Dance/movement Therapy and Bulimia Nervosa (Manual)

Repairing the broken mirror (Manual) 1 
 
 
REPAIRING THE BROKEN MIRROR: A THEORETICAL DANCE/MOVEMENT 
THERAPY MANUAL FOR THE TREATMENT OF WOMEN WITH BULIMIA 
by 
Ariele L. Riboh 
© 2009 Ariele L. Riboh 
 
 
 
 
 
 
 
 
 
 
Pocket Manual 
 
October 2009  
TABLE OF CONTENTS
LIST OF TABLES.………………………………………………………………………..3
Chapter
1. Introduction……………………………………………………………………4
2. Eating disorder fundamentals…………………………………………………7
3. Etiology………………………………………………………………………..9
4. Eating disorder symptoms……………………………………………………11
5. Diagnosis……………………………………………………………………..13
6. DMT treatment themes………………………………………………………14
7. DMT treatment goals………………………………………………………...16
8. Specific movement interventions…………………………………………….18
9. Monitoring DMT intervention results………………………………………………….25 
10. Conclusion…………………………………………………………………………………………26 
Recommended reading..……………………………………………………………………………………..28 
Bibliography……………………………………………………………………………..30
List of Tables 
Figure 1. Roadmap
Table 1. Emerging themes in the treatment of women with Bulimia nervosa
Table 2. Therapeutic goals
Table 3. Specific movement interventions

 
Introduction
The rising incidence of eating disorders, among which bulimia nervosa (BN), and
the difficulty of treating this complex illness, have prompted the use of new therapies
such as DMT to address critical mind-body integration issues not easily dealt with by
other medical and psychological treatments.
To promote the use and credibility of this relatively young discipline, it was
judged useful to provide a structured consolidation of key knowledge and best practices
that would help guide dmts engaging in the treatment of women with BN.
The aim of the pilot manual is to help provide the framework for the therapeutic
use of DMT and is open to further enrichment by the DMT community and BN
specialists. The author does not claim for this manual to be exhaustive but supports its
role as a base for further exploration.
To facilitate the practical use of this pilot manual, the contents are organized to
mirror the normal therapeutic process, from knowledge acquisition to DMT
implementation and effectiveness assessment.
This outline is summarized in the road map diagram Figure. 1. For each step of
the process, the key elements have been summarized to serve as a guide for further work
specific to each dmt’s objectives and patient needs.
As a complex, multi-factorial illness, BN requires treatment contributions by
other medical professionals. The consultation and/or coordination steps with these
professionals have been included (right side of diagram). This and other quality assurance
suggestions are expected to reinforce the effectiveness of the dmts’ own interventions.
 
Figure 1
Road map
Eating Disorder Etiology
Symptoms
DMT Diagnosis
Medical,
Psychiatric &
Nutrition input
Enquire Observe Test/monitor
- Patient personal, - Symptoms - Movement

family and social - Movement characteristics
history characteristics - Transference
- Significant life - Psychological - Countertransference
events/trauma behavior
- Social behavior
Formalize and document cumulative observations
Themes emerging in treatment (cf. full list Table 1)
Mother-infant Trauma Mind-body Validate selected

Relationship connection themes with other
professionals
 
Derive Therapeutic Goals (cf. full list Table 2)
Develop Develop positive Increase body

Autonomy coping mechanisms awareness
Movement Interventions (cf. full list Table 3)
Flocking Exploration of polar Self-massage - Ensure compatibility

Opposites with interventions of
other treating
professionals.
- Integrate pertinent
environmental
variables (group or
individual setting,
music, props, etc.
Monitoring results/consequences
- Check coherence
with other treatment
specialists
- Secure external
review
Therapy Effectiveness Patient-Therapist Interaction
- Patient observations and feedback - Assess trust status

- Treatment progress - Evaluate transference and
- Analyze potential risks and issues countertransference
- Determine need for additional
investigation /diagnosis
Adjust and pursue         Implement therapist self-care

