EMDR for Eating Disorders

EMDR and Eating Disorders [close up of an eye]
Photo by Amanda Dalbjörn on Unsplash

By Runjhun Pandit, LPCC

EMDR….Sounds scary.

EMDR therapy, these acronyms make it sound like a scary treatment intervention. And oftentimes, when I mention this to my clients, they feel scared or confused. They do have questions about how it works and how it is different from hypnosis.

Eye Movement Desensitization and Reprocessing (EMDR) is a treatment specifically created to help people deal with a traumatic situation. It was initially developed for veterans who suffered flashbacks and nightmares upon return from war and were trying to readjust back to life with their families. Soldiers experienced reenactment of the wars in their dreams, emotional outbursts leading to frequent conflicts with their families, inability to maintain steady relationships, and dissociation from reality. EMDR hence was developed by Francine Shapiro, Ph.D. with the assumption that eye movements could assist in desensitizing to a traumatic situation. 

The limbic system in our brain is responsible for our behavioral and emotional responses while the brainstem and cortex are the areas that help in relaying the message from the spinal cord to the brain and store the verbal story of the events in our daily lives. When a person experiences a traumatic situation–like an accident or exposure to prolonged emotional distress like abuse or neglect– the usual coping mechanism that would help the person effectively “process” the situation, goes into overdrive. And the limbic system isolates this memory and stores it in the form of an emotional and physical sensation. Due to this isolation, the cerebral cortex doesn’t remember the “story” but the limbic system sends out an emotional response when some events in the present trigger some areas of the traumatic event. Hence, even if the memory is forgotten, the emotions attached to the memory– like pain, anxiety, or body sensations– continue to trigger the person in the present. This prevents a person from experiencing new situations or from living in the moment since oftentimes some parts of the present emotionally burden the limbic system. 

During EMDR sessions, the therapist creates a treatment plan and simulates eye movements similar to the ones that occur during REM sleep by asking the client to follow their fingers. Our brain has the natural capacity to heal itself. During the session, the therapist might also use a light bar to help you track the light across the visual field. These movements last for a minute and the therapist will ask you to report any experience–such as a change in emotions,, memories, or thoughts–after each set of eye movements. By repeating this process, the traumatic memory eventually loses its emotional charge and gets stored in the mind instead as a neutral memory. Frequently, people also have smaller memories associated with the actual traumatic memory which also may get resolved along the way. It has been noted that the “healing” of these smaller memories also creates a noticeable change in a person’s life. 

Although EMDR was developed for Post Traumatic Stress Disorder (PTSD), growing evidence shows that it may also be helpful for the resolution of panic attacks, anxiety, depression, eating disorders, and negative body image. EMDR helps clients process the traumatic memory and assimilate it in a healthier way without an emotional charge. Studies have shown that EMDR can be used in conjunction with Family-Based Treatment (FBT) or Cognitive-Behavioral Treatment (CBT) since these treatments focus on the here and now of the eating behavior while EMDR focuses on the past experiences around body image or food that maintain the disordered eating behaviors. Research has shown that EMDR generates a connection between body, emotions, and cognitions by allowing the elaboration of traumatic events and simultaneously resolving the emotional blocks attached to the traumatic memories. 

A complete EMDR treatment helps the person to “walk through” previously considered traumatic events with greater emotional and impulse control which eventually leads to an increase in feelings of self-worth and self-esteem. 

Runjhun Pandit, LPCC is available to see adolescents for EMDR via telehealth. EMDR can be helpful for food-related traumas and other traumas that might perpetuate eating disorder symptoms such as bullying, body shame, and other invalidating experiences.  To make an appointment with Runjhun Pandit, complete this form

Sources

Bloomgarden A, Calogero RM. A randomized experimental test of the efficacy of EMDR treatment on negative body image in eating disorder inpatients. Eating Disorders: The Journal of Treatment and Prevention. 2008; 16(5): 418–427.

