Reclaiming the Lost Self in the Treatment of Bulimia Nervosa: A Neurobiological Approach to Recovery That Integrates Mind, Brain, and Body

Abstract

The pathology of bulimia nervosa reflects the 'dis-integration' of the structure of the self within the distributed nervous system, resulting in the patient's impaired sense of self and incapacity to sense self-experience. The twenty-first century definition of self as 'an embodied, sensory-based process grounded in kinesthetic experience' not only refutes the long-held myth of mind-body dualism, but also sheds light on the influence of neurobiological factors in disease onset and on how people make recovery changes within psychotherapy. The capacity to create, or reinstate, self-integration is built into the nervous system through the neuroplastic brain's ability to change its structure and function in response to thought, sensation, feeling, and motor activity. The introduction of neurophysiological (sensorimotor) and neurobiological (interpersonal, attachment-based) interventions into mainstream clinical treatment for bulimia nervosa increases exposure to embodied experience, fostering mind, brain, and body connectivity. By stimulating integrative neuronal firing and synaptic activity, top-down and bottom-up transactions enhance acuity in self-sensing, self-perception, and body image coherence, supporting the unification of the disparate self. The current focus of mainstream clinical eating disorder treatment on symptom reduction alone neglects the neurological underpinnings of the disease. This chapter describes a range of treatment options for bulimia nervosa designed to support sustainable changes at the brain level.Anorexia and Bulimia Nervosa 2 disconnection. Scientists propose that somatic, autonomic, and visceral information is aberrantly processed in people who are vulnerable to developing AN and/or BN [2]. Engaging the distributed nervous system in the treatment of BN through adjunctive interventions that combine top-down and bottom-up neurophysiological mechanisms, and/or through the psychobiological attachment bond of emotional communication and interactive regulation between the patient and therapist, heals neurobiological aberrations at their source by accessing the roots of these disorders, which are embedded in neurobiological dysfunction. By capturing images of the neuroplastic brain as it changes in real time, modern brain-scanning technology reveals that harnessing body-based movement and sensory experience in conjunction with psychotherapy facilitates the neurological convergence of the mind, brain, and body, which fosters the integration of the structure of the healthy self. The current focus of mainstream conventional BN treatment, however, is on the psychological and environmental origins of the disorder, neglecting the neurological underpinnings of disease. Scientific evidence points to the need to expand the parameters of the treatment field to promote the neurobiological reintegration of the recovering bulimic patient's healthy self through treatment modalities that sustain changes at the brain level. Recruiting brain circuitry enhances and promotes the integration of the nervous syste...

Discretion or Disorder? The Impact of Weight Management Issues on the Diagnosis and Treatment of Disordered Eating and Clinical Eating Disorders

“…The introduction of neurophysiological (sensorimotor) and neurobiological (interpersonal, attachment-based) treatment interventions into mainstream clinical treatment for ED increases exposure to mindful embodied movement experience, fostering mind, brain, and body connectivity. By stimulating integrative neuronal firing and synaptic activity, these "top-down" and "bottom-up" transactions enhance acuity in selfsensing, self-perception, and body image coherence, supporting the unification of the disparate self [38].…”

“…Psychosomatic expressions of traumatic experience are held as bodily sensations. ED heal in the same way as trauma heals, through the neurophysiological and neurobiological reintegration of the distributed nervous system, marking the return of the patient's reintegrated core self [38]. Because traumatic memories are encoded subcortically, the process of healing ED that originate in trauma requires accessing, and gaining leverage within, the structural coding of the brain and nervous system.…”

“…Neurophysiological effects of past trauma that are revealed in the present become accessible and available for remediation [38]. Trauma resolution lies in creating a psychophysiological state associated with decreased adrenergic activity, decreased muscular neuromuscular arousal, and cognitive quieting [39].…”