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The Role of Yoga in the Treatment of Eating Disorders

A nutritionist and yoga teacher explores the benefits and risks of yoga as therapy for eating disorders.

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Sometimes we don’t understand how much tension we carry inside until the moment we take the leap and surrender. I remember this moment for me, now almost a decade ago, soaked in sweat, lying in Savasana in a San Francisco room of 100 bright-eyed yogis, warm tears dripping off my face. Having found yoga as a refuge from my life as a dancer, I had come to my mat in the throes of my struggle with disordered eating, waging a powerful war against my body. I had arrived with years of successfully dissecting my body and self-worth in the dance studio mirror, and left the yoga studio each time with a reminder that I am a soul living inside a human body. As I kept showing up, over time, I learned to be compassionate and began to feel strong again in my own skin. I knew I had found my path.

An increasing number of men and women struggle with an unhealthy relationship with food. According to the National Institute of Mental Health, eating disorders, characterized by extreme emotions, attitudes, and behaviors surrounding weight and food, are a daily struggle for 20 million females and 10 million males in the United States.

Anorexia nervosa has the highest mortality rate of all mental illnesses. Beyond anorexia, bulimia, and binge eating disorder, millions struggle with a wide spectrum of exercise issues and disordered eating, defined by the National Eating Disorder Collaboration as a “disturbed and unhealthy eating pattern that can include restrictive dieting, compulsive eating, or skipping meals.” According to a study conducted by the National Eating Disorder Association, “four out of ten individuals have either personally experienced an eating disorder or know someone who has.”

Characterized by an extremely high relapse rate, eating disorders are associated with stigma and shame and a denial of the illness in the first place, all of which can be barriers to getting proper treatment. Additionally, our culture’s emphasis on normalizing and even celebrating thin body type, weight loss, and dieting only reinforces a dysfunctional relationship to food.

Yoga therapy is now being used in eating disorder treatment centers across the country, as yoga provides an integrative approach to mental, emotional, and physical health. The practice of moving consciously from the inside out can have a profound impact on someone struggling with body image and body awareness as these people tend to avoid being present. Yoga has been shown to help relieve depression, anger, and anxiety and to promote self-esteem and positive body image through the cultivation of non-judgment, confidence, and self-acceptance. A regular yoga practice can help rebuild strength and bone density that is damaged and lost with anorexia.

How Do Eating Disorders and Yoga Philosophy Connect?
In order to allow the mind to rule choices about food, body, and weight, as one with an eating disorder does, it becomes necessary to disconnect the mind from the needs of the physical body. Often, those affected by disordered eating will completely detach from their identity or values outside of the disorder itself; weight and body image become paramount to all else. This type of behavior is seen as an act of violence towards oneself, a cycle often perpetuated by the illusion that reaching a certain weight will provide a sense of control or happiness—“Once I lose 10 pounds, I’ll be happy”—which is of course an illusion, because after 10 it becomes 12, then 15, and so on.

In stark contrast to this type of aggressive control of the body, yoga teaches us to develop an awareness of an authentic self beyond the physical body. In fact, the physical body in yoga is considered a temporary vehicle for the spirit, and becomes a lens through which to stay curious about how we act in other parts of life. For instance, holding an uncomfortable posture when the instinct is to escape allows us to notice what happens mentally when we encounter a challenging situation or begin to feel anxious off the mat. Yoga philosophy also provides us with the value of “ahimsa,” the practice of non-violence, toward ourselves, our body, and others. The practice of meditation, another aspect of the yoga practice, allows for the development of “witness consciousness,” creating separate space between the observer (our mind), the thoughts that arise, and our reactions.

People with eating disorders and other destructive food behaviors are in a constant state of physiological stress, increasing the likelihood of a host of medical consequences including loss of bone density, heart muscle deterioration, and a heightened level of adrenaline, the body’s hormone responsible for fight or flight response when survival is threatened. Studies on mindfulness have shown that both meditation and breath-work reduce the body’s physiological stress response by decreasing sympathetic nervous system activation, and increasing activity in area of the brain responsible for confidence, emotion regulation, and mental flexibility. Interestingly, studies on yoga’s therapeutic effects in the general population show how the capacity to tolerate low levels of stress, such as learning to stay in an uncomfortable posture, is correlated to overall well-being and quality of life.

