Eating disorders are disorders of the brain, mind and body. Eating
disorder pathology is reflected in the loss of the nervous system’s capacity to
integrate mind, brain and body, impairing the integrity and function of the
core self. Negatively impacting one’s relationship with the self, eating
disorders give rise to distortions in self-sensing and self-perception, and the
diminishment of self-regulation and self-trust. By re-defining the development
of the self as an “embodied, sensory-based process grounded in kinesthetic
experience,” 21st century brain research and technology have
substantively expanded the breadth and scope of clinical ED practice.
Incorporating mindful somatosensory-based neurophysiological and
psychophysiological treatment interventions as adjuncts to traditional ‘best
practice’ treatment techniques facilitates mind-brain-body connections,
fostering self-integration, self-regulation and emotional resiliency, all
components of a complete and sustainable ED recovery. Though research points to
the centrality of the neuroplastic brain’s role in effective ED treatment and
recovery, the introduction of bottom up and top down neurophysiological
somatosensory-based treatment interventions into the mainstream clinical milieu
has, to date, been rarely applied. The future of eating disorder treatment lies
in the partnership between the brain and distributed nervous system, as well as
the therapist and patient. Approaches to
care that stimulate intra- and inter-personal neuronal connectivity enable the
brain’s capacity to heal itself and the patient, and the patient’s capacity to
heal one’s self through integrating the brain and distributed nervous system.
Keywords: Clinical eating disorders, Neurophysiological interventions,
Psychophysiological interventions, Somatosensory interventions,
Self-integration, Mind-brain-body connections, Embodied brain
Abbreviations: ED: Eating Disorder(s); BBAT: Basic Body Awareness Therapy; PTSD:
Post Traumatic Stress Disorder
THE ROLE OF THE BRAIN IN EATING DISORDER PATHOGENESIS
It has been said that “the days of differentiating
psychology versus biology versus neurology are fading” . Eating disorders
(ED) are disorders of the brain. Though their symptoms manifest in behaviors
that impair physiological function, “neurobiological vulnerability makes a
substantial contribution to the pathogenesis of anorexia nervosa and bulimia
nervosa” . Disrupting the integrity of the patient’s core self, the wiring
of the eating disordered brain creates impairment in self-sensing,
self-perception, and the self-regulation of thoughts, emotions and behaviors.
“Anorexic body image distortions suggest “abnormalities of circuits through the
postulated ‘self’ networks” [3,4]. Because diagnoses of anorexia nervosa,
bulimia nervosa and binge eating disorder are “defined by aberrations in brain
circuitry and physiology, treatment needs to be aimed at correcting or
ameliorating aberrant circuitry” . The focus of clinical treatment needs to
address healing the disordered brain, along with the patient…healing the self,
along with one’s relationship with food.
REINTEGRATE THE FRAGMENTED CORE SELF
“The domain of the
Self seems to be where psychology crosses path with brains and bodies” .
Mind, brain and body connectivity is an objective reality,
with no valid integrative fabric, with no one single element separated from any
other . In further
refining this definition, the field of interpersonal neurobiology has
conceptualized the Self as “an embodied sensory-based process grounded in
kinesthetic experience” , thus
expanding the breadth and scope of treatments that promote self-healing through
marked by the lack of integration between mind, brain and body, a condition
negatively impacting the integrity of the core self” . The introduction of
mindful, somatosensory-based neurophysiological and psychophysiological
treatment interventions as
adjuncts to traditional ‘best practice’ ED treatment strategies carves new neuronal pathways that create activity in neurons that fire and wire
together within and between domains that harbor the functions of ED pathology.
By enhancing sensory awareness
and sensory integration, these interventions foster mind-brain-body connections
which promote self-integration and self-regulation, cultivating emotional
resiliency; all are components of a complete ED recovery.
“The somatosensory system is a 3-neuron system that relays
sensations detected in the periphery and conveys them via pathways through the
spinal cord, brainstem, and thalamic relay nuclei to the sensory cortex in the
parietal lobe” . “All
experience encompassing thought, sensation, feeling and behavior [movement], be
it conscious or unconscious, is embedded in neurons” . “Where attention goes, neural firing occurs,
catalyzing the integration of isolated segments of one’s mental reality” . “Somatosensory-based movement with attention has been called the
‘specificity scalpel into the brain to re-carve neuro-circuits” . “Motor mobilization
precedes the consciousness of feelings” .
Examples of kinesthetic ‘bottom up’
neurophysiological somatosensory interventions include the Feldenkrais Method
of Somatic Education™ , which
allows patients to consciously reconnect with their unconscious sensorimotor
repertoire; and trauma-informed yoga , which accesses traumatic memories that are encoded
sub-cortically . Experience
and action affect the brain from ‘the outside in,’ (bottom up); thought, imagination
and feelings affect the brain from ‘inside out’ (top down .
