Eating Disorders are Early Developmental Trauma
By Kathleen Love, LMFT, LPC, SEP
I am trapped in this body.
No one really hears me.
No one really sees me.
Everyone thinks they know how to fix me.
Everyone thinks they know what is wrong with me.
They don’t know.
I don’t know.
I am still trapped.
Every moment, of almost everyday, is a nightmare.
I can’t bear this anymore.
Shifting from a place of darkness and contracted survival to a place of breath, brightness, and love. How do I shift someone to this place? A place where one can hear compassionate and empathetic thoughts toward themselves, a place where they can sense safety in their gut, and a place where their heart can soften, come forward and open with love for themself and others. Why do some people struggling with eating disorders get stuck in darkness and never seem to fully recover? Why do some spend years, perhaps even decades trapped behind the eating disorder? We all have seen these people- maybe they were a patient, a friend, or family member. Maybe some of us, have even been these people. No one, absolutely no one, deserves to be trapped and alone behind an eating disorder with no hope of finding a way out.
Deep in my bones I have known for quite some time that something was still missing in the treatment of eating disorders, especially for the population of people that seem to struggle for countless years. Clinicians in the field of eating disorders are some of the most determined and compassionate people I have ever known. Many are recovered themselves and decided to pursue a life to support the recovery of others. These clinicians have discovered countless effective interventions for supporting healthy eating, working with body image, and changing distorted belief systems, to name a few. These clinicians have had great success and many people have recovered from eating disorders. In this article, I am targeting those who spend countless years trapped behind the eating disorder and do not seem to recover.
Research seems to indicate that between 30-40% of those who are diagnosed with eating disorders do not fully recover. It appears from my work that a common link between people in this group, seems to be that the body is not in congruence with the thinking brain- that the new thoughts and beliefs learned in treatment are not in congruence with the body. One can have the thought that they are not fat and are beautiful for who they are, but if the gut is reporting a constant state of fear to the brain, healing can only go so deep. This didn’t surprise me when I learned that about 80% of the neuron pathways between the gut and brain, travel from the gut to the brain. This understanding led me to take a closer look at the body. It was my hope that learning more about the body’s contribution to the eating disorder, that a missing piece in treatment might be discovered. A piece that would help put an end to countless years of therapy for many.
I was drawn repeatedly to somatic work and what happens to the body when trauma occurs. I dove deep into this work and took countless trainings over numerous years. And then a lightbulb went on after I learned about developmental trauma. Developmental trauma seems to be a rupture or trauma that occurred typically before the age of 3 and is ongoing rather than a single event. Developmental trauma appears to lead to gut issues, migraines, exaggerated fear responses, autoimmune diseases, obsessive/compulsive behaviors and insecure attachments. Developmental trauma also seems to hinder the normal sequential development of the brain leaving people more in the reptilian or the fight, flight, freeze part of the brain. Perhaps the most important learning, was understanding how developmental trauma profoundly impacts the nervous system. Developmental trauma appears to inhibit the ability for one to settle and calm into what is called the low-tone parasympathetic branch of the nervous system. Or, more simply said, the rest and digest branch of the nervous system. This means the neuron pathway for calming and down-regulation does not exist- true rest and digest, is never experienced for those with developmental trauma. The only way for someone with developmental trauma to “calm” is for their system to go into a numb, dissociative-like state (the high-tone parasympathetic branch of the nervous system). Porges calls this state a high cost of doing business because in this state, digestion, rest, and normal bodily functions are extremely compromised. Over time this inability to calm into low-tone parasympathetic can lead people to finding and using what are called defensive mechanisms. These mechanisms appear to be used as an attempt to offset the chronic states of anxiety or disconnection. Examples of such defense mechanisms include eating disorders.
So, this seems important, developmental trauma is associated with insecure attachments and eating disorders. Could a possible gap in treatment include addressing the impact of developmental trauma? Could including work targeted at repairing and healing the effects of developmental trauma and insecure attachments support the healing of a greater number of people? I believe so.
I was out for a walk about a month ago during the Covid pandemic on a hill in East Bay San Francisco. Looking down, I could see green rolling hills and dense pockets of oak trees scattered here and there. As I started down a concrete path, a crack in the path grabbed my attention. Growing out of the cracked path was a thriving green weed with a beautiful yellow-gold flower. The flower was like sunshine popping through the Covid black clouds. I thought, there is always the possibility of healing and growth. Even though the seed of this flower was deep beneath a thick piece of concrete, it had all it needed within itself to grow and develop into something beautiful. All it needed was to sense the unconditional warmth of the sunshine on the other side of the concrete.
As I walked back home, it occurred to me that this flower reminded me of what I have learned over the years about how secure and insecure attachments are formed. In secure attachments the baby, who is dependent on the caretaker’s nervous system for calming, can sense warmth and compassion from the caretaker. In secure attachments the caretaker has a neuron pathway for calming and downregulation that settles the baby anytime it gets distressed. And, when a prolonged, consistent sense of safety and calm, and soothing exists, the self is allowed to come forward and bloom.
With insecure attachments, the baby does not settle when distressed because the caretaker does not have a neuron pathway for down-regulation and calming (most likely because of their own trauma history). Therefore, when the baby gets upset, the only way for the baby to “settle” is to go into a numb, freeze-like state. If we look at the above story, imagine that the sun’s energy radiated fear instead of warmth and light? One can imagine that a flower seed in this relationship dynamic may stay trapped behind the concrete, or if it did find a way out, it would most likely be small, fragile and struggle to fully bloom to its potential.