Yoga and Eating Disorder Recovery
Although yoga has shown some efficacy as a treatment for asthma, depression, and anxiety, research on the effects of yoga specifically in the treatment of eating disorders is still limited. One reason for lack of studies within this population is the high co-morbidity between eating disorders and other mental health illnesses such as anxiety, depression, and obsessive-compulsive disorder.

Jennifer Daubenmier, Ph.D., conducted research while at the University of California, Berkeley, examining how practicing yoga affects body awareness, body responsiveness, and body satisfaction. In this study, 138 women, averaging 37 years old, were split into three groups: a yoga group, an aerobic exercisers group, and a control group. Participants were given surveys that measured body awareness, body satisfaction, and eating disorder symptoms. The yoga group reported lower scores on all measures associated with eating disorder behaviors, including greater body awareness when compared with non-yoga practitioners. The results indicate that yoga decreases eating disorder risk factors at higher rates than other forms of exercise.

A 2006 Princeton University qualitative study showed how yoga is effective in increasing self-efficacy and reducing anxiety. Eating disorder expert Robin Boudette, Ph.D., a psychologist at Princeton University, obtained data from eating disorder patients undergoing yoga therapy. The methods in this study were based on gentle, therapeutic yoga techniques used by renowned instructors such as Christina Sell in her book Yoga from the Inside Out: Making Peace with Your Body. According to Boudette, “Many patients become much more aware of the body for how it feels, rather than how it looks, which opens a window into a new experience of the body off the yoga mat.”

Yoga encourages practitioners to tap into inner wisdom, and has the potential to replace a dependency on external validation, such as a scale, by supporting a more internal relationship of trust and gratitude for the body. There are times, however, when yoga can be misused to support the eating disorder rather than recovery. For instance, the asana (physical) practice can become another form of overexercise and a way to continue ignoring the body. If a person is medically unstable or severely underweight, a physical yoga practice can be dangerous and even life threatening. Furthermore, 30% of people with eating disorders are believed to also have a trauma history, and may report feeling increased anxiety levels when asked to connect to, and feel, their body.

Related: How Yoga Helped Me Overcome Trauma and Abuse

In order to support the healing aspects of yoga, it is important to create a safe, non-competitive environment that focuses on compassion and self-acceptance. “Edge” is yet another powerful tool yoga therapists use to help practitioners explore how to set healthy boundaries and tolerate low levels of stress and discomfort. In Phoenix Rising Yoga Therapy, an experiential therapy method I teach that integrates yoga, breath-work, and introspection, an “edge” is often described as a place that’s not too little or not too much, where something of interest is happening. Exploring edge in asana practice can support crucial aspects of eating disorder recovery such as tolerating fullness. For instance, when someone undergoing re-feeding feels uncomfortably full, as is often the case for someone who needs to gain weight in recovery, this sensation can trigger the urge to use eating disorder behaviors such as purging or restricting to compensate for food intake. By learning to stay with discomfort and find breath during yoga, a recovering person can also learn to find breath in the discomfort of fullness, and thus allow the body to undergo its natural processes without compensating.

Similarly, exploring edge allows for a healthier way to relate with hunger. Oftentimes when hunger signals return, someone who is used to ignoring hunger will feel confused and angry with his or her body. Edge can be a tool to create enough space to observe what is happening, soften judgment, and eventually allow for more acceptance of the body’s needs. Beyond the physical, practicing edge can be a means to practice speaking truth. For those with low self-esteem, an eating disorder can become an unhealthy method of communication, and therefore part of their recovery process requires learning how to express even when it feels uncomfortable.

Yoga also provides us with the ability to look at transitions as metaphor. People who struggle with eating issues often have a very difficult time with flexibility and change. Calling attention to the physical experience of moving through postures is one way to cultivate awareness about our relationship to transitions off the yoga mat. Bringing yoga into eating disorder recovery is a way to access memories, messages, and wisdom stored in the body that are not always accessible in more traditional forms of talk therapy. The ultimate goal of recovery is in fact yoga: re-connecting and integrating all parts of the self to live a more intuitive, peaceful, and soulful life.

Photo by Hailey Wist

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