Of particular relevance to ED patients with post-traumatic stress
disorder (PTSD), bottom up neurophysiological interventions have been proven
effective in addressing “the repetitive, unbidden, physical sensations,
movement inhibitions and somatosensory intrusions of unresolved trauma” . Empathic resonance, a
potent psychophysiological treatment tool, represents a mindful, interpersonal
psychotherapeutic right-brain to right-brain hemispheric connection between
psychotherapist and patient which gives rise to “a therapy relationship so
deeply ensconced in psychophysiology as to be considered sharing a common brain” .
THE CURRENT STATE OF THE
Eating Disorders are integrative disorders that impact the mind, brain and body. Their onset is brought about by an integration of factors that
potentially include genetics, neurobiology, physiology, nutrition, cognitive
function, behavior, attachment dysfunctions, mood disorders, emotional
development, and past trauma. Treatment requirements for comprehensive, diverse and integrative
approaches to ED care that facilitate mind, brain and body connections demand uniquely specialized treatment
protocols that lie beyond the purview of generic psychotherapy practice. The
unique requirements of ED care have not yet been universally recognized
and accepted by professionals in the field of mental health treatment. Minimally referenced in ED research and treatment
literature, integrative neurophysiological somatosensory-based treatment
strategies are rarely applied within
the ED clinical milieu. Effective ED treatment needs to spotlight the
significant role of the neuroplastic brain within a healing three-pronged
partnership with the patient and therapist.
The fulfillment of the intention to change
habitual behaviors requires changes in the body and the nervous system, as well
as the mind. In conjunction with more traditional forms of ‘best practice’ ED
treatment, the introduction of in-session, neurophysiological movement-based
and/or breath-related techniques (be it in
chairs, standing upright or on floor mats) promotes body-centered
self-awareness, self-sensing, and self-regulation, facilitating the patient’s
self-integration, self-trust and
autonomous self-care, all hallmarks of timely and sustainable ED recovery. Enhancing the process, clinicians who
provide psychoeducation for patients and families by ‘talking the talk’ about
the role of neurobiology in disease onset, development, and healing, clarify
how and why a complete and sustainable recovery needs to take place
within the distributed nervous system. Cognition and movement, in
conjunction with experiential sensory-based self-awareness, augments the
patient’s incentive and capacity to heal, while giving rise to feelings of
empowerment and global well-being.
Within the context of a mindful, safe and
trusting psychotherapeutic relationship between therapist and patient, the ED
clinician’s versatile and ever-flexible use of oneself within the therapeutic
moment requires mindful
sensibility, courageous spontaneity and personal and professional comfortability in introducing interventions that harness the global resourcefulness of the patient’s brain
domains otherwise passed over through the sole reliance on more
traditional forms of treatment. The treating professional’s own personal
engagement in various forms of somatosensory interventions offers invaluable
sensory-based self-awareness, creating and informing professional insight and
intuition into when, with whom, and how best, to introduce relevant, practicable, healing neurophysiological interventions into the unique therapeutic moment in response
to the unique needs of the patient.
At the start of the 21st century, the
advent of brain tracking technology began to shed significant light on how
people make changes in psychotherapy. “The lack of knowledge about the
pathogenesis of clinical eating disorders in the brain and nervous system
hinders the development of effective treatment” . The future of treatment for ED and body image
disturbances lies in the use of alternative, nontraditional approaches to care (i.e., adjunctive
somatosensory-based, neurophysiological and psychophysiological interventions)
that harness genetics and neuroscience in the service of more effective healing
and prevention. The inclusion of adjunctive
neurophysiological interventions in front-line clinical practice brings the
neuroplastic brain on line, providing novel opportunities for growth and
learning, inspiring motivation
and confidence in one’s capacity to change. Integrative forms of treatment that
stimulate intra- and inter-personal neuronal connectivity facilitate the
brain’s capacity to heal itself and the patient, and the patient’s capacity to
heal one’s self through integrating the brain and the distributed
Recent scientific evidence suggests a shift towards more targeted
brain-based interventions , as seen in a 2019 study of an innovative
psychomotor physiotherapeutic technique (Basic Body Awareness Therapy - BBAT)
that addresses one’s relationship to one’s body, demonstrating an increase in body
acceptance and well-being . Additional
research suggests that “global health could benefit from safe effective
evidence-based breathing techniques and related mind-body practices integrated
into healthcare systems and other community services through training
healthcare providers, yoga therapists, school personnel, first responders and
those who work in non-profits and non-governmental organizations” . There is significant room for improvement in
ED treatment efficacy. Bridging the research/practice gap that currently exists
within the ED field promises to define new directions for quantitative research, as
well as clinical practice.
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