Treatment
 
Eating Disorder Fundamentals
To understand the complex etiology of eating disorders as well as their mental
and physical effects for the practice of DMT, clear definitions are needed. The three
following definitions provide a comprehensive summary of the most important elements
concerning eating disorders
According to Krantz (1999), “Eating disorders refer to disturbances of eating
behaviors and body-image distortions with underlying psychodynamic, cultural, and
gender conflicts” (p. 82).
Davis (2009) defines eating disorders as primarily psychological disorders where,
“food and eating are symbolized or given meaning beyond ordinary nourishment and
consumption and because, as food and eating is symbolized, a variety of medical,
psychological and social problems are created” (p. 36).
Eating disorders comprise two major subtypes, anorexia nervosa and bulimia
nervosa (BN). Anorexia nervosa is defined as “a refusal to maintain a minimally normal
body weight” (DSM-IV-TR, 2000, p. 583). It is divided into two subtypes: restrictive and
binge-eating/purging type. As the focus of this pilot manual is on BN, no further
discussion of anorexia is included.
The DSM-IV-TR (2000) text revision, defines BN as “repeated episodes of binge
eating followed by inappropriate compensatory behaviors” (p. 583). A binge is defined
as, “eating in a discrete period of time an amount of food that is definitely larger than
most individuals would eat under similar consequences” (p. 589). Binging behavior is
characteristically done in secrecy and is associated with intense feelings of shame and
guilt. The DSM-IV-TR (2000) text revision states that binging is “typically triggered by
 
dysphoric mood states, interpersonal stressors, intense hunger following dietary restraint,
or feelings related to body weight, body shape and food” (p. 590). This behavior is
utilized as a means of self-regulation and provides temporary relief for the person. It is
thought that often during these phases of binge and purge the person enters into a
dissociative state that is subsequently felt as an utter loss of control. To compensate for
this loss of control, many engage in compensatory behaviors known as purging. The most
common means of purging is by self-induced vomiting. Some 80% to 90 % of people
with bulimia use this method of purging. Bulimia nervosa is also divided into purging
and non-purging types. However, the two are very similar in their psychological
development and symptomology. Other disordered behaviors are also used to compensate
for binging behavior and to prevent weight gain. Such behaviors include abuse of
laxatives and diuretics, excessive exercise, fasting between binges, and so forth.
Associated with this symptomology, people suffering from bulimia nervosa often suffer
from depressed mood states and present symptoms fulfilling the criteria for mood
disorders, anxiety disorders, and personality disorders.

 
Etiology
Eating disorders are complex disorders that affect individuals mentally and
physically. According to current knowledge, the most prevalent medical hypotheses of
etiology are:
- Genetic predispositions
- Neurobiological vulnerabilities (neuropeptide dysfunction in neuron message
transmission, hormonal dysregulation, appetite control disturbances related to
serotonin fluctuations)
- Brain abnormalities
Although these factors are not directly actionable by DMT practices, it is
important that this knowledge be taken into account to insure compatibility of DMT
interventions with other medical treatments.
Current psychological research demonstrates the critical role of the mother infant
relationship and how impingement and mismatches in this relationship can greatly affect
normal child development and potentially lead to the development of BN. Examples of
these are:
- Deficit or trauma in nurturance from primary caregivers within the family
environment
- Non-negotiation of critical stages of separation-individuation
- Development of unsecure, avoidant, and ambiguous attachment patterns
- Underdeveloped sense of self and body self
- Negative self-worth perception
- Distorted body image

 
- Lack of adequate coping mechanisms
- Limited self-awareness
- Difficulties with self-regulation (emotions and physical sensations)
These issues are central to the psychological development of the child and are
often translated into future eating and behavioral disorders.
Another compounding factor is trauma from:
- Childhood sexual abuse
- Physical abuse
- Mental/verbal abuse
Trauma can be considered either a causal or an aggravating factor in the development of
eating disorders.
Cultural and societal influences can also play a significant role in the development
and maintenance of eating disorders. In particular influence from the media and the body-
care industry, which impose standards and pervasive stimuli (advertisements, body care
products, dieting products, etc.) that are not necessarily consistent with one’s body make-
up and psychological dispositions.

