214. The Trauma Behind the Eating Disorder Symptoms with Heather Ferguson, LCSW
In this episode, Heather Ferguson is back, and we're taking that conversation a whole lot deeper. We're talking about what happens when we slow down enough to pay attention to what's happening in the body, how trauma can show up when someone doesn't have the words to explain what they're experiencing, and why recognizing the connection between trauma and an eating disorder doesn't automatically tell us how to support someone through healing. Heather Ferguson, LCSW, is a psychoanalyst, faculty member, and supervisor at the Institute for the Psychoanalytic Study of Subjectivity and the National Institute for the Psychotherapies. As a certified hypnotherapist and EMDR practitioner, she incorporates embodied techniques into her psychoanalytic work. She writes about eating disorder treatment, the role of intergenerational trauma transmission, and how embodied techniques can deepen psychotherapeutic engagement. Heather is co-editing a forthcoming book with Susan Klebanoff entitled Revisiting Ferenczi's Unwelcome Child in Turbulent Times. She maintains a private practice in New York City. There's a lot packed into this conversation, and honestly, I could have kept asking questions for another hour. So grab your headphones and listen to the full episode. Quotes "So many of our patients are in that hypoarousal, more dissociated, collapsed state with disordered eating, particularly those that are really disordered and are maybe underfed, that their sort of neocortex is not online, that their thinking brain is not fed enough, and they are kind of shut down." - Heather Ferguson "I think helping patients learn the sequence of what happens; An emotion, a feeling state, a sensation and maybe their own protective defenses that may be the shutdown neurobiologists talk about the dorsal response, the collapse." - Heather Ferguson "And I should say that I also use my body as information." - Heather Ferguson "We have mirror neurons, right? We map empathically, and we often imagine and feel with our patients." - Heather Ferguson "EMDR is not magical; it's just intense." - Heather Ferguson "And I think to sort of indicate how it's ingenious, how there's so much shame, and you know this." - Heather Ferguson "Let's not forget. We don't have to always fix it." - Heather Ferguson "Everyone doesn't walk around with equal freedom and safety in their bodies." - Heather Ferguson "There's two versions of the stuckness. There's the person who stays in this almost intellectual place of, 'This is the body that I want. This is the body that I don't have.' And there's no amount of work or talking about it that's going to change that. Then there's a different version of stuck. They've identified their associations with poor body image. They understand how their history connects here, and then they're like, 'Okay, we've talked about it.' And they're still stuck." - Rachelle Heinemann Frequently Asked Questions 1. Can trauma cause an eating disorder? Trauma can be a significant risk factor for developing an eating disorder, although there isn't always a simple cause-and-effect relationship. Trauma can influence emotions, body image, self-esteem, and coping, and eating disorder behaviors may become a way of managing experiences that feel overwhelming. 2. What is the connection between trauma and eating disorders? Trauma and eating disorders can become closely intertwined. Eating disorder behaviors may temporarily help someone numb, avoid, control, or cope with difficult thoughts and feelings. Over time, those behaviors can become part of the cycle that keeps both the distress and the eating disorder going. 3. Can an eating disorder be a coping mechanism? Yes. Eating disorder behaviors can serve a purpose for someone, even when those behaviors are harmful. Restriction, bingeing, purging, or other behaviors may provide temporary relief from anxiety, difficult emotions, shame, or a sense of being out of control. Understanding what a behavior is doing for someone can be an important part of treatment. 4. How does trauma affect body image? Trauma can affect the way someone experiences and relates to their body. For some people, body dissatisfaction, shame, or attempts to change or control their body can become connected to difficult experiences. Body image can also be influenced by lots of other factors like social expectations and other lived experiences. 5. What is trauma-informed eating disorder treatment? Trauma-informed treatment considers a person's history and the ways trauma may influence their thoughts, emotions, behaviors, and relationship with their body. It means creating space for that history without assuming every eating disorder has the same origin or that every client needs the exact same treatment approach. 6. Can you treat trauma and an eating disorder at the same time? Yes, trauma and eating disorders can be addressed through an integrated treatment approach. The timing and approach matter, especially when someone is actively struggling with eating disorder behaviors or is medically compromised. Treatment needs to be mindful not to do trauma work before they're ready. 7. Why is body awareness important in eating disorder recovery? Learning to notice sensations, emotions, and physical responses can help someone better understand what is happening internally and how that connects with their behaviors. For some people, this creates a bridge between intellectually knowing something and actually experiencing it in their body, which can be an important part of the therapeutic process. Resources Be sure to sign up for my weekly newsletter! Brave on Purpose! - Grab my new book here! Grab my Journal Prompts Here! Looking for a speaker for an upcoming event? Let's chat! Now accepting new clients! Find out if we're a good fit! LEAVE A REVIEW + help someone who may need this podcast by sharing this episode. Be sure to sign up for my weekly newsletter here! 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