SPT-Fall2014

than 27 studies reveal that only 45%
of all bulimics experience full
recovery after years of treatment
(Steinhausen & Weber, 2009).
Studies of brain functioning in
individuals with anorexia and bulimia
also have shown impairments in the
functioning of the insula and the
anterior cingulate 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 is also
responsible for assigning 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-inspace
and when impaired lead to
symptoms of body dysmorphia, at
worst, or body dissatisfaction, at best
(Saxena & Feusner, 2006).
This article explores the adjunctive
use of somatic approaches to restore
the nervous system’s capacity for
autonomic regulation, thereby
eliminating the need for symptoms
believed to serve that function. Eating
disorders are characterized by deficits
in the self-regulation of food intake,
emotion, cognition, and behaviors.
The body is the battlefield for the
uncontrolled emotions, and motions
of incomplete survival responses—
the autonomic nervous system is
either stuck in a dorsal vagal freeze
or sympathetic over-activation (fight
or flight). The war manifests as selfdestructive
behaviors that are,
paradoxically, conditioned attempts
to maintain the body’s autonomic
homeostasis for the purpose of
survival. Dissociation from bodily
experience, leading to a chronic
disregard of the body’s needs, also is
a hallmark of these disorders
regardless of where they fall on the
spectrum – starvation and emaciation
in anorexia, binge-purge cycles in
bulimia, or binge eating and obesity
in the other extreme. Therefore,
therapies such as Somatic
Experiencing® could be critical in
restoring body awareness and
autonomic regulation.
Eating Disorders and Trauma
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,
longer length of illness, and poor
prognosis (Briere, 2007; Everill et al.,
1995; Lockwood et al., 2004;
Mantero & Crippa, 2002).
These rates may be higher when
using a broader definition of trauma
that includes any event that taxes the
person’s organismic capacity to
protect their integrity or is perceived
as life threatening. These may have
been pre- and/or peri-natal events, or
chronic patterns of threat such as
abuse, neglect, and invalidation.
Early histories of persons with eating
disorders include injuries to the
attachment system, without which the
neural pathways that mediate affect
regulation cannot develop (Chassler,
1997; O’Kearney, 1996; Schore,
2000, 2002). Because their pathways
between limbic and cortical areas of
the brain are undeveloped, they live
in a constant flux of dysregulation
that includes a dorsal vagal survival
response that makes persons ‘numb’
to most stimuli coming from the gut
to the brain, e.g., hunger and fullness
signals (Porges, 2010).
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’
in the sense that it keeps a person in a
physiologically-stressed state of
constant hyper-vigilance. 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.
Case Study: Bulimia
In bulimia, food serves to soothe
sympathetic over-activation but
because satiety responses have been
interrupted a binge occurs, leading to
a purging discharge that serves to
expel uncomfortable sensations from
the body. Once purged, the person
experiences the numbness
characteristic of a dorsal vagal
Somatic Psychotherapy Today | Fall 2014 | Volume 4 Number 2 | page 61