Body-Based Conceptualization of Eating Disorders
Eating behavior through the lens of fear and safety
Our autonomic nervous system (ANS) is best described as our “personal surveillance system.” It’s always determining and responding to the question, Am I safe? The polyvagal theory, coined the “science of feeling safe,” was developed by Dr. Stephen Porges, internationally-renowned trauma researcher and neuroscientist. The vagus nerve is an information superhighway in our body connecting our face, heart, and breathing to our gut. It informs our ANS when there is danger to mobilize protective measures and puts on the brakes when we are safe and all systems are “clear to go.” It can also signal the ANS to shut the system down in the case of a super threat, which makes sense considering the behavioral expressions of hyperarousal and hypoarousal in response to fear. This theory has informed many therapists to see their client symptom behaviors through a lens of threat and safety, responding with body-based interventions as primary to the healing process.
As a certified eating disorder specialist who uses body-based conceptualization and polyvagal-informed therapies, I now see eating disorder symptoms more clearly and compassionately. I understand my clients are simply attempting to feel better, find safety, or avoid danger. In fact, conceptualizing many behaviors as a body decision rather than a cognitive process allows for more compassion and less “blame the victim” countertransference. Unfortunately, most of us either miss the symptoms or see the symptoms as a willful act. I did for years, until I was trained to look more closely.
Let’s take a closer look at the body-based conceptualization of eating disorders.
To start, I want to examine some common eating disorder symptoms and see how they may be explained through the lens of fear and safety.
Avoidant Restrictive Food Intake Disorder (ARFID)
Otherwise known as “picky eating,” ARFID may be the most obvious example. In nature, certain tastes, smells, and textures are interpreted by the brain as dangerous. Bitter and sour tastes, for instance, are meant to warn the brain that something may be rotten, spoiled, or poisonous. Many of these aversive tastes are acquired by cultures and not natural, such as the taste of bitter coffee or sour kimchi. Some individuals have a heightened alert system (ANS) and simply don’t feel safe eating certain foods. Some have an exaggerated gag reflex and are afraid they will unintentionally vomit. One category of ARFID is based entirely on the fear of adverse consequences. All these responses interrupt a normal eating process and, over time, create physical and social consequences.
Some eating disorder symptoms revolve around a heightened interoception, especially as related to the gut or enteric nervous system. Interoception is generally referred to as “the perception of internal body states.” These individuals may feel nausea or bloated or may find the act of digestion intolerable. Coupled with a dorsal vagal (below the diaphragm) fear response, they may feel full and lack hunger even though they are starving.
One theory is that those with Anorexia may in fact be instinctively afraid to eat because their body is telling them it is too dangerous. This messaging may be a throwback to the hunting and gathering days where staying in the cave is a safer option than seeking food when predators are lurking.
Other individuals have a dulled sense of interoception, meaning they can’t read internal signs, such as hunger or fullness, pain, or even the felt experience of emotion. These are individuals who’s eating disorders contribute to a more dissociative process, such as binge eating and purging. Dissociation is a protective response to fear and trauma.
Additionally, some body perceptions are aggravated by tactile sensitivities, such as certain fabrics, tight waist bands, or tags inside clothing. Everything feels tight, leading them to believe that they are fat or large in addition to feelings of feeling bloated. This leads to further restriction when combined with distorted body image.
Auditory and light sensitivities including Misophonia, signal the ANS to danger, which prompts a reaction to isolate and protect. Becoming overwhelmed can lead to “meltdowns” and tantrums. When individuals are asked too many questions and support providers try to help, it can further agitate these individuals and social connections begin to break down. Symptoms of social anxiety and problems with interpersonal relationships are common themes in those with eating disorders.
Anxiety is a hallmark symptom in eating disorders. In fact, many times the anxiety precedes the eating disorder symptoms, especially in the case of obsessive-compulsive disorder (OCD) or post-traumatic stress disorder (PTSD). Anxiety is a fear response of the body. Our brain often creates bizarre narratives to make sense of the body’s defensive responses. That’s why anxiety and eating disorders seem so irrational.
But it didn’t start as a cognitive process; it started with the body. The bodies fear responses are expressed in inattention, impulsivity, and pushing others away. The use of food (restriction or bingeing) are strategies to calm the body, to put the brakes on the fear, and signal safety in the body. In other words, they activate the vagal response (the vagus nerve signals the heart to slow down). Some bodies don’t have good brakes, and their vagus nerve is slow to respond. They are born that way or a trauma response has rewired their system (Fool me once, not going to be fooled again).
The way I see it, it starts and stops with the vagus nerve.
It doesn’t mean that we don’t have to deal with the cognitive distortions or revisit the interpersonal damage; it just means we must start with the body. If the body doesn’t feel safe, our clients aren’t going to have the cognitive capacity to take in the cognitive strategies or feel safe enough to connect interpersonally. So, we need strategies to tone the vagus nerve to be more responsive. Quite literally, we need neural exercises.
There are several “portals” to the vagus nerve that can help. The ear is one such portal.
The Safe and Sound Protocol (SSP) is a listening therapy that acts as an acoustic vagal nerve stimulator.
It teaches our nervous system to feel safe and calm through a bottom-up process of training the vagus nerve. Dr. Porges has developed this therapy based on the polyvagal theory and has proven its effectiveness with decades of research. Not surprisingly, the first population researched using this therapy were the neurodivergent. It has spread to those with PTSD, ADHD, and chronic pain and has demonstrated effectiveness with those needing help with anxiety reduction and emotional regulation.
I have started developing case studies for those with eating disorders. The SSP is a five-hour auditory intervention designed to reduce stress while promoting calm and resilience through a more regulated nervous system. It’s a non-invasive intervention that can complement or accelerate other forms of therapy. Providers who use this therapy have found accelerated results when added to their other therapeutic process. Other nervous system regulating activities are through sensory mindfulness, vocalizations, breath work, and targeted movements using pressure and other sensations on the neck, joints, and skin.
My book, Food, Body and Love, but the greatest of these is love, explains the connection between the vagus nerve and eating disorders. It provides therapeutic and lifestyle-based interventions for helping individuals live with less fear and shift their vagal responses toward an experience of safety and connection.
Visit my website to learn more about my counseling, consulting, and coaching services as well as my current courses.
Porges & Dana (2018) Clinical Applications of The Polyvagal Theory. The Emergence of Polyvagal-Informed Therapies. Norton. New York.