This chapter presents a case study of a sensorimotor psychotherapy (SP) approach to eating disorder (ED) treatment. In contrast to traditional psychotherapeutic approaches, such as cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), and acceptance and commitment therapy (ACT), that lean heavily on the impact of thoughts on emotional experiences and somatic patterns, also known as top-down processing, SP also uses bottom-up processing, the effect that one’s somatic organization has on affect and affect regulation, cognitive functioning and specific beliefs about self and other. The very core of SP is four foundational principles that cultivate therapeutic presence and guide both content and quality of interventions: organicity, nonviolence, unity, body/mind/spirit holism. SP understands human experience through the lens of five core organizers: thoughts, emotions, and three somatic organizers. SP explores actions as a cycle with four stages: clarity, effectiveness, satisfaction, and relaxation.

This chapter focuses on an interpersonal/relational psychodynamic approach to working with eating disorders (EDs), which illuminates the links between symptom and meaning, action and words, isolation and relatedness. The work of any treatment of EDs is an ongoing, complicated mixture of direct intervention with the symptom and exploration of what the intervention means to the patient, including the role the symptom plays in the patient’s intrapsychic and interpersonal world. Understanding this as it unfolds relationally allows the intersubjective experience of both patient and therapist to collide, mingle, and ultimately coexist. Thinking about working with patients with EDs from this vantage point means that the experience of conflict is a therapeutic gain, not obstacle. Multiplicity and the capacity for dissociation are seen as part of the manifestations of what happens with patients with EDs.

This chapter deals with structural dissociation in the treatment of trauma and eating disorders. Dissociation is the inability to stay present when intolerable feelings and mental contents are activated. It is a way of making the overwhelming less overwhelming. A dissociative process is an unconscious attempt to sequester the intolerable away into the recesses of the mind, never to be contacted again. The chapter uses structural dissociation theory of the personality. Structural dissociation theory distinguishes two action systems that govern human behavior. The first action system is daily life and second action system is defense. The theory defines three levels of dissociation, primary dissociation, secondary dissociation, tertiary dissociation. Treating dissociation is a phase-oriented approach. The first phase is stabilization and preparation for trauma reprocessing. This is where the dissociation is treated. The second phase is reprocessing the painful memories. The third phase is full consolidation and integration.

Eating disorders (EDs) may be among the most self-destructive and persistent behaviors that emerge in the aftermath of trauma. Researchers are becoming curious about the role of the body, and, in particular, the nervous system, as it relates to ED symptoms and the management of dysregulated affect states. This chapter highlights the psychobiological processes that somatic experiencing (SE) is built upon with regard to working with trauma, with specific considerations for its application when working with the ED population. A natural starting point for understanding the intersection between trauma and EDs involves a brief overview of the effects of trauma on the nervous system. SE treatment goals are accomplished not only by listening to the client’s narrative but also by closely watching the body’s expression of the nervous system to slow the process down and explore the various elements of an experience.

This chapter discusses art therapy: images of recovery. Art therapy is a mental health profession that provides an alternative means of communication and often can be the treatment of choice for clients processing recovery from traumatic events, as well as eating disorders (EDs). Through the art making process, a visual dialogue between the client and the art images is created. The client’s self-talk and internal messages can be documented in an imagistic form. Art therapists are extensively trained to assist the client in creative expression and in facilitation of the client’s self-exploration. Using art therapy with EDs is a unique therapeutic approach that exposes conflicts, problems, thoughts, and behaviors that are not simply about food or a number on the scale. ED patients have extreme fear of being negatively evaluated. The art therapist works toward eliminating those fears by giving the clients creative control over their selfexpression.

This chapter explores the neurological link between trauma and eating disorders (EDs) by describing one of humans’ basic functions: response to stressors. Adverse life events interact with the genome and developmental processes, leading to biological changes that predispose one to a broad range of psychiatric problems, including EDs. The mechanisms involved include abnormalities in the stress response, changes in appetite, altered reward sensitivity, and increased sensitivity to rejection. Specific genes increase one’s susceptibility to stressful experiences, and stressful experiences have the ability to alter one’s genes (i.e., epigenetics). Epigenetics refers to the way in which environmental exposures have the capacity to influence the genome in a way that affects later gene expression. Findings from epigenetic research and neural-based interventions offer evidence against the long-standing understanding of genes and neurocircuitry as “rigid” structures.

This chapter explores parts or ego states somewhere in the middle of the two that are invested in one or the other form of eating disorder (ED). “Ego state” and “part” are used interchangeably in this chapter. The chapter provides a short neurological explanation of ego states, their purpose, and the difference between dysfunctional and dissociated ego states. It provides an overview of various traditions of parts, which, although not exhaustive, can uncover the common and universal characteristics of ego state work. EDs are very difficult to treat in that they demand attention on so many levels: psychological, emotional, physical, behavioral. The authors believe that it is the reality of dissociation that makes this work all the more difficult, a reality that demands an invitation to all parts of our client to come together and collaborate in the service of healing.

This chapter discusses what happens in the aftermath of trauma, abuse, and disordered eating. This aftermath includes connection to illness as identity and disconnection from sense of self, spiritual identity, higher power, and significant others. Furthermore, there is disconnection from spirituality, passion, purpose, meaning in life, internalized principles, dreams, and deepest desires. We have also provided a few of the many interventions that we have found valuable in reducing suffering and helping clients to reclaim their identity. It focuses our attention on the processes of assessment and therapeutic intervention, and, by so doing, directly addresses the building and nurturing of self. The chapter attempts to describe the journey from ED and trauma identity to knowing, strengthening, valuing, honoring, and sharing self. It is through this that an individual is able to withdraw trust and faith in illness as a way of dealing with life.

Hypnosis relates to when a person’s behavior shows he or she is in a trance like frame of mind, dissociated from his or her usual conscious awareness. Hypnosis challenges the polarization between the different aims of behavioral and analytical therapy. The reports of many of the patient shows the real source of their distress, and sometimes seem to make the problem worse. This has been eloquently expressed by a young doctor, a survivor of childhood anorexia. “When you live with anorexia, you fight your own thoughts and fears, your own self, every second of every minute of the day. Recognizing this spontaneous hypnosis or trance state as a clinical sign involves a different level of listening skills, a modified approach to history taking and to all the advice given. The focus of therapy is turned from the past to the future from regression to progression.