How Marginalization Impacts Eating Disorder Recovery and the Autonomic Nervous System

By: Rachel Sellers, M.Ed., M.S.

Despite being portrayed in the media as disorders experienced only by white, cis, thin, able-bodied females, eating disorders impact all bodies. People that live in marginalized bodies face even more barriers and stressors when it comes to getting help. The term “marginalized bodies” refers to people who belong to a racial minority, as well as those who are trans, queer, disabled, fat, or old. These bodies have often been invisible to the eating disorder community and while this is beginning to be acknowledged, there is significant work left to do. 

 People with these identities often feel judged or invisible, which has led them to experience challenges and barriers. They often question whether they’ll be taken seriously, wondering whether they will be believed if they share about struggling with an eating disorder while not matching the ED stereotype. They question if they will have access to treatment and whether they’ll feel safe in therapy programs. They often don’t see themselves reflected in the therapy staff, among peers in treatment, and even within the body positive or body neutrality movement. It takes tremendous courage to seek treatment for an eating disorder and that is especially true for those who live in bodies that don’t reflect the idealized “norm.”

 The experience of being marginalized poses all sorts of barriers to treatment and recovery including one that isn’t typically named— a heightened amount of nervous system dysregulation. When someone who lives in a marginalized body seeks help, they often experience yet another trauma piled on top of the trauma they’ve already experienced from being marginalized in the first place. It is traumatic to have to question whether you will be taken seriously or not because of your body size, age, gender, race, or ability. It is traumatic to feel invisible because of a recovery community that has in many ways catered treatment to privileged bodies. 

 We often talk about how these experiences impact thoughts and emotions but what is talked about less is how the experience of being othered impacts the nervous system. So how do these experiences impact the body? More specifically, how does being underrepresented in the eating disorder community impact someone who wants to recover? The Polyvagal Theory shows us how. 

 The Polyvagal Theory, simply stated, describes how the autonomic nervous system functions and how the body responds to cues from the environment. When the body detects or senses safety, it shifts into a Ventral Vagal state. In this state, people are able to engage socially, and remain present, curious, grounded, and energized. The hallmark of this state is safe connection, connection with the self and connection with others. When the body detects or senses danger in any way, whether from being oppressed or chased by a bear in the woods, the nervous system shifts into a state of self-protection. First, the body will shift into a Sympathetic state, which is marked by the “fight or flight” response. If the threat cannot be resolved by moving towards or away from the threat, the body shifts into a Dorsal Vagal state. Here the body collapses and becomes immobilized, becoming frozen by fear. 

 Our bodies were biologically designed to move through these 3 states, and this oscillation between connection and protection is really important for survival. In a perfect world, we’d all have well-regulated and integrated nervous systems, nervous systems that could easily move from a state of self-protection back into a state of safety and connection after a threat has passed. 

 But we don’t live in a perfect world; we live in an unjust, unpredictable and overwhelming world and the trauma that we face has caused all of us, to varying degrees, to have frequently dysregulated nervous systems. Our nervous system becomes dysregulated when it senses there is a threat to ward off, whether the danger is real, imaged or from the past. When this happens, the nervous system gets stuck moving between the Sympathetic state and the Dorsal Vagal state. This might look like swinging between intense bouts of anxiety and depression, as anxiety is the hallmark emotion of the Sympathetic state and depression is indicative of a Dorsal Vagal state. Dysregulation can also look like having physiological and emotional reactions that are characteristic of the “fight, flight or freeze” responses despite being in a safe environment. This is because of unresolved trauma that is trapped inside the body.  

 Eating disorders, trauma and high levels of nervous system dysregulation all go hand in hand. In fact, eating disorder behaviors are often attempts to cope with traumatic stress as behaviors tend to provide a false (yet very real) sense of safety and comfort. In other words, eating disorder behaviors often serve as a way to achieve a sense of embodied safety and protection, which is what trauma ultimately robs a person of. People struggling with eating disorders have difficulty feeling safe in their body and regulating their bodily sensations and emotions, emotions that are connected to past or current traumas. This experience is amplified for those who belong to marginalized and oppressed groups, making the process of seeking out treatment and moving through recovery even more difficult. 