Eating Disorder Symptoms
The intermingling of multiple mental and physiological causes in this illness is
reflected in a variety of symptoms, which can be clustered as follows:
Body related elements
- Distorted body image/self-perception
- Negative feelings about body shape and weight
- Specific body tensions
- Inhibited movement range/vocabulary
- Reactivity to touch
Self-worth issues
-Negative self-worth perception
-Feelings of inadequacy
- Sense of failure
Relationship to food and eating
- Binge and purge behavior (excessive eating followed by self induced vomiting, use of
laxatives, diuretics, generally done in hiding)
- Inability to differentiate hunger from satiety
- Excessive dieting episodes
Sexuality
- Hyper/hypo sexuality
- Anxiety around sexuality

 
Mood
- Dysphoric mood states
- Aggression/anger
- Depression
- Anxiety
Social Relationships
- Difficulty forming interpersonal relationships
- Social isolation
- Reduced eye contact
Self-Regulation
- Impulsive behavior
- Psychomotor agitation episodes
- Poor frustration tolerance
- Poor coping mechanisms (difficulty tolerating intense emotions and feelings)
- Excessive exercising
Diagnosis
As summarized in the roadmap diagram Fig. 1, the diagnostic methodology can be
subdivided into three steps of input gathering and analysis. Namely:
1) Inquire about the patient’s background in relation to the occurrence of the illness.
Similarly investigate the family and social context as well as significant events
(e.g. trauma) that can explain the emergence or maintenance of the illness.
2) Observe, in the appropriate settings, the symptoms associated with the
psychological, physical and social behaviors.
3) Perform tests chosen by the dmt in order to reveal symptoms, which cannot
readily be identified without action and challenges. For example engaging the
patient into a body expression exercise or organizing specific interactions with the
therapist can help assess transference and countertransference patterns which
would further clarify the diagnosis.
To enrich and validate the dmt’s diagnosis for this multi-factorial illness, it is
appropriate to share views with psychiatric, medical and nutrition professionals and to
formalize a coherent diagnosis from which respective interventions will be derived.

DMT treatment themes
From the analysis of BN etiology, diagnoses and the survey of experienced DMT
therapists, the most significant themes that emerge in the treatment process of women
with BN have been compiled in table 1. These themes have been categorized in general
themes and the corresponding specific themes.
Table 1
Emerging themes in the treatment of women with Bulimia nervosa
General themes in treatment Specific themes
1. Mother-infant -Patient starvation for care and affection
relationship and personal -Poor ego strength as manifested by a need for self-
development validation through others
- False-self
2. Trauma - Reenactments of trauma
- Difficulty with touch
3. Mind-body connection - Mind-body disconnection
- Lack of body awareness
- Difficulty understanding internal signals
4. Body-image - Body image distortion
- Dissatisfaction with own body
- Unclear body boundaries

General themes Specific themes
5. Self-worth - Low self-esteem
- Feelings of inadequacy
- Sense of failure
- Shame
- Guilt
6. Mood - Depression
- Anxiety
- Anger/ aggression
7. Self-regulation - Loss of control/need for control
- Search for relief through binge/purge behaviors
- Inadequate coping mechanisms
8. Relationship to food and - Emotional eating
eating - Disrupted eating patterns
9. Social relationships - Social isolation
- Difficulty forming relationships
- Secrecy
10. Sexuality - Avoidance
- Anxiety/fears
- Hypo or hyper sexuality

