Eating disorders, at their core, are disorders of autonomic distress regulation. Dissociation from bodily experience leading to disruptions in response to the body’s needs are a hallmark of these disorders. In persons with eating disorders, the body has become the battlefield for uncontrolled emotions, and the war manifests as self-destructive behaviors that are, paradoxically, attempting to maintain the organism’s integrity. Characterized by pervasive core deficits in the self-regulation of food intake, emotion, cognition, behaviors, eating disorders (and their often-accompanying self-mutilation) represent dissociated compensatory attempts to serve self-regulatory functions.
Early histories of persons with eating disorders often include injuries to the secure attachment system, without which it is veritably impossible for the neural pathways that mediate affect regulation to develop. Because these pathways between the limbic and cortical areas of the brain are missing or insufficient, people with eating disorders live in a constant flux of autonomic dysregulation – or become dorsal dominant and “numb” to most stimuli, including hunger and fullness signals.
Studies of brain functioning in individuals with anorexia and bulimia have shown impairments in the functioning of the insula and the anterior cyngulate gyrus, areas responsible for interoceptive awareness, the integration of sensory information and emotions, the regulation of aggressive impulses, as well as behavioral motivation and coordination of motor impulses. The insula also is responsible for assigning reward value to foods, a function disrupted in persons with anorexia who respond differently to taste stimuli. Furthermore, these same areas of the brain are largely responsible for the perception of the body-in-space, and when impaired, lead to symptoms of body dysmorphia (at worst) or body dissatisfaction (at best).
A review of the literature indicates that individuals with eating disorders are more likely than others to have a history of trauma and, conversely, those with trauma are more likely to report disordered eating patterns – making trauma a risk factor for eating disorders. Studies report rates of up to 45 percent of eating disordered patients endorsing traumatic experiences, with the highest trauma rates reported by patients with bulimic symptoms. These rates are much higher, closer to 80 percent, when taking into account a broader definition of trauma that might include any event that taxes the person’s capacity to protect their integrity and is perceived as life threatening at a conscious or subconscious level. Any history of trauma in these eating disorder patients is correlated with increased levels of impulsivity and dissociation, both of which increase symptom severity and are correlated to longer length of illness and poor prognosis. Again, symptoms of eating disorder serve functional, albeit distorted, survival strategies to overwhelming, chronic, inescapable stress and acute trauma in childhood.
All of these factors support the use of practices that increase interoceptive awareness, assist in the regulation of autonomic hyperarousal or hypoarousal, and discharge the “un-digested” (pun intended) survival energies of trauma. Mindfulness, particularly mindfulness of body sensations, is a great adjunct to any treatment of eating disorders. Scientific studies have shown that mindfulness practice increases gray matter in the areas of the brain known to regulate emotion. Antonio Damasio, who introduced the concept of somatic markers, posited that rational decision making cannot be divorced from emotion or body awareness. These qualities of awareness of self must be cultivated and enhanced to increase our resiliency and wellbeing.
Finally, Somatic Experiencing® is particularly suitable in the treatment of eating disorders, where eating behaviors have been equated with stress at a sub-cortical level – whether the stress comes from hunger, which is regulated by over-feeding in binge eating, or by fullness, which is regulated by starvation in anorexia. In bulimia, food serves to soothe sympathetic over-activation, while the purging cycle discharges serve as a way to 'purify' or cleanse the self, and serve as a metaphor for expelling uncomfortable or "dirty" feelings and experiences from the body, returning the person for a moment to a dorsal vagal state of numbness. On the other extreme, men (more often than women) who pursue over-muscularity (some call it “bigorexia”) are creating a “body-shield” sourced in past physical abuse.
In eating disorders, needs are overcoupled with shame, people become mistrustful of cues related to hunger and fullness, want to eliminate signs of sexuality from the body, and feel like they are “too much,” or “not enough.” Society, and sometimes family, fosters that sense of shame when it does not permit physical, sexual, or emotional diversity to exist. Living in a world where hunger is in constant conflict with the “thin ideal” and where being “fat” in a “thin world” oppresses young men and women every day, can be “traumatic.” Wanting to restrict food intake and “failing” leads people to feel “betrayed” by their own bodies. When bodily responses fail to measure up to these impossible standards, eating disorders brew.
Regardless of the presentation, somatic awareness to deepen therapeutic interactions, provide access to disconnected emotions, and nurture a sense of “safe” embodiment becomes crucial to healing. Using SE, treatment providers can “titrate” (gradually expose) all aspects of treatment, including nutritional and weight restoration, within the person’s “window of tolerance.” All overcoupled and undercoupled aspects of the person’s experience (sensation, image, behavior, affect and meaning) can be gradually discharged or integrated to restore a person’s sense of wellbeing and resilience. This includes the internal hunger, fullness and satiety cues necessary to long-term recovery and the end of the dieting, starvation, binge eating, purging cycles.
