How eating disorders are experienced in the brain & body
Eating disorders, including anorexia nervosa, bulimia nervosa, and binge-eating disorder, involve complex interactions between psychological, biological, and social factors. These disorders are associated with distinct changes in the brain’s structure, function, and neurochemistry. Understanding these changes helps illuminate the mindset and lived experience of individuals with eating disorders.
Understanding the brain and mindset of individuals with eating disorders involves recognizing the complex interplay between biological, psychological, and social factors. The changes in brain structure and function, coupled with cognitive distortions and emotional challenges, create a unique and often distressing lived experience. Comprehensive treatment approaches, including medical, nutritional, and psychological interventions, are essential for addressing both the physical and psychological aspects of these disorders.
That’s why it’s our mission to help children and families become mindful of bodily sensations. This awareness helps reduce the intensity of high emotional arousal significantly!
It is body awareness that helps these children become mindful, better behaved and more in control of their inner and outer worlds.
Eating Disorders: Changes in the Brain:
Structural Differences
Brain Volume: Individuals with anorexia nervosa often exhibit reduced brain volume, particularly in areas like the gray matter. This reduction can affect regions involved in cognition and emotional regulation. With treatment and weight restoration, some of these changes can be reversible.
White Matter Integrity: White matter, which facilitates communication between different brain regions, may also be altered in those with eating disorders, potentially impacting how efficiently different parts of the brain communicate
Gray Matter and White Matter: Variations in the density and distribution of gray matter and white matter has also been observed. These differences can affect how brain regions communicate with each other.
Functional Differences
Reward Processing: The brain’s reward system, particularly areas involving dopamine pathways such as the ventral striatum, can function differently. Individuals with eating disorders might derive different levels of satisfaction or reward from food compared to those without these conditions.
Executive Function and Self-Regulation: Regions like the prefrontal cortex, responsible for decision-making, impulse control, and self-regulation, often show altered activity. This can contribute to the rigid thinking patterns and difficulties in controlling eating behaviors seen in eating disorders.
Body Image Processing: The parietal lobe, involved in processing body image and spatial orientation, may exhibit atypical activity. This can lead to distorted body image perceptions commonly seen in individuals with eating disorders.
Chemical Differences
Serotonin and Dopamine: Imbalances in serotonin and dopamine, neurotransmitters crucial for mood regulation and reward processing, are often observed. These imbalances can affect mood, anxiety levels, and the reward response to food and eating behaviors.
Eating Disorders: Changes in the Body:
The nervous system of a person with ADHD has fundamental differences that impact how the body experiences the world. These varying impacts can affect the automatic reactions a person has to bodily sensations, new experiences, rejection, frustration as well as the body’s automatic fight-or-flight responses.
Nervous System Differences
Autonomic Nervous System (ANS) Imbalance: The autonomic nervous system, which regulates involuntary bodily functions, often shows dysregulation in individuals with eating disorders. There can be an imbalance between the sympathetic nervous system (responsible for the fight-or-flight response) and the parasympathetic nervous system (responsible for rest and digestion).
Neurotransmitter Imbalances: Serotonin and dopamine levels, crucial for mood regulation and reward processing, are often imbalanced. These neurotransmitter issues can affect emotional stability and the ability to experience pleasure from food.
HPA Axis Dysfunction: The hypothalamic-pituitary-adrenal (HPA) axis, which controls the stress response, can be dysregulated. This dysfunction can result in an exaggerated stress response and altered cortisol levels, impacting overall stress management and energy metabolism.
Differences in Body Sensations and Experiences: Understanding their Mindset
Cognitive Distortions: Individuals with eating disorders often have pervasive cognitive distortions related to food, body weight, and self-worth. These might include obsessive thoughts about food, extreme fear of weight gain, and a distorted perception of body size and shape.
Perfectionism and Control: Many people with eating disorders exhibit high levels of perfectionism and a need for control. These traits can manifest in strict dietary rules, obsessive exercise routines, and an intense drive for thinness.
Emotional Regulation: Eating behaviors can serve as coping mechanisms for managing negative emotions, stress, and anxiety. Restrictive eating, binge eating, or purging can provide a temporary sense of control or relief from emotional distress.
