By Paula Scatoloni, LCSW, CEDS, SEP
Understanding the Connection Between Eating, Attachment, and Trauma
One of the first things I tell my clients is, “eating disorders are about food and they are not about food.” This usually gets their attention. Next, I explain that eating disorder behaviors inform us about two things: First, our relationship to ourselves (our capacity to self-regulate), and second, the behaviors inform us about our relationship with people (our capacity to co-regulate). Today, thanks to emerging research from pioneers such as Dr. Stephen Porges and Dr. Allan Schore we know that self-regulation and co-regulation are inextricably linked. Schore’s Regulation Theory and Porges Polyvagal Theory both demonstrate that infants come into this world with a limited capacity to regulate their nervous systems, emotions, sleep, etc. and it is primarily through the dyadic interaction with caregivers that the neural platform for co-regulation and, later, self-regulation are put into place.
Food (suckling) is one of the first ways that humans learn to regulate as infants. The act of eating uses the same neural platform as the social engagement system – our neurobiological system that supports the ability to bond and seek out relationships for support (Porges, 2012). The field of eating disorders has mainly referred to behaviors such as binge eating, exercise, or purging as “compensatory” behaviors, or attempts to regulate emotions when other methods fail. But a more nuanced view of the disorders invites us to move away from focusing on symptom reduction to consider the ways that the symptoms reflect the relational struggle that most individuals with eating disorders encounter. These interpersonal difficulties are often concurrent and precede the development of the diagnosis (i.e. difficulty reaching out for support, taking in needs, and digesting relational connection).
Similarly, the field of trauma is providing a new paradigm for us to understand eating disorder behavior through the defensive systems. The defensive system involves our biological impulse to protect and defend through fight, flight, or freeze. Individuals with disordered eating can be “stuck” in their defensive systems due to an early trauma or pervasive trauma that is reflected in the eating disorder behavior. Consider the following: individuals who experience stuck flight energy will present with anxiety, panic, obsessive thoughts, food rituals, binge eating, or excessive exercise. Individuals struggling to express fight energy manifests it through purging, chewing and spitting, anger turned on the body, and self-harm behaviors. The freeze response involves a sense of disembodiment (dissociation, numbing), inability to track fullness or hunger, inability to engage in relationships, and depressed mood. Often individuals who struggle with disordered eating manifest all of the above, shifting from one nervous system state to the other on any given day.
Understanding eating disorders through the attachment and defensive systems involves a paradigm shift away from traditional cognitive models of treatment that are designed to intervene at the level of the prefrontal cortex (the thinking brain). This part of the brain is usually “offline” when a person is experiencing high states of emotional arousal or shutdown. Current body-oriented models of treatment that incorporate the body, the very place where the war is being waged are the missing link to treating this pervasive, and at times, life-threatening disorder. Incorporating the body through modalities such as Somatic Experiencing™, Sensorimotor Psychotherapy™ and related methods provides pre-cortical interventions to support areas of the brain that are responsible for attachment and basic nervous system regulation. A somatic-based approach to eating disorder treatment recognizes the connection between eating, attachment, and trauma and works to cultivate the biological and relational structures that support the ability to regulate emotions, connect with other humans, and ultimately thrive in the world.
Paula Scatoloni, LCSW, CEDS, SEP is a Somatic Experiencing™ Practitioner, an eating disorder specialist, and the creator of EASE™ (Eating, Attachment, and Somatic Education), a professional workshop for health and mental health practitioners. She is also the co-founder of Embodied Recovery, a professional training program in Durham NC. The training program offers courses on the Embodied Recovery approach for individuals, groups, and treatment centers. The curriculum is designed for somatically trained providers with limited background in eating disorders and for eating disorder professionals who wish to gain awareness in the basic principles of somatic therapy.