SPT-Fall2014

Somatic Wisdom
and the Polyvagal Theory
in Eating Disorders
By Inge Sengelmann, LCSW, SEP, RYT
A 52-year-old female with a 36-
year history of anorexia nervosa was
referred to me for Somatic
Experiencing® after failing to
progress following ten years of
traditional treatment. The client and
her former therapist described the
client as ‘stuck’ in all areas in her
life: unable to fully restore her
weight, successfully maintain any job
or relationship, or complete desired
activities such as remodeling her
home. Her past traumas included
disruptions to early attachment,
having been raised by a dismissive
and invalidating mother in rural
Cuba, which was compounded by the
physiological trauma of severe
starvation from age sixteen, a
traumatic head injury with a coma at
age twenty-eight after a cycling fall,
and a high-impact fall from a
telephone pole in her mid-thirties
when she worked for the local phone
company. She presented with
somatization of unwanted emotional
experience, which manifested as
recurring migraines, abdominal pain,
and slowed cognitive and verbal
processing. She had no language to
describe emotional experience other
than the physical symptoms. Bodily
she engaged in bracing responses—
stiffening and extending her arms
and legs with the mildest amount of
activation—and she avoided all eye
contact. Behaviorally, she restricted
entire foods and food groups, drank
three two-liter bottles of diet coke per
day instead of water, and engaged in
excessive daily long-distance
cycling.
Gradually, through the use of
Somatic Experiencing (SE) practices,
the bracing responses completed and
began to lessen. We ‘nurtured’ her
ventral vagal social engagement
system by using imaginal exposure to
eye contact with her beloved cat (no
human contact felt as safe), which
universally elicited a wide smile and
softening of her entire body. We also
used vocalization and singing, one of
her stifled passions, as a way to
‘awaken’ her dorsal vagal complex
and release the vagal break at a pace
that she could tolerate. In a few
months, she began to mobilize and
socialize. She began to notice hunger
cues and to recognize that she could
not ride for endless miles without
nutrition and hydration. She
eliminated the use of soda and began
drinking water. She reduced her
cycling treks and incorporated more
walking. She remodeled her home
and traveled out-of-state to pursue
vocational training. She obtained and
has maintained a part-time job, and
she began dating for the first time
since she was twenty-eight.
She has since been able to
participate in a Dialectical Behavior
Therapy skills training group to learn
to identify, label, and process
emotions, acquire skills for
interpersonal effectiveness at work
and in relationships, as well as
expand her nutritional palate, which
is still challenging due to her fear of
weight gain. Through mindfulness
and body awareness she is now able
to give voice to her emotions, and the
headaches and stomach pain have all
but disappeared. The results seem
miraculous to the skillful
professionals who previously treated
her with every tool in their arsenal
except somatic awareness and
processing. In this client’s case,
adding Somatic Experiencing® as a
precursor and preparation for DBT
has made a significant impact on the
quality of her life and her potential
for a more meaningful recovery.
Why Somatic Approaches?
The etiology of eating disorders is
largely unknown. They are multifaceted
and multi-dimensional in
origin, presentation, and response to
treatment. Current (largely cognitivebehavioral)
treatments are limited in
scope and outcome. Anorexia is
considered to be one of the deadliest
mental health disorders – with nearly
20 percent of people suffering from
anorexia dying prematurely from
complications related to their eating
disorder, including suicide and heart
problems (Arcelus et al., 2011). More
Somatic Psychotherapy Today | Fall 2014 | Volume 4 Number 2 | page 60