Lived Experience
Altered Interoception: Interoception, the ability to sense internal body states (e.g., hunger, fullness, pain), is often impaired in individuals with eating disorders. This can lead to difficulties in recognizing and responding appropriately to hunger and satiety cues.
Heightened Sensitivity to Bodily Sensations: Many people with eating disorders report heightened sensitivity to physical sensations. This heightened awareness can contribute to discomfort with normal bodily functions, such as digestion and the physical sensations of eating.
Chronic Pain and Discomfort: Due to malnutrition and the physical strain of behaviors such as purging or excessive exercise, individuals with eating disorders often experience chronic pain, gastrointestinal issues, and overall physical discomfort.
Temperature Regulation: Malnutrition and low body fat can lead to impaired temperature regulation. Individuals with anorexia nervosa, in particular, often feel cold even in warm environments due to decreased metabolic rate and loss of insulating body fat.
Fight-or-Flight Responses: Eating Disorders
Exaggerated Stress Response: Individuals with eating disorders often have an exaggerated fight-or-flight response. This heightened reactivity can result in increased anxiety and panic in response to stressors, including those related to food and body image.
Emotional Dysregulation: The heightened stress response contributes to difficulties in regulating emotions. This can result in intense emotional reactions, mood swings, and increased anxiety or depression.
Avoidance and Compulsive Behaviors: The fight-or-flight response can drive avoidance behaviors related to food and eating situations. Compulsive behaviors such as binge eating, purging, or excessive exercise can serve as maladaptive coping mechanisms to manage stress and anxiety.
Increased Cortisol Levels: Chronic stress and HPA axis dysfunction can lead to elevated cortisol levels, contributing to muscle breakdown, bone loss, and further stress on the body’s systems.
Living with a Eating Disorder
Daily Challenges: The dysregulated nervous system can make daily activities challenging. Constant preoccupation with food, body image, and physical discomfort can interfere with work, school, and social interactions.
Emotional and Physical Exhaustion: The chronic activation of the stress response can lead to emotional and physical exhaustion. Individuals may feel constantly on edge, fatigued, and unable to relax.
Coping Mechanisms: Individuals often develop specific coping mechanisms to manage their heightened stress response. These can include avoidance of food-related situations, rigid control over eating habits, and engagement in behaviors like purging or excessive exercise to reduce anxiety.
Therapeutic Interventions: Effective treatment for eating disorders often includes approaches that address both the psychological and physiological aspects of the disorder. Cognitive-behavioral therapy (CBT), dialectical behavior therapy (DBT), somatic yoga and other therapeutic interventions can help individuals develop healthier coping strategies and improve emotional regulation.
Supporting children with Eating Disorders:
At the core of somatic therapy for eating disorders is the importance of mind-body connection. There also is a need to acknowledge the role of trauma in eating disorders that includes the patient’s body in the therapeutic process. It then follows that recovering from an eating disorder would entail not only traditional approaches such as talk therapy (also called cognitive or top-down modalities) but also somatic therapy (which is considered a body-based or bottom-up modality).
Contrary to popular belief, eating disorders are not merely about food and weight.
Patients with eating disorders (ED) are not simply obsessed with their appearance. Instead, their condition is complex and multifactorial, often stemming from various stressors accumulated over many years.
Treating an eating disorder effectively is more intricate than most realize. It involves addressing aspects that even patients may not recognize as relevant, such as past trauma. According to the National Eating Disorders Association, approximately 20 million women and 10 million men in the United States will suffer from an eating disorder at some point in their lives. The Mayo Clinic highlights that individuals with eating disorders are at risk for complications like growth and development issues, anxiety, depression, relationship problems, school or work difficulties, substance use disorders, suicidal thoughts, and even loss of life.
Somatic therapy was developed to address eating disorders caused or complicated by trauma, aiming to prevent or reverse such complications.
