An Embodied Approach To Eating Disorder Recovery
I am almost finished completing my Level 1 training through The Embodied Recovery Institute, an Introduction to Embodied Recovery for Eating Disorders (ERED). I have been searching for an eating disorder recovery program that includes the body as an important voice in the recovery process.
My own eating disorder recovery journey began very traditionally as a a top-down, cognitive approach. Over time, I found that talking was not enough; I was still afraid of my own body. Slowly without really realizing what I was doing, I found myself engaging in embodiment practices as a way to get to know my body and how it communicates - but without much support from anyone who was eating disorder-sensitive. When I found this training, I could not believe my luck!
We all have a relationship with food and our bodies, and at some points in our lives, we may have used food and/or our body to cope. For some of us it lasts for a phase and for some of us (like me), the coping strategies that the eating disorder provides brings so much comfort and release that it takes over and soon has a feeling like it will never, ever, go away.
It can be frustrating and triggering when we are told to just “eat normally”. Many of us know this: it is not about the food. The food is a tool to try cope, manage, and regulate. The body responds to these coping strategies, showing us where the dysregulation is happening.
This training offers a compassionate, bottom-up approach that views the body as an important resource for the healing process.
A typical eating disorder treatment process is what ERED calls a bio-psycho-social model. Here we look at recovery through pharmacology, re-feeding, nutritional rehabilitation and yoga (the bio aspect), education about emotions, CBT-style therapies, and practices that aim to change one’s thoughts to change behaviour (the pyscho aspect), and family and dynamics, one’s sense of belonging in the world, the culture, and in the family (the social aspect). There is also usually a treatment team that includes a dietician, psychiatrist, physician, and family therapist etc.
This approach emphasizes the need to get someone to eat a prescribed amount of food to achieve some BMI, eat in a “normal” way, and change or stop behaviours. It views these behaviours as responses to an attitude towards the body.
But something is missing.
Traditional treatment does not look at how the body is expressing and communicating. We have become so focused on the mind, forgetting that if we listen to how the body is responding, we see how it is expressing a dysregulation through to the eating disorder behaviours.
From an ERED perspective, we work with the body rather than against it, bringing it into the conversation, and into relationship. We learn how to resource the body rather than it viewed as an obstacle.
When we work with the body first the body can support us in our relationship with food. From this model, anatomy, physiology, kinesiology, movement, and posture are included. The body collaborates with us (we are working together) at the physiological level to support the infrastructures that govern emotional regulation, memory, and sustained healing. This is what a bottom-up approach means.
Recovery is the practice of embodiment, not behaviour change. It is about adding. Not further restricting and subtracting.
Increasing embodiment occurs by enhancing our awareness of what is around us in our environment through our far senses (sight, sound, taste, touch, feel) and the awareness of our own body (interception, proprioception, vestibular). Embodiment is the intersection of our own awareness and our physical container; it is where our consciousness and physical body intersect. An eating disorder simply shows us where and how we are not fully embodied.
ERED talks about three ways in which we may experience disembodiment: our sensory integration system, our attachment system, and our defense system.
sensory integration system
Influenced by conception, birth trauma, premature birth
Trauma, generational trauma
Sensitivity (genetics)
If we are sensitive, the vagal system gets overloaded, overwhelmed and starts to shut down. We then go into sympathetic or dorsal states which do not give support for effective ingestion, digestion, and elimination.
If this system is impacted, it impacts our early reflexes, resulting in sensory processing issues. This can then influence our attachment system (and visa versa). For eating disorders, we need to gently feed the senses to support ventral vagal engagement by resourcing the sensory integration system to help manage all of the information coming in. We may see restrictive eating as a tool to not feel the overload (sensory avoidant). We may see binge eating as strategy to feel something (sensory seeking). Both these responses are accommodations to regulate challenging sensory information coming in.
From this perspective, we can see how eating disorder behaviours are actually pointing us to where there is dysregulation and a window into where we are not fully embodied.
attachment system
How we relate to food corresponds to our relational dynamics.
How we move through the world - seeking connection or disconnection - relates to our attachment system.
We have basic developmental movement patterns (yield, push, reach, grasp, and pull) that have either been allowed to be fully expressed or truncated through our early attachment providers.
For example, the ability to yield, that is, to rest, to just be, to allow the support to meet our body, to lean in and receive correlates to the type of attachment and nurturance we were given as babies. Yielding is crucial for ingestion. Knowing how to yield means we also know when to stop, and to not feel the need to have to jump straight into the next thing. Yielding means we know when to take in food, to allow for the whole swallow, to finish our food, to know when enough food is enough, and when to take in food again.
Being able to yield comes with the beliefs that “I am enough", “there is enough for me”, “I belong in the world”. When yield is not embodied it comes with the beliefs of not being enough, results in perfectionist pursuits, overeating, not eating at all, unaware of how much weight one is loosing, or not being able to stop exercising.
From a treatment perspective, “yield” means something unique to the dietician, bodyworker, and therapist and thus everyone is working together through their own respective fields of how to bring the client into a deeper ability to yield. Each member of the recovery team can address it as an integrated approach.
defense system
If we have not been able to complete a defense action, our nervous system is dysregulated which does not support normative eating. Digestion cannot occur when we are stuck in a dysregulated state. Trauma is thus something that fundamentally impacts us on a foundational level. Trauma truncates our attachment system that brings us into connection, keeping us separate and stuck in a hyper or hyporarousal state.
polyvagal theory
ERED forefronts Polyvagal Theory and the window of tolerance. The vagus nerve and its functional relationship with digestion is impacted by birth trauma and attachment deficits. When we have a robust window of tolerance, we can identity hunger, our fullness, our physiological and emotional state, able to connect with others, and move between sympathetic and parasympathetic with awareness and ease. When the window is disrupted and smaller, we have to make accommodations and strategies to regulate. Eating disorders are behaviours to try be in this window of optimal arousal. This is what we call a “faux window”. As such, this regulation is an illusion.
The eating disorder are simply behavours showing us where and how we are dysregulated, the state of one’s ventral vagal, the state of relationships and physiology.
With this in mind, can we allow the body to have the space to speak? Can I speak from my body?
Let’s train the nervous system to do what it did not get to do in the early years of life. Let’s practice neuroception, what it means to feel safe , physiologically and neurobiologically. Let’s practice somatic scaffolding. Let’s examine attachment, defensive, regulatory, and co-regulatory capacities of the whole family and acknowledge the impact that our society and culture has on our sense of feeling safe.
I am excited to share more of what I am learning from the training and look forward to bring more of somatic-based approaches to eating disorder recovery.
Have in any thoughts or questions? Feel free to reach out.
With gratitude,
Francesca