If developmental trauma appears to lead to insecure attachments and defensive mechanisms like eating disorders, how can we modify or supplement existing treatment to account for a developmental trauma component? How can we as clinicians in this field, be the soothing, consistent sunshine that radiates warmth and light to repair the attachment?
To answer this question, I looked to some of the best in this field including Stephen Porges, Bruce Perry, Allan Schore, Stephen Terrell. All these amazing researchers, teachers, healers and authors agree that the trauma is in the body. And, since the trauma is early, when access to the left brain is not fully developed, a right brain to right brain approach is necessary. A right brain approach includes somatic (touch, intentional touch), non-verbal, and intuitive interventions. It also appears that a closer look at primitive reflex integration needs to be addressed. Primitive reflexes need to integrate before age 1 or they can add activation to the system. Unintegrated primitive reflexes have been correlated with eating disorders (specifically Fear Paralysis Reflex). Lastly, since attachment occurs in-utero and during the first few years of life, it appears that repair needs to be targeted at this time period.
Going forward, I believe looking at eating disorders through a developmental trauma lens, may expand upon some existing beliefs about eating disorder symptoms and bring some new considerations to the table. Here are a few:
Severe Restricting: In a highly activated state, the viscera organs function at less than optimal levels and messages about food/hunger are almost non-existent. With regulation on-board the body is able to access the part of the nervous system for rest and digest (low-tone parasympathetic branch of the nervous system.)
Binge Eating: Is binge eating an attempt to feel the gut? An attempt to access the rest and digest part of the nervous system?
Binging and Purging: Could binging and purging be an “effective” defense mechanism because it results in a reduction in hyper-arousal and decreased pain sensitivity? Many clients report that the resulting “numbing” sensation can be effective to give a sense of calm.
Inability to feel inside the body: Could there be too much activation to go inside? That the somatic systems of the body are signaling “all is not well”.
Osteoporosis: When the body is in a state of high arousal, high cortisol levels can also exist. Chronic, high cortisol levels deplete bones. This can also be seen in people with chronic high arousal who do not have eating disorders.
Body Image: Is there a possibility that body image issues may not necessarily always be an external battle of physical looks? Rather, could this also be an internal battle with a part or parts of the body that are highly activated? Trauma seems to compartmentalize in our bodies and result in a highly activated areas or dissociated areas.
Excessive Exercise: What if behaviors were not necessarily about losing or managing weight? What if exercise was an attempt to move out of freeze or a numb state? What if exercise was a learned way of trying to feel something, to feel alive?
The treatment of eating disorders has come so far. Addressing the developmental trauma component of an eating disorder appears to be an important consideration that holds potential for even deeper healing and may be a key to supporting the healing for those that existing treatment approaches are not enough. Utilizing somatic interventions targeted at the first years of life can support the development of a neuron pathway for regulation and movement toward secure attachment. As one moves toward secure attachment, the gut softens out of constant fear, the heart opens with love for self and others, the thoughts begin to transition from judgement, distortion and shame to compassion, empathy and understanding of self and others. Defensive mechanisms like eating disorders are no longer needed. New healthy relationships begin to form and support the next stage of growth. The ability to experience the world from a new lens of breath, brightness and love is within reach.
Please join me in learning more about this huge opportunity to support deeper and greater healing from eating disorders. In a follow-up article, I will be sharing some specific somatic, non-verbal interventions targeted at healing developmental trauma and insecure attachments. I will also be sharing an innovative treatment protocol that takes our existing learnings and adding developmental trauma work.
We are on this journey together to support healing. Here are some ways to learn more, experience an early developmental somatic approach, or simply to ask a question.
Wonder is the beginning of Wisdom Socrates
About the author:
Kathleen Love is a Licensed Professional Counselor, Marriage and Family Therapist, and Somatic Practitioner. Her training includes a masters degree in Counseling Psychology, completion of an extensive 3- year Somatic Experiencing Trauma training, completion of over 1000 hours of Touch Trainings and Somatic Resilience and Regulation trainings for early developmental and attachment trauma and Bruce Perry’s Neurosequential Model of Treatment. She has logged over 11,000 hours of somatic trauma sessions.
She has studied(s) studies with Stephen Terrell (Expert in Early Developmental Trauma), Peter Levine (founder of Somatic Experiencing), Kathy Kain (Researcher and Expert on Early Developmental Trauma), Bruce Perry (Neurosequential Model of Treatment).
She is a member of AED, (Acadamy of Eating Disorders), APPPAH (Assoc of Prenatal, Perinatal Psychology and Heath), Somatic Experiencing Trauma Institute, and participates in special interest groups on somatic interventions, neuropsychology, and trauma.
She has 2 amazing children, whom are a result of my own healing journey and whom continue to challenge and inspire her on a daily basis to learn more about the healing from developmental trauma.
Kain, Kathy and Terrell, Stephen. 2018. Nurturing Resilience: Helping Clients Move Forward from Developmental Trauma-An Integrative Somatic Approach. North Atlantic Books.
Perry, B. D. 2018. Neurosequential Model of Treatment On-line Clinical Program.
Porges, S. W. 2011a. The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, and Self-Regulation. New York: W. W. Norton.
Schore, A. 2019. Right Brain to Right Brain Psychotherapy. WW Norton and Company.
Wisdom from life experiences.