DMT treatment goals
The themes illustrated previously can serve as a guide to identify specific themes
for each patient and the corresponding therapeutic goals. The most meaningful
therapeutic goals identified through the study are listed in table 2.
Table 2
Therapeutic goals
General themes in treatment Therapeutic Goals
1. Mother-infant - Develop sense of autonomy/ self-differentiation
relationship and personal - Renegotiate stagnations of separation-individuation
development - Promote impetus to move forward with self-development
- Develop alternative secure attachments
- Development of authentic self
2. Trauma - Safe processing of traumatic material
3. Mind-body connection - Foster mind-body integration
- Develop sense of psychological and body self
- Regenerate body’s potential to move
- Develop/increase ability to express self through
movement
- Develop capacity to symbolize and play
- Improve overall body awareness

General Themes in Therapeutic Goals
Treatment
4. Body-image - Decrease of body-distortion
- Clarification of body boundaries
- Development of stable body image
5. Self-worth - Foster positive self-esteem
6. Mood - Decrease depression
- Reduce level of anxiety
- Increase movement vocabulary
7. Self-regulation - Develop capacity for self-nurturance
- Development of positive coping mechanisms
- Provide alternatives to binge/purge behaviors
- Releasing body tensions/stress
- Increase ability to express emotions safely through
movement
8. Relationship to food - Understand and manage emotional eating
9. Social relationships - Develop trusting relationship with therapist
- Decrease social isolation
- Develop improved social skills
10. Sexuality - Increase patient comfort with own sexuality

Specific movement interventions
Specific movement interventions gathered from the literature review and those
recommended by experienced therapists, through the survey, have been classified in table
3 and are matched with the most relevant therapeutic goal.
Understandably, these movement intervention examples are not exhaustive or
exclusively limited to one therapeutic goal. It is up to the dmt’s judgment and creativity
to apply these movement interventions to other relevant therapeutic goals.
For some of the therapeutic goals listed, recommended movement interventions
were rather limited. This highlights the need for further research and a more extensive
survey of experienced therapists to enrich treatment options and to complete this first
pilot manual.
Table 3
Specific movement interventions
Therapeutic Goals Specific Movement Interventions

- Decrease social isolation - In group setting, movement synchronization through use
of rhythm can foster a sense of relatedness, identification
and belonging to a group.
- Use of imitative walking. Patient(s) adopt each other’s
walk pattern.
- Increase patient comfort - Self-massage
with own sexuality - In group setting, if appropriate trusting relationships
have been established, patients can give each other foot or

 
shoulder rubs.

- Develop sense of - Utilizing Chacian circle concept, pass leadership from
autonomy/self- patient to patient.
differentiation - Use of conga lines, alternating leaders
- Flocking
- Renegotiate stagnations of - Seated mirroring with therapist as leader (reminiscent of
separation individuation early pre-ambulatory tie) (Krueger and Schoefield).
process/ Promote impetus to - Patient led mirroring
move forward with self- - “Facing the mirror” (Krueger and Schofield): patients
development move facing a mirror (this simulates the practicing sub-
phase of separation-individuation process)
- Develop alternative secure - Use of mirroring and moving in synchrony with patient
attachments to show empathy and give patient experience of being
understood and accepted
- Development of authentic - Movement improvisation by patient as means of
self awakening the unconscious
- Use of authentic movement technique by patient as
means of discovering own unconscious process
- Processing of traumatic
material safely
- Regenerate body’s - Improvisation
potential to move
 
 
- Mind-body integration - Use of Bartenieff fundamentals
- Mobilization (Evans): encourage self-created movements
that reconnect movement and feelings.
- Functional technique (Evans): targeted movement
exercises aimed at supporting psychological shifts.
- Develop capacity to - The use of props such as balls, parachutes, scarves, etc
symbolize and play can facilitate the development of play
- Clarification of body - Self touch
boundaries - Self-massage
- Exploring personal space defined with a rope. This is
used as a metaphorical delimitation. One can remain alone
in this space or invite others in.
- In pairs, one person stands still and the other slowly
advances till the standing person asks them to stop. This
is an exploration of comfort with distances between self
and others.
- Increase/foster positive - Leadership activities such as conga lines, flocking and
self-esteem so on.
- Decrease depression
- Provide alternatives to - cf. self-regulation interventions.
binge/purge behavior
 
