Somatization and Dissociation in Eating Disorders

I was lucky enough to be a guest on the Understanding Disordered Eating Podcast to talk about eating disorder research! Check out the episode, What does the research really show on Spotify | Audible | Podchaser.

I was also lucky enough to get to interview the host, Rachelle, about her work in eating disorders, especially somatization, dissociation, and emotions. Read about it below:

Rachelle Heinemann is a licensed mental health counselor in New York who specializes in eating disorders (and also common comorbidities like depression, anxiety, and trauma). She is trained psychoanalytically and hosts the podcast Understanding Disordered Eating. She is also active in leadership and public speaking endeavors.

Rachelle has a number of goals for public speaking and podcasting. For one, she hopes to educate individuals about a variety of topics related to eating disorders (EDs), including the nuances of protective factors, how to work with clients with EDs, how to notice EDs sooner, and how to improve treatment. For the podcast in particular, the goal is to reach a wide audience to teach listeners tools to enhance therapy and/or start self-help on their own.

Uniquely, Rachelle is particularly interested in the role of emotions, somatization, and dissociation in eating disorder development and maintenance. Somatization is the physical manifestation of emotions or stress, often in symptoms or illness. Dissociation consists of feeling disconnected from one's body or reality.

Most diagnoses have a component of emotion dysregulation. Often, disconnection and somatization occur when emotions are so big and overwhelming that an individual cannot. Coping may be lacking when modeling of healthy emotion regulation did not occur in development.

These strategies protect us and keep us safe, especially in response to trauma. The problem is they can be damaging later on. For example, if a person grows up in an emotionally volatile environment, they may dissociate to protect themself from the chaos. Later in life, however, dissociation can be harmful or distressing. In terms of disordered eating, it can look like engaging in regular binges that feel numbing and dissociative.

If individuals therefore cannot feel the emotions, they cannot tap into them nor the information they are trying to provide. The first step is to create an environment where it is finally safe to feel the emotions. Then, one can focus on body sensations, and general emotions before more specific ones. Emotion wheels can be helpful as a "multiple choice" option when learning to put words to feelings.

Some things Rachelle wants clinicians to know include:

1. Treating EDs is nuanced, just as most things in therapy. Pay attention to what (and who!) is in front of you, even if you've learned what to do for a specific case. See what they need. First, get to know them and develop the relationship. Lean into intuition, but first nurture the relationship.

2. Whatever happens in the therapy room is not personal. The point of an effective alliance is to evoke transference (i.e. anger), which can be hard for therapists to handle. Get support as needed. Help patients learn that they're safe and that emotions are both safe and useful. Be curious about your clients’/patients’ way of interacting with you.

3. EDs are protective, or were at some point. They are developed and maintained via protective factors. But, keep in mind that while this is great for clinical conversation, it's also a wonderful way to intellectualize, so it isn't always helpful to start with this in therapy.

Want to know more? Interested in a therapy consult? Check out Rachelle's website and her podcast (links at the top).