying them out.

• Semi-starvation drives eating disorder symptoms. Restricted eating leads to many of the symptoms that individuals with eating disorders struggle with, such as preoccupation with food and urges to binge. For this reason, normalizing food intake and reaching a healthy weight play a vital role in recovery from an eating disorder.

• Semi-starvation maintains eating disorder symptoms. Symptoms of semi-starvation are likely to perpetuate aspects of eating disorders. For example, social isolation may lead to increased preoccupation with weight and eating, while starvation-related emotional distress may fuel disordered eating, such as restricting or binge eating in response to difficult feelings.

• Severe food restriction isn’t the only cause of semi-starvation. Symptoms of semi-starvation can also arise when people eat irregularly or intermittently, limit their intake of energy-rich foods (most notably carbohydrates), or engage in compensatory behaviors which reduce energy absorption and storage, such as high levels of physical activity.

• Starvation effects sometimes persist. Some participants in the Minnesota study continued to struggle with symptoms even after their weight and eating had returned to normal. This suggests that learning to regulate food intake and eat intuitively may take some time after food intake has begun to normalize.

Key tips for explaining starvation symptoms to clients

1. Normalize without minimizing

Everybody experiences symptoms of starvation when they don’t eat enough, but people who struggle with an eating disorder might experience them intensely or very often. Many symptoms of an eating disorder appear to be a direct result of starvation syndrome.

2. Highlight that people can experience semi-starved states

Severe and prolonged food restriction is not the only cause of starvation syndrome. People also experience symptoms of semi-starvation if they eat irregularly, limit their intake of certain foods, or reduce the energy available to their body.

3. Link eating patterns to thinking, feeling, and behavior

Research shows that the effects of starvation (which can relate to both what people eat and how much they eat) can have a big impact on the way they think, feel, behave, and relate to others.

4. Connect symptoms to maintaining cycles

Symptoms of semi-starvation can keep an eating disorder going. For example, withdrawal can lead to more opportunities to dwell on shape, weight, and eating, while starvation-related emotional distress may fuel disordered eating (e.g., binge-eating in response to stress or frustration).

5. Prepare clients for gradual change

Eating more regularly (including regular carbohydrates) can reduce the effects of starvation, but full recovery from an eating disorder usually involves more than just improving food intake. Other issues such as negative body image, emotional regulation, interpersonal difficulties, perfectionism, low self-esteem, and personal identity can also be an important issues to address in therapy.

• Kalm, L. M., & Semba, R. D. (2005). They starved so that others be better fed: remembering Ancel Keys and the Minnesota experiment. The Journal of Nutrition, 135, 1347–1352.

• Keys, A., Brozek, J., Henschel, A., Mickelsen, O., & Taylor, H. L. (1950). The biology of human starvation. University of Minnesota Press.

• Waller, G., Cordery, H., Corstorphine, E., Hinrichsen, H., Lawson, R., Mountford, V., & Russell, K. (2007). Cognitive behavioral therapy for eating disorders: A comprehensive treatment guide. Cambridge University Press