 
 
 
- Development of stable - “Mirror image” (Totenbier): the patient is asked to
body image imagine looking at herself in a mirror then progressively
imagines looking at herself from different angles. She then
moves to the examination of her body as a whole unit.
Next, she is asked to hold out her right hand and examine
it from various angles. This is then repeated with the other
arm, legs, torso, neck and head. Again she is asked to
view her mirror image as a whole unit and not as
fragments. This is followed by a discussion of feelings,
associations, and so on that emerged during the activity.
- Reduce levels of anxiety -Relaxation techniques (e.g. stretching, vigorous shaking,
self-massage)
- Simple breathing techniques
- Progressive relaxation
- Guided imagery
- Increase ability to express - Physicalization (Evans), which consists of transforming
emotions safely through an experience into actions with feelings.
movement
- Understand emotional - Improvisation around topics related to eating
eating
 
 
 
- Decrease body-distortion - “Bigger than life” intervention by Stark et al. (1989).
Utilizing music, patients are asked to focus a part of their
body that they dislike, then dance with the image of it
getting bigger and bigger. At the end of the intervention,
the patients are asked to strip that image off and place it in
a pile in the middle of the room, symbolically removing
the negative image from themselves.
- Have patient place 2 chairs side by side at the distance
they believe represents their body width. Then ask them to
stand between them and assess the dimensional difference
between perception and reality.
- Increase movement - Improvisation: the process of free association of
vocabulary movements
- Authentic movement with therapist as witness
- Working in groups, patients can pick up movement from
others.
- Mobilization (Evans): encourages self-created,
spontaneous movement exploration and the reconnection
of movement with feelings.
- Develop improved social - Rehearsal of social situations through movement with
skills therapist or peers

 
 
- Improve overall body - Self-massage
awareness - Breath work (e.g. any form of deep breathing)
- Touching body with objects that have different tactile
properties
- Pressing body parts against different surfaces
- Exploration of posture
- Body-focusing (Dosamantes-Alperson):
patients are first led through a relaxation sequence, then
they are ask to gauge levels of comfort and discomfort in
this state.
- Develop capacity for self - Use of fabrics to wrap around body
nurturance - In group setting, sitting back to back in pairs and rocking
to music
- In circle, holding hands and rocking/swaying to music
- Development of positive - Exploration of polar opposites (e.g. push/pull,
coping mechanisms and open/close) and the gradual transition between the two
ability to self-regulate opposites. The patient is asked to notice feelings and
sensations emerging during this process.
- The use of props: pillows, punching bags, balls,
parachutes, etc. can provide a less threatening way to
release emotions such as anger.
 
 
 
- Development of positive - Exploration of polar opposites (e.g. push/pull,
coping mechanisms and open/close) and the gradual transition between the two
ability to self-regulate opposites is supported by the therapist. The patient is
asked to notice feelings and sensations that occur during
this process.
- The use of props such as pillows, punching bags, balls,
parachutes, etc. can be helpful in providing a less
threatening way of releasing emotions such as anger.
- Releasing body - Relaxation techniques
tensions/stress - Breathing and identification of areas of tension with
progressive release (e.g. body scan).
- “Full Breathing”: technique using the image of three-
dimensional breathing.
- Develop trusting - The use of mirroring or moving in synchrony with others
relationship with therapist can be effective.
and peers * People with BN are very self-conscious and mirroring
must be done carefully so that the patient does not feel
mocked.
- “Trust falls”: patients let themselves fall backwards into
a parachute held by the group or into the arms of the
therapist or a peer.
 
