How somatic therapy helps people with eating disorders

If you’re worried about your own or someone else’s health, you can contact Beat, the UK’s eating disorder charity, on 0808 801 0677 or beateatingdisorders.org.uk. Or find US-based resources from the National Eating Disorders Association here.

Ani Waggoner has battled anorexia for 28 years. She’s been to seven different treatment facilities, and cycled in and out of recovery for her entire adult life. It wasn’t until her last residential stay, at the Renfrew Centre in Florida, that she hit a breakthrough. “A lot of trauma is ingrained in my body, and my eating disorder played into that,” she says. Starvation was her way of punishing a body that she didn’t trust. 

This insight occurred in Renfrew’s movement room, where Waggoner was receiving somatic therapy. While progressing through slow, gentle gestures like stretching her fingers, tapping her feet and undulating her back, she was learning to unlock pent-up muscular tension. She began this work cowered under a table in the corner; by the end of her treatment, she was able to travel across the floor, incorporating moves from her ballet background without triggering the perfectionism and insecurity that once kept her frozen in place. “I was so in my head that I wasn’t listening to the rest of me,” she recalls. “Somatic therapy is the way I got to trust my body.” 

Somatic, or body-based, therapy posits that the body is the seat of emotion. Using techniques like breathwork, yoga, dance and bilateral tapping, it aims to process psychic turmoil from what practitioners call the “bottom up.” Cultures around the world have honoured the body’s healing power for millennia (think: tai chi in China and yoga in India, among many traditions), but it’s only recently entered mainstream Western wellness. Recent media coverage has forecast the potential of somatic therapy to treat everything from depression to alcoholism, while on TikTok, videos hashtagged #somaticreleasemassage garner millions of views.

Amidst the clamour of enthusiasm for all that somatic therapy might cure, little has been said about its use in eating disorder treatment. This oversight is puzzling, considering that eating disorders hinge on disavowing the body’s wants and needs. “A disconnect happens with eating disorders where you can’t be in your body because it doesn’t feel good to be in your body,” says Wednesdae Ifrach, an expressive arts therapist in Connecticut who uses somatic methods to treat eating disorders. It’s common for people with eating disorders to lose the ability to recognise hunger and fullness cues. “Even reading your own likes and dislikes can become really difficult,” Ifrach says, since patients can’t distinguish between an eating disorder thought and an intrinsic bodily signal. Such profound disembodiment is why somatic therapy is especially well-suited to treat eating disorders. By teaching interoception, defined as “sensitivity to stimuli inside the body,” somatic therapists can help patients reclaim the sensory building blocks of lasting recovery. 

Unfortunately, interoceptive training is not a priority at traditional eating disorder care facilities; at least, not the ones that answer to insurance. Insurance companies demand evidence-based treatments, and somatic therapy is difficult to study quantitatively. Plus, the successful rollout of somatic interventions takes time and money – resources that corporate-run treatment centres are reluctant to supply, says Rachel Lewis-Marlow of the Embodied Recovery Institute in North Carolina.

Current statistics for eating disorder recovery are heartbreaking: relapse rates reach 70 per cent, and mortality rates are among the highest of all mental illnesses. What somatic therapy offers – communion with the self as a body, a protean bundle of muscle, sinew and bone – could be the missing answer to this failing system.

Despite insurance barriers, somatic interventions are starting to crop up in eating disorder care, often through yoga, dance and equine therapies. “The field is growing,” says Susan Kleinman, a board-certified dance/movement therapist at the Renfrew Center, “very slowly.” Today, she estimates that there are 20 to 25 clinicians with her specialty in Florida; when she started at Renfrew, over 30 years ago, she was the only one in the state. 

Dr Ann Saffi Biasetti, a New York-based somatic therapist who specialises in eating disorders, sees her modality bubbling up at private-pay treatment centres, which “have more freedom to do what they wish to do.” It’s not news that patients who pay out of pocket receive more innovative care, which often means better care. But the widening income gap, coupled with the fast-dwindling pool of eating disorder clinics, brings this inequality into sharper relief. 

Even people with robust insurance plans, or ample funds to supplement them, might not access somatic therapy until it’s too late. According to Dr Biasetti, somatic interventions are crucial in the early stages of eating disorder treatment, when patients are at the height of bodily dysregulation. The onset of any treatment program will trigger a host of fight-or-flight responses, like a racing heartbeat and clammy palms, as patients are thrust into meal plans, weigh-ins and emotionally charged therapy sessions. Before they even begin to relearn hunger and fullness, cues that Dr Biasetti classifies as “high-level interoception,” it is essential to establish awareness of the most basic somatic fluctuations.  

Patients often stumble upon somatic therapy in their second, or fifth, or final attempts at recovery. Anastasia Nevin, a New York-based eating disorder dietitian who specialises in somatic healing, says that nearly all her clients come to her after being failed by traditional providers. “Cognitively, they know what they’re supposed to be doing,” she says, “yet there’s this inability to really integrate that.” Dr Biasetti estimates that 60 to 70 per cent of her clients have already received inpatient treatment.

One explanation for the rampant relapse rates is that patients enact what Dr Biasetti calls “feigning.” In the race to recover before insurance coverage dries up, they resort to performing behavioural changes – following a meal plan, refraining from a binge, flushing the bottle of laxatives down the toilet – without probing the root causes of their disorders. It’s relatively easy to check off the boxes of recovery on paper; what’s harder is to own the internal experience of trauma that drives harmful behaviours to begin with. 

Ani Waggoner, the Renfrew alum, is staggered by her outcomes from somatic therapy; overall, she calls the progress “insane.” Though she doesn’t yet consider herself fully recovered, she says she is closer than she’s ever been. Today, she loves finding moments of joyful connection with her body – dancing to K-pop, playing with her cat, and staging outdoor photoshoots. She hopes to teach dance to kids one day, and use her own experiences to advocate for eating disorder education.

“Sometimes we just don’t have the words to share what we want to say,” Waggoner reflects. The good news? Our bodies do.