Characterized by pervasive core deficits in the self-regulation of food intake, emotion, cognition, behaviors, eating disorders are disorders of autonomic nervous system dysregulation. They represent dissociated compensatory attempts to manage internal overwhelm. 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 body's autonomic nervous system in balance between sympathetic and parasympathetic activation.
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. Any history of trauma 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 (Briere, 2007; Everill et al, 1995; Lockwood et al, 2004; Mantero & Crippa, 2002). A broader definition of trauma includes any event that taxes the person's capacity to protect their integrity and is perceived as life threatening. Living in a world where hunger is in constant conflict with the "thin ideal," and where being "fat" in a "thin world" oppresses young people every day, can create a chronic stress response.
Attachment also plays a role. Early histories of persons with eating disorders often include injuries to the secure attachment system, without which the neural pathways that mediate affect regulation cannot develop (Chassler, 1997; O'Kearney, 1996' Schore, 2000, 2002). Because these pathways between limbic and cortical areas of the brain are missing or insufficient, people with eating disorder live in a constant flux of autonomic dysregulation - either hyperaroused, or hypoaroused, both survival responses according to Stephen Porges and his polyvagal theory of emotion, attachment and self regulation (Porges, 2007, 2010).
Brain studies of individuals with eating disorders have shown impairments in functioning of the insula and the anterior cyngulate gyrus (Kaye, 2008), 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 (Damasio, 2000; Fogel, 2009; LeDeux, 2002). The insula also assigns reward value to foods, a function disrupted in persons with anorexia who respond differently to taste stimuli (Kaye, 2008). 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 or body dissatisfaction (Saxena & Feusner, 2006). There is also evidence of a destabilization of the vago-vagal feedback loop in bulimics (Faris, 2006, 2009), making relapse common and beyond the locus of control of the sufferer once the binge-purge cycle becomes "hard-wired."
To summarize, because eating behaviors have been equated with stress at a sub-cortical, mid-brain level, it makes sense to incorporate practices that take patients "beyond talk," especially when the reasoning, cortical brain is off-line due to starvation or malnutrition. Since the body is the battleground of the emotions, therapists and their clients might benefit from understanding the language the body is "speaking."
Mindfulness and somatic practices increase interoceptive awareness, assist in the regulation of autonomic hyperarousal or hypoarousal, and discharge the "un-digested" survival energies bound in the nervous system that fuel symptoms. Therapeutic yoga practices, expressive arts therapies, psychodrama, and psychotherapies that integrate mind and body, such as Sensorimotor Psychotherapy (Ogden, 2006) or Somatic Experiencing (Levine, 1997, 2010), might be essential adjunctive elements to traditional treatment approaches. The use of sensory tracking skills fine-tune awareness of internal bodily states, thereby strengthening the insula, cyngulate gyrus and connections between limbic and cortical areas (Holzel et al, 2010).
Regardless of the eating disorder presentation, somatic awareness to deepen therapeutic interactions, increase therapist attunement, provide clients access to disconnected emotions, and nurture a sense of "safe" embodiment, becomes crucial to healing. By bringing the body into the equation, treatment providers can gradually expose all aspects of treatment, including nutritional and weight restoration, within the person's autonomic nervous system's "window of tolerance" to restore physiological and psychological resilience.