Somatic Psychotherapy
Somatic psychotherapy, or somatic therapy, is a holistic and multidimensional approach to treating ED patients, focusing on overcoming trauma to promote healing from disordered eating patterns. Named Somatic Experiencing (SE) therapy by psychologist Dr. Peter Levine, somatic therapy is a short-term, naturalistic method. Dr. Levine observed that wild animals do not develop post-traumatic stress disorder (PTSD) or neurotic behaviors despite their harsh environments, unlike humans who can be traumatized for years by a single event. Dr. Levine collaborated with NASA to help astronauts manage stress and trauma.
When a person experiences a distressing event, their normal coping mechanisms can become overwhelmed, leading to improper or incomplete processing of memories and related stimuli. This results in constant reminders of the traumatic event and its associated emotions, as if the experience is being replayed in their brain.
A traumatic event for one person may be an ordinary experience for another. Trauma can occur if an event is too much, too soon, or too quickly for a person’s nervous system to handle. The inability to cope with traumatic thoughts and emotions can lead to psychological conditions, including eating disorders.
The Role of Somatic Therapy
“Soma” is the Greek word for “living body.” In somatic therapy, the patient’s body is crucial to recovering from an eating disorder. Somatic therapy enhances sensitivity to and release of physiological responses—such as physical tension and nervous system arousal—stemming from unresolved traumas. It aims to address the root cause of these symptoms by encouraging self-protective motor responses and releasing survival energy trapped in the patient’s body.
Body Based Therapies to try:
Somatic Yoga:
Physically, yoga can be tailored to support digestion, relieve constipation and reduce reactivity around the painful process of refeeding. Emotionally, yoga supports a connection with internal resources so that feelings, needs and longings are grounded. With a design that first “opens” the body through stretching and ends with relaxation, stressful thought patterns that perpetuate eating disorders can often fade (at least temporarily). Sometimes, emotions that have burdened us for years are able to be released during or after a yoga practice.
For some, yoga might feel confrontational. We are asking people to sit in direct experience with their body and breath. For those living with eating disorders, this simple process can feel extremely uncomfortable. For so long, these individuals have experienced turmoil and disconnect between body and mind. For this reason this connection has been altogether avoided.
Research has shown the following benefits without negative affect on weight:
- a significant decrease in depression, anxiety and body image disturbance [1]
- lower negative affect before meal times [2]
- Increased use of coping skills and self soothing, feeling of calm, awareness of internal cues and negative self talk, and positive body image [3]
One study compared traditional therapy to traditional therapy combined with yoga. Eating Disorder Examination (EDE) scores decreased over time in the yoga group, whereas the group without yoga showed initial decline but then returned to baseline EDE scores by week 12.
Body Movement Dance Therapy:
Dance Movement Therapy is a helpful way of allowing individuals that struggle with verbal processing or communication to process using the physical.
Individuals can then connect their physical experience with metaphors to their daily life, struggles, and eating disorder beliefs and behaviors.
These sessions can focus on numerous emotional, physical, social, and psychological processes and might involve themes of learning to be present with the body, engaging in mindful and slow movement, coping with symptoms of depression, anxiety, or PTSD using movement, processing psychological experiences through movement metaphors, communicating using the body, or building a more empowered relationship to the body through movement, to name a few.
Dance Movement Therapy is incredibly beneficial for those with eating disorders for many reasons. As the ADTA specifies, “DMT provides a way to safely become more aware of feelings that arise from the body’s sensations, and teaches people with eating disorders how to listen to their body’s needs [1].”
Additionally,the focus on relationships and connection with others in DMT “helps the individual risk connecting to others in supported, honest and meaningful ways [1].” Finally, the ADTA specifies that “DMT helps people understand how their feelings are given form through their actions, and empowers them to take risks. Healing cannot fully take place unless they are able to challenge themselves to live in their bodies, a central component of their body image. DMT provides a structure so that this can occur [1].”
Helping Children with ED
Extra Support for Families Dealing With Eating Disorders
CREATE uses a family first approach that focuses on building connection between parent and child. We combine that with a body centered framework that aims to build a child’s capability to identify, sit with and process strong feelings.
Contact us to work with our therapist if you are interested in addressing your child’s specific needs with our approach. We offer one-on-one therapy, homework and school support, and activities focused on improving family connection. We even have staff certified in Somatic Yoga for eating disorders, trauma, cancer and more!