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 defi-nition of self as ‘an embodied, sensory-based process grounded in kinesthetic expe-rience’ 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 unifica-tion 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. differentiated, and ultimately re-integrated through her movement experiences she became more adept at differentiating and reintegrating her emotions as well, becoming calmer and increasingly regulated. Lana spoke of her Feldenkrais experience as “clearing out the cobwebs in my brain.” At the end of one Feldenkrais session, in response to my lifting her leg off the treatment table in order to assess her degree of neuro-skeletal integration, Lana described feeling a sense of “overwhelm-ing relief and gratitude” for the now seemingly apparent weightlessness in her leg, in contrast with her own self-perception. “This is the first time I can remember feeling good about living inside this body of mine”].