 
 
Monitoring DMT intervention results
DMT is clearly a dynamic process, during which the therapist further discovers
the patient and her response to the chosen interventions. For this result-monitoring phase,
a well-planned methodology and formal documentation of the conclusions are
recommended.
The assessment of therapy effectiveness ought to include patient feedback,
treatment progress and illness relief, emerging issues or risks and the need for further
diagnosis.
The evaluation of the patient-therapist relationship ought to cover the level of
trust established and the transference/countertransference outcomes emerging from their
interaction.
To complement the evaluation of intervention effectiveness and patient-therapist
relationship, input from external reviewers (e.g. supervision) and other professionals
contributing treatment would be beneficial.
The conclusions of these evaluations can then be exploited to fine-tune the patient
treatment and to address the therapist’s need for self-care.

 
Conclusion
With the hope that this pilot manual would contribute to greater use and
effectiveness of DMT for BN treatment, the author wishes to share her perspectives on
additional initiatives that could encourage the use of this type of manual, enrich its
contents and reinforce its credibility.
To broaden the use of the manual, the following actions are recommended:
- Distribute this manual to DMT therapists and other professionals dealing with
eating disorders for a constructive review and improvement suggestions.
- Devise a forum for ongoing exchange between dmts (websites, blogs, meetings,
etc.) and develop a consensus about the format and contents for an optimal
manual.
To enrich the contents:
- Broaden the survey of dmt therapists and plan periodical updates to gain
additional input about their field experience.
- Investigate important topics for which sufficient information was not available
for this manual (intervention sequencing guidelines in the therapeutic process, age
specificity for movement interventions, additional methods to reduce binge/purge
behaviors, etc.).
- Use the exchange forum to share novel movement interventions/techniques
developed by dmts.
To reinforce DMT credibility for BN treatment:
- Organize broader national surveys or specific evaluations that can yield
quantitative data about the most successful DMT interventions.

 
- Develop a reliable and collaborative methodology to assess intervention
effectiveness and to create a shared data bank.
- Determine an official process for the validation of proven and specific
movement interventions.
 
Recommended reading
Bartenieff, I. & Lewis, D. (1980) Body movement: Coping with the environment. New
York: Routeledge.
Dosamantes-Alperson, E. (1981). Experiencing in movement psychotherapy.
American journal of dance therapy, 4(2), 33-43
Gillespie, J. (1996). Rejection of the body in women with eating disorders. The Arts in
Psychotherapy, 23(2), 153-161.
Hornyak, L. M., & Baker, E. K. (Eds.). (1989). Experiential therapies for eating
disorders. New York: The Guilford Press.
Kleinman, S. (2008, October). Challenging body distortions through the eyes of the body.
Retrieved January 9, 2008, from http://www.eatingdisorderhope.com/body-
distortions.html
Kleinman, S., & Hall, T. (2005). Women with eating disorders. In F. Levy (Ed.), Dance
movement therapy: A healing art (2nd rev. ed., pp. 221-228). Reston,VA:
National Dance Association. (Original work published 1988)
Krantz, A. M. (1999, Fall/Winter). Growing into her body: Dance/Movement therapy for
women with eating disorders. American Journal of Dance Therapy, 21(2), 81-
103.
Kruger, D., & Schofield, E. (1986). Dance/movement therapy of eating disordered
patients: A model. American Journal of Dance Therapy, 13, 323-331.
Musicant, S. (2001, Spring/Summer). Authentic movement: Clinical considerations.
American Journal of Dance Therapy, 23(1), 17-28.
doi:10.1023/A:1010728322515
 
Stark, A., Aronow, S., & McGeehan, T. (1989). Dance/movement therapy with bulimic
patients . In L. M. Hornyak & E. K. Baker (Eds.), Experiential therapies for
eating disorders (pp. 121-143). New York: The Guildford Press.
Taylor, J. (2007, March). Authentic movement: The body’s path to unconsciousness.
Body, Movement and Dance in Psychotherapy, 2(1), 47-56.
doi:10.1080/17432970601025402
Totenbier, S. L. (1995). A new way of working with body image in therapy,
incorporating dance/ movement therapy methodology. In D. Dokter (Ed.), Art
therapies and clients with eating disorders (pp. 193-207). Philadelphia: Jessica
Kingsley Publishers.
 
