How Relational Somatic Practices Can Help with Eating, Food, Exercise and Body Image Struggles

I came upon the following questions recently from a fellow therapist, and it occurred to me that when one person notices or questions something, many others do too. Here’s a Q&A on how relational somatic practices can help with eating, food, exercise and body image struggles.

Question: I work with people who come to me with developmental trauma. Whether they are aware of the trauma or not, they’re aware of compulsive patterns or behaviors from disordered eating to chronic anxiety. I have noticed a lot of them do not recognize their hunger cues. They are very disconnected from their bodies. How do you understand this and work with helping them to reconnect with their body in a healthy way?

Helping people to sustainably reconnect to their body and food/eating/body image is my specialty as a psychotherapist and trauma-informed embodiment coach. I use an attachment-based, polyvagal-informed, trauma-sensitive framework, which basically means I integrate healthy relational support, nervous system science and trauma response/care into my work with clients.

Attachment-based somatic practices for body-brain nourishment: In addition to listening to people stories, fears, wishes and places where they feel stuck, I use attachment-based co-regulation practices to help expand a person’s ability to attune to their belly hunger as well as their figurative deeper hungers. These developmentally-informed Chi for Two early relational life practices are not prescriptive but process-based and invited into the therapeutic work as developmental and relational areas craving support that show up as unsustainable coping mechanisms or rituals, expressions of insight or feeling, gestures, movement patterns, vocal patterning, body language and body awareness, to name a few.

While cognitive approaches can be valuable when keeping each unique person in mind, when we explore how to support one’s hunger for connection and/or lack thereof from a body-based, relational approach, over time we have a greater capacity to help feed one’s hungers, possibilities for connection and sustainable nourishment. Integrating bottom-up or somatic relational therapeutic practices of how the body influences the mind along with a mindful approach to cognitive approaches can help birth an Embodied Cognition and greater capacity for Social Engagement System functioning (commonly known as regulated nervous system functioning).

Polyvagal-informed approach for reconnecting with hunger cues: Based on Porges’ polyvagal theory, when we are operating in Social Engagement System functioning, the autonomic nervous system senses safety along with the ability to connect with ourself and others in a way that feels steady and present, hence the name “social engagement.” This state of regulation and ability to connect with self and others is also experienced in our physiology with access to interoceptive cues of hunger, fullness, an urge to play/move/work and rest. Instead of using eating/food/dieting/exercise behaviors to temporarily numb or unsustainably soothe, Social Engagement System functioning senses relational and environmental cues of safety and connection that allow our body to eat, digest, move and rest in a more physiologically sustainable, intuitive and playful way.

Trauma-informed approach for processing not pathologizing: In order to restore that Social Engagement System functioning so someone doesn’t have to work so hard to maintain disordered eating and exercise, relational support is key. As studies show the importance of the therapeutic relationship for healing, science also shows us the value of using a trauma-informed approach using concepts such as presence and establishing safety, offering choice to develop agency, taking baby steps, and staying curious about matching and mismatching patterns (see below).

Question: Many of my clients who have disordered eating also struggle with chronic depression, and I often feel it’s deeper and a suppressed need and wonder how to address or support it in a way that supports them not only developmentally for healing but also productively and explicitly for meaning and generativity.

Normalizing mismatch to reduce shame and blame: First, I want to expand on my last comment about the importance of a trauma-informed approach appreciating not only the “matching” patterns of relationship but also the “mismatching” patterns that are 70% of our love relationships. These mismatch patterns are often overlooked and undervalued in many of our cultural and therapeutic systems. Still Face Paradigm researcher Edward Tronick and pediatrician Claudia Gold MD published a book in 2020 called The Power of Discord highlighting the “messiness of mismatch” as a path toward deepening relationships. Understandably, without experience of how to understand and appreciate mismatching patterns in relationships, encountering mismatch can cause distress and possibly repeats multi-generational trauma patterning causing dysfunctional cycles to be passed down.

*Therefore, as related to eating disorders treatment, this is not about direct mother-blaming but looking at the systemic, cultural, social and multigenerational aspects of trauma that is passed down the line. Additionally, this helps to shine light on the possibility of healing relational wounds and re-patterning the generational family dances by incorporating healthier family, caregiver and social support.

Becoming curious about inhibited movement/expression as depression: When mismatch arises and connection wanes, our sense of safety and security could be threatened. Developmentally, when this has happened multiple times in various settings, one’s nervous system response might lean toward dissociation and/or depression. Since we can’t maintain the cocktail of chemicals that keeps us in fight/flight for survival, we eventually succumb to a passive response of depression that closes off parts of us that could be used for meaning and generativity. The multiple ruptures and a lack of celebration of mismatch (and particularly early development patterns that initiate separation) often present as inhibited movement/expression (a cutting off of hunger recognition and fulfillment in both soma and psyche). This shutdown, or depression that can also show up as food/exercise coping, is also commonly pathologized versus invited with curiosity from a developmental and relational perspective.

Recognizing inhibited movement as a path toward deeper hungers: When one’s deeper hungers and expression of self can be slowly welcomed and celebrated—no matter how small or “big”—using a relational and embodied approach, there is a greater capacity for nervous system re-patterning and eventual self regulation (and feeding of deeper hungers). This is where early relational co-regulation practices can be invited and processed to help slowly birth the movements/expressions that have been shut down. Instead of a fixed state of depression or another disorder, one can literally move into their body-mind for meaning-making and fulfillment rather than away from their body and life.

Developmental practices as symbolic nourishment and healthy embodiment: You will often see push/pull or deprivation/binge dynamics in people with disordered eating/exercise (along with chronic depression/anxiety) as well as themes of emptiness and fear of being “too much.” These developmental needs for connection and separation with unconditional love are ideally supported within a secure attachment relationship throughout childhood. When things don’t go so well in these developmental years, food/body wars and other compulsive or maladaptive coping behaviors can present as an attempt for nourishment instead of gaining sustenance through supportive relationships and an eventual robust sense of self. When we helpers can offer specific early relational co-regulation practices based on developmental patterns and stages to help re-pattern nervous system functioning, we can help to shift a person’s Reach for coping mechanisms to a Reach for healthy relational connection with self, others and life itself.

M-Bodied Therapy and Coaching uses specific early relational co-regulation practices based on a multi-generational trauma healing method called Chi for Two®—The Energetic Dance of Healthy Relationship. Visit us here to read more about Chi for Two’s development and synthesis and professional trainings.