Eating disorder recovery is often described as a process rooted in challenging thoughts and changing behaviors. Clients might do this by eating the meal even when the eating disorder tells you not to. Challenging the negative body image thoughts. Sitting with the discomfort. Stop engaging in the behavior that is keeping the eating disorder alive. While these things can absolutely be part of recovery, there is often something bigger happening beneath the surface. 

Many people with eating disorders a dysregulated nervous system at some point in their recovery. When the nervous system perceives a threat (whether that threat is real or not) the body can shift into a state of survival. In that moment, asking someone to simply “think logically” or make the choice that goes against their eating disorder can feel a little like throwing oil onto a fire. If recovery were as simple as knowing what to do and then doing it, many people would have recovered a long time ago. 

What does the nervous system have to do with eating disorder recovery?

Recently, I’ve been reading The Body Keeps the Score. Not exactly a fun poolside book, but intriguing enough that I somehow forgot to reapply my sunscreen. 

One of the ideas that has continued to stick with me is the way our experiences can live not only in our thoughts and memories, but in our bodies. Our nervous systems are constantly taking in information from the world around us to make judgements about whether we are safe or unsafe. When we perceive danger, our bodies are designed to protect us. Our heart rate may increase, our breathing may change, our muscles may tense, and our thoughts may become more focused on escaping, avoiding, or controlling the situation. 

This survival response is incredibly useful when we are facing an actual threat. 

The challenge is that our nervous sytems do not always distinguish between actual danger and something that simply feels dangerous. For someone with an eating disorder, eating a fear food, experiencing fullness, changing their body, missing a workout, or losing access to a familiar coping mechanism may trigger a very real physiological stress response. 

How does the nervous system become dysregulated?

There are many reasons why someone’s nervous system may become dysregulated, and no two people’’s experiences look exactly the same. 

Trauma

Trauma can impact the way we experience safety in our bodies and in the world around us. It may be connected to a specific event, but it can also develop through repeated experiences of stress, instability, neglect, criticism, loss, or situations where a person felt powerless or unsafe. These experiences can be emotional, psychological, or physical.

Over time, the nervous sytem may become more sensitive to perceived threats. The body may become accustomed to being on high alert, making it difficult to fully relax even when there is no immediate danger. 

For some of my clients, their eating disorder behaviors develop as a way to cope with these overwhelming experiences. Food restriction, binge eating, compulsive exercise, avoidance of texture, body checking, or other behaviors may temporarily provide a sense of control, numbness, predictability, or relief. This does not mean that every eating disorder is caused by trauma. However, understanding each clients relationship with stress and safety can provide important context for understanding their recovery.

Chronic stress and maladaptive coping mechanisms

Trauma is not the only experience that can impact the nervous system. Chronic stress can also leave the body feeling as though it is constantly operating in survival mode. So many of us struggle with the weight of work demands, relationship stressors, perfectionism, and social expectations. When stress becomed overwhelming or constant, we naturally look for ways to cope. Sometimes those coping mechanisms are helpful. Sometimes they become maladaptive. 

An eating disorder may have originally developed because, at some point, it worked for the nervous system. 

Maybe restricting food became a temporary sense of control. Maybe exercise provided relief from anxiety. Maybe binge eating offered comfort or an emotional escape. Maybe focusing on changing the body provided something tangible to focus on when everything else felt uncertain. These are coping mechanisms that provide short-term relief, and as a provider, raise a red flag for disordered behaviors to be reinforced. 

How can you regulate your nervous system during eating disorder recovery?

Healing a dysregulated nervous system is not about reaching a permenant state of calm. We are supposed to experience stress and uncomfortable emotions. A regulated nervous system does not mean that you never feel anxious, angry, sad, or overwhelmed. Regulation is about developing the ability to move through these experiences without becoming completely consumed by them. In doing so, your body will recognize that discomfort does not always equal danger.

Recognize the coping mechanisms that contribute to the cycle

Eating disorder behaviors often serve a purpose, even when they are causing harm. Getting curious about that purpose can be an important part of recovery. Asking yourself questions such as: “What happens before the urge to (insert behavior)?”, “What emotion or physical sensations are present?”, “What does the behvior provide in the short term?” can help you understand the cycle.

Once you, and your treatment team, understand why the behavior is needed to cope, you can begin exploring other ways to meet that same need. The goal is not simply to take away a coping mechanism and leave someone with nothing. The goal is to build new tools while also addressing what made the old tools necessary in the first place. 

Explore healthier coping mechanisms

There is no universal nervous sytem regulation technique that works for everyone. Some people find grounding techniques helpful. Others may benefit from breathing exercises, journaling, connecting with other, spending time outside, or engaging in creative activities. 

For some individuals, a more somatic approach may also be helpful.

Somatic therapies focus on the connection between the mind and body and can involve becoming more aware of physical sensations and learning ways to respond to them. This might look like noticing tension in your body, feeling your feet on the ground, stretching, shaking out your arms, or simply pausing to observe what sensations are present without immediately trying to change them.

Build a trauma-informed treatment team

Working with providers who understand eating disorders and approach treatment through a trauma-informed lens can be particularly valuable. Trauma-informed care recognizes that an individual’s experiences impact their mental health and that healing is about more than reducing unwanted behaviors. This collaboration between a patient and their providers emphasizes safety, trust, and empowerment. 

As an eating disorder dietitian, part of my job is to listen and learn about you as my client — not just what you eat, but what your nervous system has been through and how it’s learned to protect itself. I bring a trauma-informed, lens to every session, which means I’m not just looking at meal plans and macros. I’m curious about the behaviors that developed to help you cope, and I hold space for the fact that healing isn’t linear or purely logical.

This might look like slowing down together to notice what a fear food brings up physically, not just mentally. It might mean building grounding tools you can use in the moment an urge shows up, rather than just talking about willpower. It often means collaborating with your therapist or treatment team so that your nervous system’s needs are part of the bigger picture, not an afterthought. Together we can explore nutrition in a way that supports nervous system regulation, without compromising your road to recovery.

If you’re struggling with an eating disorder or disordered eating, we can help! We’re a group of dietitians who take a non-diet, body-positive, identity-affirming approach to recovery and healing your relationship with food. Go here to learn more about nutrition counseling for kids, teenagers, and adults, in-network with most major insurance companies and offered virtually to clients in North Carolina and over a dozen other states.

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