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Dance/movement Therapy and Bulimia Nervosa (Manual)

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Dance/movement Therapy and Bulimia Nervosa (Manual)

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Repairing the broken mirror (Manual) 1

2. Eating disorder fundamentals…………………………………………………7

4. Eating disorder symptoms……………………………………………………11

6. DMT treatment themes………………………………………………………14

7. DMT treatment goals………………………………………………………...16

8. Specific movement interventions…………………………………………….18

Table 2. Therapeutic goals

Table 3. Specific movement interventions

other medical and psychological treatments.

role as a base for further exploration.

mirror the normal therapeutic process, from knowledge acquisition to DMT

implementation and effectiveness assessment.

specific to each dmt’s objectives and patient needs.

As a complex, multi-factorial illness, BN requires treatment contributions by

Eating Disorder Etiology

Enquire Observe Test/monitor

- Patient personal, - Symptoms - Movement

Formalize and document cumulative observations

Themes emerging in treatment (cf. full list Table 1)

Mother-infant Trauma Mind-body Validate selected

Develop Develop positive Increase body

Movement Interventions (cf. full list Table 3)

Flocking Exploration of polar Self-massage - Ensure compatibility

- Patient observations and feedback - Assess trust status

Adjust and pursue Implement therapist self-care

To understand the complex etiology of eating disorders as well as their mental

following definitions provide a comprehensive summary of the most important elements

concerning eating disorders

According to Krantz (1999), “Eating disorders refer to disturbances of eating

behaviors and body-image distortions with underlying psychodynamic, cultural, and

gender conflicts” (p. 82).

Davis (2009) defines eating disorders as primarily psychological disorders where,

consumption and because, as food and eating is symbolized, a variety of medical,

psychological and social problems are created” (p. 36).

nervosa (BN). Anorexia nervosa is defined as “a refusal to maintain a minimally normal

binge-eating/purging type. As the focus of this pilot manual is on BN, no further

discussion of anorexia is included.

The DSM-IV-TR (2000) text revision, defines BN as “repeated episodes of binge

eating followed by inappropriate compensatory behaviors” (p. 583). A binge is defined

common means of purging is by self-induced vomiting. Some 80% to 90 % of people

disorders, anxiety disorders, and personality disorders.

physically. According to current knowledge, the most prevalent medical hypotheses of

- Neurobiological vulnerabilities (neuropeptide dysfunction in neuron message

transmission, hormonal dysregulation, appetite control disturbances related to

Although these factors are not directly actionable by DMT practices, it is

interventions with other medical treatments.

- Deficit or trauma in nurturance from primary caregivers within the family

- Non-negotiation of critical stages of separation-individuation

- Development of unsecure, avoidant, and ambiguous attachment patterns

- Underdeveloped sense of self and body self

- Negative self-worth perception

- Distorted body image

- Difficulties with self-regulation (emotions and physical sensations)

often translated into future eating and behavioral disorders.

Another compounding factor is trauma from:

- Childhood sexual abuse

Trauma can be considered either a causal or an aggravating factor in the development of

up and psychological dispositions.

Eating Disorder Symptoms

The intermingling of multiple mental and physiological causes in this illness is

reflected in a variety of symptoms, which can be clustered as follows:

Body related elements

- Distorted body image/self-perception

Repairing the broken mirror (Manual) 1 

Adjust and pursue         Implement therapist self-care