 According to the Polyvagal Theory, what regulates the nervous system are experiences of genuine connection, felt safety, and compassion. Research in neurobiology, attachment theory, and trauma—all of which undergird the Polyvagal Theory— reveal an important truth: eating disorder treatment that isn’t inclusive and that doesn’t take into consideration how experiences of oppression and marginalization impact the body can be incredibly damaging and lead to even more nervous system dysregulation, perpetuating even further a person’s eating disorder behaviors. Historically, eating disorder treatment hasn’t felt safe for many people with marginalized identities which not only creates a barrier for high quality care, but it also amplifies and intensifies eating disorder symptomology. 

Professionals who treat eating disorders need to have a basic understanding of how oppression and marginalization impact a person’s nervous system and they need to realize how important it is to offer safe spaces and relationships. Deb Dana, therapist, consultant, and Polyvagal expert refers to these safety cues as “glimmers”. Dana (2018) states, “Glimmers can help calm a nervous system in survival mode and bring a return of autonomic regulation” (p. 68). Common glimmers include things like talking with a trustworthy friend, walking, comforting scents, receiving a hug, nature, deep breathing and feeling the sun on your face. Glimmers are the good stuff, the experiences that offer a sense of connection to the greater world and to your own soul. 

Given the importance of cues of safety in regulating the nervous system, professionals need to consider how they’re offering these glimmers in both their relationships with patients and the spaces where these relationships exist. Someone who has experienced trauma, including the trauma of being marginalized from treatment spaces, has a greater threshold for feeling safe and this felt safety has to be there for a person to be successful in recovery. So, while things like soft, non-threatening eye contact, a prosodic tone of voice, and a genuine smile might seem like ‘small things’, according to the Polyvagal Theory, they are not. 

 An important question to ask and consider when we talk about the importance of embodied safety is how this can be done in a society and culture where very real threats exist for marginalized bodies. This is an important question. Perhaps you’ve heard it said that eating disorders and social justice issues are inseparable, and this question demonstrates why this is true. If we want to see all people in all bodies be able to recover from their eating disorder then we need to create a safer world, a world where all bodies are actually equal and receive the same quality of care. Until marginalized bodies are accepted, respected and embraced, and until systemic and cultural threats no longer exist for people in these bodies, we are going to continue to see people cling to whatever they can to make them feel safe, including their eating disorder. 

 Eating disorders impact every body, and nervous system dysregulation plays a significant role in the development and maintenance of eating disorders, especially for those with extensive trauma histories and with marginalized identities. We cannot underestimate the power of the word “safety” because it is felt safety that allows a person to shift from chronic self-protection towards embodied connection and ultimately, healing.  

 I think it’s important that the eating disorder community learn from people in the field who live in a marginalized body. It’s important that those of us who live in privileged bodies listen and learn from those with lived experience and our colleagues in the field. So, for that reason, I’ve created a list of amazing humans you can start to learn from. See below! 

·       Megan Jayne Crabbe: @bodyposipanda

·       Ashlee Bennett: @bodyimage_therapist

·       Whitney Trotter: @whitneytrotter.rd

·       Meg Boggs: @meg.boggs

·       Brianna M. Campos: @bodyimagewithbri

·       Sam Dylan Finch: @samdylanfinch

·       Dalina Soto: @your.latina.nutritionist

·       Lindo Bacon: @lindobacon

·       Rachel Millner: @drrachelmillner

·       Anna Sweeney: @dietitiananna

·       Kent Thomas: @kentthomasmsw

·       Mimi Cole: @the.lovely.becoming 

·       Ayana Habtemariam: @thetrillrd 

·       Alishia McCullough: @blackandembodied