Maria Zaccagnino, Cristina Civilotti, Martina Cussino, Chiara Callerame and Isabel Fernandez (February 1st 2017). EMDR in Anorexia Nervosa: From a Theoretical Framework to the Treatment Guidelines, Eating Disorders – A Paradigm of the Biopsychosocial Model of Illness, Ignacio Jauregui-Lobera, IntechOpen, DOI: 10.5772/65695. Available from: https://www.intechopen.com/books/eating-disorders-a-paradigm-of-the-biopsychosocial-model-of-illness/emdr-in-anorexia-nervosa-from-a-theoretical-framework-to-the-treatment-guidelines

Verardo A, Zaccagnino M, Lauretti G. Clinical applications in the context of attachment: the role of EMDR. Clinical applications in the context of attachment: the role of EMDR. Infanzia e Adolescenza. 2014; 13: 172–184

Veterans and Eating Disorders

eating disorders in veterans [image description: silhouettes of veterans in front of American flag with text that reads "Veterans Day: Honoring All Who Served"]by Elisha Carcieri, Ph.D.

I had the privilege of completing my training as a psychologist at the VA in Long Beach, CA. During this time I spent two years working with Veterans from all walks of life ranging in age from 20 to 90. Some had served in WWII, others in Vietnam, and still others in the more recent conflicts in Iraq and Afghanistan. I treated Veterans for PTSD, depression, anxiety, and insomnia. I provided support to Veterans as they navigated recovery from life-changing experiences such as spinal cord injuries, stroke, and vision loss. I advocated for Veterans who were coping with prolonged hospitalization and listened as some Veterans came to terms with the end of life.

Eating disorders are one of many significant mental health problems Veterans face and they often go overlooked. This is perhaps because eating disorders are typically thought of as a problem that occurs only among women (though the number of female Veterans is growing every day), or perhaps because of the myriad of other physical and mental health problems many Veterans are coping with. This is unfortunate given all we know about the seriousness of eating disorders and their associated health problems.

Eating disorders occur at least as commonly among Veterans as they do in the general population, with some studies suggesting slightly higher rates. Eating disorders occur in female and male Veterans. Unlike the general population, some studies show similar rates of eating disordered behaviors among active duty men and women. This may be related to required compliance with weight standards, measurements, and fitness assessments in the military.

Eating disorders appear to be especially common among those military personnel or Veterans who are also struggling with depression, PTSD, and substance use, each problem heightening the severity of the other. It is likely that some Veterans enter the military having already developed an eating disorder, while some Veterans experience significant stressors, especially combat exposure, that (along with a predisposition or vulnerability to developing an eating disorder) may serve to increase risk for developing an eating disorder.

Veterans face unique challenges in receiving care, particularly for a specialized problem like an eating disorder. Mental health stigma is common in the military, often interfering with active duty service members seeking help. Many are fearful that seeking help or disclosing mental health problems may somehow get back to their superiors, may make them appear weak or unfit, or may put their job in jeopardy. This stigma continues to affect Veterans following their service time with many going untreated, despite the availability of mental health care via VA or other resources such as vet centers and recent efforts of the VA and department of defense to destigmatize mental health care and increase utilization.

For those who do seek help, it may be difficult to find mental health providers who specialize in eating disorders within VA, which may affect the quality of treatment. Alternatively, Veterans may be referred to outside locations that do specialize in eating disorders but don’t have a good understanding of the unique experiences, challenges and stressors Veterans face, which can negatively impact attendance and compliance with treatment. Veterans may be more likely to present to primary care for physical problems related to an eating disorder, but are not likely to be asked about eating problems, and are not likely to disclose spontaneously. All considered, Veterans would benefit from regular screening for eating disorders in primary care and in mental health clinics, especially if they have been diagnosed with PTSD, depression, or substance abuse.

This Veteran’s day, I’ll bring to mind the Veterans I worked with, and I’ll reflect with gratitude on the sacrifices all Veterans have made. I am a better clinician and a better person because of my time at the VA. I continue to hope for reduced stigma and access to good, evidenced-based treatment for Veterans struggling with eating and other mental health disorders.

Veterans in crisis can call the Veterans Crisis Line 24/7 at 1-800-273-8255 (press 1) for confidential support. Confidential chat and a resource locator for mental health services are also available at veteranscrisisline.net

Dr. Carcieri is a staff psychologist at Eating Disorder Therapy LA.