Fight-or-Flight: When the Surreal Becomes Real
By: Susan Kleinman, MA, BC-DMT, NCC, CEDS-S & Adrienne Ressler, LMSW, CEDS, F.iaedp 
I am mindful that the pandemic spawns not only serious physical illness but also fear and panic, and we need to be able to mitigate both. – Susan Ice, 2020
You don’t have to be a rocket scientist to understand there comes a time when you know what you don’t know is controlling your life focus. The traumatic fear related to the unknown may trigger and/or mirror eating disorder symptoms. A fight-or-flight response is the body’s physiological reaction that provides a choice of one of two options – either stay and fight or flee. (Cherry, K). A patient with an eating disorder, whose threshold for confusion or imagined danger is very low, may be overwhelmed with the chaos of their fight-or-flight responses. As these symptoms deepen and worsen, the patient’s regression activates a return to emotionally driven behaviors.
One patient, Erin, struggling with her recovery, recently wrote the following regarding her fight- flight responses:
I can totally relate with the urge to restrict due to feeling a huge sense of being out of control. The unknown of what is happening in our world is extremely scary and holding onto something familiar is very comforting – I feel a desperate need to get out of myself. To “run” from myself. Turning to the ED gives safety. It gives a “connection” to something familiar.
It is so difficult to be living in a world where human connection has needed to end. My team provides the only sense of safety I feel in my life. In a sense, that fear of losing human connection with my team, along with the fear of what is happening, makes everything feel worse.
Like Erin, most eating disorder patients experience the detachment of abandoning the body in order to diminish the power of the perceived threat. By using their eating disorder symptoms to provide themselves with an illusion of control, their connection with the body becomes compromised; all feelings are considered to be dangerous or unacceptable.
It is ironic that at this time of pandemic proportions, we find ourselves turning to Marie Curie, the famous Polish chemist and physician who, over 100 years ago, was known for opening the doors to the fight against various cruel diseases. A quote attributed to her, so relevant to the circumstances facing us today, reads, “Nothing in life is to be feared, it is only to be understood. Now is the time to understand more, so that we may fear less.” (Curie, M)
Our challenge then becomes attuning to and understanding our patients’ fears and concerns, making it safe enough for them to experience and explore all their feelings and thoughts. Utilizing our ability to tap into our own feelings as well as those of the patients in an embodied fashion, we can open doors to provide hope and understanding for what is possible. The answers lay in our ability to create, through the therapeutic relationship, the “heart” that inspires a rapport to flow between patient and clinician. (Ressler, Kleinman & Mott, 2010, pp. 404-425).
“When clinicians invite opportunities for creativity and spontaneity to emerge, authenticity, growth, and connection are maximized as clinicians’ own feelings can serve to help their patients move deeper into their own feelings. It should be clear that the separation of mind and body is a false dichotomy, for how can we not recognize the importance of the body in the work we do — the body freezes in fear, vibrates with life, slumps in defeat, trembles in anger, jumps for joy, and melts with love.” (Ressler & Kleinman, 2018).
About the authors:
Susan Kleinman, MA, BC-DMT, NCC, CEDS-S, a board certified Dance/Movement Therapist, National Certified Counselor and Certified Eating Disorder Specialist, is Creative Arts Therapy Supervisor and Dance/Movement Therapist for The Renfrew Center of Florida. Ms Kleinman is a trustee of the Marian Chace Foundation, Past President of the American Dance Therapy Association, and past Chair of The National Coalition for Creative Arts Therapies. She has published extensively, presented widely, and is the recipient of the American Dance Therapy Association’s 2013 Lifetime Achievement Award and the 2014 Spirit of iaedp award. Her work is featured in the documentary entitled Expressing Disorder: Journey to Recovery.
Adrienne Ressler, LMSW, CEDS, F.iaedp, is Vice President, Professional Development, The Renfrew Center Foundation, and has served as senior staff for more than 28 years. She attended the University of Michigan for both her Bachelor of Science and Master’s degrees and received a faculty appointment as a Lecturer in the School of Education. A body image specialist, Ms. Ressler’s trainings reflect her background in body-focused/somatic methods to treat eating disorders and body image. Fellow and past-President of the Board of Directors of the International Association of Eating Disorders Professionals (iaedp), she presently chairs iaedp’s Senior Advisory Council. Ms. Ressler is the Co-Founder and former Co-Chairperson of the Somatic and Somatically Oriented Therapies Special Interest Group of the Academy for Eating Disorders and an Advisory Board Member of the non-profit, Eating Disorder Recovery and Support in Petaluma, CA.
In 2016, she was selected as the inaugural recipient of Eating Disorder Hope’s Seal of Excellence award for her “empowering work as a body image specialist” and in 2013 was granted the “Hope” award by South Florida’s Gratitude for Giving annual recognition breakfast. Author of chapters on the use of experiential therapies for eating disorders in three textbooks, Effective Clinical Practice in the Treatment of Eating Disorders: The Heart of the Matter, Treatment of Eating of Eating Disorders: Bridging the Research-Practice Gap, and Embodiment & Eating Disorders: Theory, Research, Prevention and Treatment, her work has also been included in the first Encyclopedia of Body Image and Human Appearance. Ms. Ressler is published in Social Work Today and Pulse, the journal of the International Spa Association. A frequent contributor to the popular media, she has appeared on the TODAY show and Good Morning America Sunday.
References:
Cherry, K. How the Fight or Flight Response Works, Retrieved , April, 2020 from https://www.verywellmind.com/what-is-the-fight-or-flight-response
Curie, M. Retrieved, April, 2020 from https://www.goodreads.com/quotes/16738-nothing-in-life-is-to-be-feared-it-is-only
Ice, S..( March, 2020) Personal communication.
Ressler, A., Kleinman, S., & Mott, E. (2010). The use of holistic methods to integrate the Shattered self. In M. Maine, B. H. McGilley, & D. W. Bunnell (Eds.), Treatment of eating disorders: Bridging the research practice gap (pp. 404-425). London, UK: Academic Press.
Ressler, A. & Kleinman, S. (2018). H. Mc Bride & J.. Kwee.e (Eds). Bringing the Body Back into Body Image: Body Centered Perspectives on Eating Disorders. In Embodiment and Eating Disorders, Theory, Research, Prevention and Treatment ( pp. 328-341). New York, Routledge