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Nervous System Regulation: A Missing Piece in Eating Disorder Recovery

  • Writer: Caroline Young
    Caroline Young
  • Jul 16
  • 5 min read

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When I first began working as a dietitian in an eating disorder treatment center, I often heard patients described as "resistant," "stuck," or "non-compliant." Like many providers, I felt frustrated when clients seemed unable to follow their meal plans or kept slipping back into disordered behaviors—despite access to therapy, nutrition sessions, and support groups. Patients themselves were often confused too. They knew that eating enough and using coping tools would help—but something still made it feel impossible.

Everything clicked for me when I was introduced to the role of the nervous system in recovery. I started to understand that these clients weren’t choosing to stay stuck—they were responding to unseen, physiological signals of danger. Their nervous systems were in survival mode, reacting to perceived threats in a way that couldn’t simply be reasoned away. Without a deep sense of safety—especially around food—taking steps forward in recovery was nearly impossible.

Why the Nervous System Matters

Research confirms what many clinicians observe: nervous system dysregulation is common in people with anorexia and other eating disorders. When your nervous system feels unsafe, your body can override logic and push you into protective patterns—like restriction, bingeing, or avoidance.

Understanding what’s happening in your body can help you recognize these patterns and learn tools to shift into a more regulated, grounded state.

With nervous system tools, you can respond more intentionally to struggles in recovery—instead of being hijacked by automatic reactions.

A Crash Course in the Nervous System

The autonomic nervous system (ANS)—a part of your peripheral nervous system—manages automatic body processes like heart rate, digestion, and stress response. According to polyvagal theory, the ANS has three key branches:

  • Sympathetic Nervous System (SNS) – kicks in for fight-or-flight responses.

  • Dorsal Vagal Branch – linked to the freeze or shutdown response.

  • Ventral Vagal Branch – supports calm, connection, and safety.

This internal system is always scanning for danger—without us even realizing it. Besso describes the ANS as our "personal surveillance system" that constantly asks, “Am I safe?”

Understanding the Three Nervous System States

  1. Fight or Flight (Hyperarousal) In this state, your body is on high alert. You may feel anxious, wired, or restless. Physically, you might experience a racing heart, sweaty palms, or difficulty digesting food.

  2. Freeze (Hypoarousal) This is your nervous system’s shutdown mode. You may feel emotionally numb, tired, checked out, or dissociated. Even basic tasks—like deciding what to eat—can feel overwhelming.

  3. Calm and Connected (Ventral Vagal State / Window of Tolerance) This is the “regulated” state where you feel safe, grounded, and connected to yourself and others. You’re able to eat, rest, and process emotions more effectively.

When Safety Feels Threatening

Many people in eating disorder recovery don’t feel safe in their bodies. For some, eating—especially foods tied to fear, guilt, or trauma—can feel like a threat. Even physical sensations like hunger or fullness can be misread as danger due to disrupted interoception (your brain’s ability to interpret internal signals).

Disordered behaviors like restriction or purging often serve as temporary attempts to soothe this inner chaos. They’re coping skills to temporarily regulate the nervous system—not acts of defiance.

What Dysregulation Can Look Like

In hyperarousal, you may experience:

  • Obsessive thoughts about food or rules

  • Overexercising, bingeing, or purging

  • Digestive discomfort from anxiety (like bloating or irregular bowels)

In hypoarousal, you might notice:

  • Emotional numbness or withdrawal

  • Avoiding meals or sticking to “safe” foods

  • Trouble participating in therapy or making food choices

  • Difficulty connecting with others

Both states can make recovery feel impossible—but regulation makes it more manageable.

The Power of Regulation in Recovery

Helping clients return to a regulated state can completely change the recovery process. When people feel safe in their bodies, they can:

  • Eat more consistently and with less anxiety

  • Process emotions without turning to disordered behaviors

  • Show up more fully in relationships and therapy

  • Make decisions aligned with their values

As Besso notes, the goal isn’t to eliminate discomfort—it’s to build the capacity to sit with it safely.

Practical Tools for Nervous System Regulation

Here are 9 therapist- and dietitian-approved tools to support your nervous system:

  1. Build Awareness Learn how hyperarousal, hypoarousal, and regulation feel in your body. Journaling, therapy, or books like Anchored by Deb Dana can help.

  2. Lean on Co-Regulation Being around safe, supportive people helps your system feel secure. During meals, this might mean having someone eat with you, offer a grounding hug, or simply be present.

  3. Create a Safe Mealtime Environment Bring comforting objects to the table (like a soft scarf or a calming playlist), or make your space feel cozy and visually soothing.

  4. Use Breathwork & Mindfulness Try slow belly breathing or extended exhales when anxious. Use energizing breaths (like breath of joy) when feeling shut down.

  5. Move Mindfully Gentle movement, dancing, shaking, or stretching can release energy or lift you out of freeze mode. Yoga is especially regulating for many people.

  6. Try Grounding Techniques Use your senses to reconnect with the present. Name 5 things you see, 4 you can touch, and so on—or feel your feet against the floor to anchor your body.

  7. Use Cold Water Splash cold water on your face or hold an ice pack. This can stimulate the vagus nerve and help bring your system back into balance.

  8. Look for “Glimmers” Tiny positive moments—like hearing birdsong or watching a sunrise—can cue safety. Seek them out regularly to gently train your system toward calm.

  9. Check In With Yourself Before and after meals, ask: “Where am I right now—regulated, hyperaroused, or hypoaroused? What do I need to feel safe?” Over time, this practice builds self-trust and awareness.

Closing Thoughts

Regulating your nervous system is a powerful, compassionate way to support your recovery. It helps you move away from automatic behaviors and toward choices that align with your well-being. With practice, these tools can help you create a real sense of safety—not just around food, but in your life.


If you need help healing your relationship to food and body, please reach out to us via the contact page.


Thanks for reading and take good care,

Caroline


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