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Binge Eating Disorder in

Focus
A Strengths-Based IFS Treatment
Approach for Resilient Recovery
Amy Pershing, LMSW, ACSW, CCTP-II

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Binge Eating Disorder in
Focus
A Strengths-Based IFS Treatment
Approach for Resilient Recovery
Amy Pershing, LMSW, ACSW, CCTP-II

Rehab Kids

ZNM059963
9/24
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Rehab Kids
 MATERIALS PROVIDED BY

Amy Pershing, LMSW, ACSW, CCTP-II, is the founding director

of Bodywise, the first BED-specific treatment program in the
United States, and president of the Board of the Center for
Eating Disorders in Ann Arbor, Michigan. She is the founder of
Pershing Consulting, which offers training to clinicians treating
BED and trauma worldwide. Amy is also the co-founder of
“Attune”, an online coaching program for attuned eating and
recovery support.

Amy is an internationally known leader in the development

of treatment paradigms for BED, and one of the first clinicians
to specialize in BED treatment. Based on 35 years of clinical
experience, Amy has pioneered an approach to BED recovery
that is strengths-based, and trauma informed, incorporating
Internal Family Systems (IFS) and body-based techniques to
heal the deeper issues that drive binge behaviors. Her approach
integrates a non-diet body autonomy philosophy, helping
clients create lasting change with food and body image. She
is the author of the book Binge Eating Disorder: The Journey
to Recovery and Beyond and Emotional Eating, Chronic Dieting,
Bingeing and Body Image: A Trauma-Informed Workbook, with
co-authors Judith Matz and Christy Harrison. She also offers
a variety of trainings on BED treatment through PESI. Amy
maintains her clinical practice in Ann Arbor, Michigan.

For speaker disclosures, please see the faculty biography in activity advertising.

Materials that are included in this course may include interventions and modalities that are beyond the
authorized practice of certain professionals. As a licensed professional, you are responsible for reviewing
the scope of practice, including activities that are defined in law as beyond the boundaries of practice in
accordance with and in compliance with your profession’s standards.
 Binge Eating Disorder in Focus:
A Strengths-Based IFS
Treatment Approach
for Resilient Recovery

Amy Pershing LMSW, ACSW, CCTP-II

Founder, Bodywise BED Recovery Program, Ann Arbor, MI

President of the Board, Center for Eating Disorders, Ann Arbor, MI

Author, Binge Eating Disorder: The Journey to Recovery and Beyond (Routledge, 2018)

Co-author, The Body Positivity Deck (PESI Publishing, 2020)

Co-Author, The Emotional Eating, Chronic Dieting, Binge Eating and Body Image Workbook, (PESI, 2024)

Training Opportunities: PESI.com

Scope of Practice

Materials that are included in this

course may include interventions and
modalities that are beyond the
authorized scope of practice for your
profession. As a licensed professional,
you are responsible for reviewing the
scope of practice, including activities
that are defined in law as beyond the
boundaries of practice in accordance
with and in compliance with your
profession’s standards.

1
 Conflict of Interest Disclosures

As required by several accrediting boards,

speaker and activity planning committee
conflicts of interest (including financial
relationships with ineligible organizations) were
disclosed prior to the start of this activity. To
view disclosure information, please see activity
advertising.

2
 The Voices Throughout

All are clients unless
otherwise noted

Some are named, some are
not, as requested

All quotes are used with
permission

My immense gratitude for
the risk takers

What is an eating disorder?

A ”biopsychosocialgeneepigenetic” disorder that

occurs within a cultural milieu of various kinds of
oppression and bias, particularly weight stigma

People NEVER choose an eating disorder; the
behavior may start as a choice

Eating disorders cause extreme distress; they rob
sufferers of most of their energy, attention and
focus; they basically have nothing but the ED in life.

No one with an ED can simply stop the behaviors;
willpower has nothing to do with it

No matter how difficult, people are terrified to let
go of the ED.

For those with EDs and trauma, the ED may have
allowed them a way to survive

3
 What is an eating disorder?

A response to deprivation

A response to fear and shame

A response to hunger

A response to oppression

A response to weight stigma and the thin ideal

What is
Binge Eating Disorder (BED)?

“For me, binge eating was the one
thing that was completely mine.
When I first entered treatment, I
felt two very different things. Part
of me was ready to change. The
other part was very clearly saying
no way am I doing what I’m
supposed to do. I nearly died doing
that my whole childhood.”

“I do know there are times I eat
when I’m angry. Or when I feel
self-loathing. Knowing I’m not
healthy, that I’m struggling with
pre-diabetes, with autoimmune
issues, with food allergies, with
high cholesterol. And I binge
anyway. In spite of it. To spite it.
To spite myself. To spite life. To
spite God. To make it worse.
Because I feel so, so, so bad. And
sometimes feeling worse kind of
helps me express the anger.”

4
 Clinical Definition of BED

“
Recurrent episodes of binge eating”: Eating in a discrete
period of time (e.g. 2 hours) an amount of food larger than
most people would eat in a similar period under similar
circumstances

Binge eating occurs, on average, 1 day per week for at least 3
months

Disturbance does not occur exclusively during the course of
anorexia or bulimia

A sense of a lack of control over the eating during the
episode

Clinical Definition of BED

Binge eating episodes associated with at least 3 of the

following:

Eating more rapidly than normal

Eating until feeling uncomfortably full

Eating large amounts of food when not hungry

Secretive eating

Feeling disgusted, depressed or guilty after binge

10

5
 The Statistics

BED affects approximately 15

million people (3.5% of women
and 2% of men)

Most common eating disorder
by 5x

Affects the biggest number of
men of any ED

Most underdiagnosed ED
(“obesity” as focus; diet as
“treatment”)

70% of people seeking WLS
have BED/ED.

60% of people seeking BED tx
have one or more diagnosable
mental health issue (including
anxiety, depression, PTSD)

11

Comorbidities

• Type 2 diabetes • Anxiety

• High blood pressure • Sleep apnea/sleep
disturbances
• High blood cholesterol
• PCOS (polycystic ovary
• Gallbladder disease syndrome)
• Heart disease • Cushing’s Syndrome
• Certain cancers (overproduction of cortisol)
• Osteoarthritis • Asthma
• Joint and muscle pain • Stress related illnesses
• Gastrointestinal problems • Nutritional Deficiencies
• Depression

12

6
 Etiology/Co-Occurring and BED

Highest rates of trauma of any of the EDs (SA, PA, neglect, early
loss, greater situational trauma (e.g. poverty))

High rates of developmental/attachment trauma in FOO

High rates of substance use disorders in FOO

Significant rates of co-occurring mood disorders

Significant social anxiety

Significant histories of dieting/restriction

High rates of weight related bullying/weight stigma experiences

13

Perceptions of BED
- Often viewed as problem of
willpower, low-self-esteem,
depression - not as a “real”
eating disorder
- Only overweight people have BED
- Overweight people DO have BED
- Perception of binge eating
increases stigma of obesity; “just
stop overeating” mentality,
- Shame as a tool of change:
“bootstrap method” of health
- Medicalization of weight;
thin=healthy for every body
- BED target of more blame than
other psychological disorders and
other EDs LaPorte, 1997; Mond &
Hay, 2008; Wilson et al., 2009;
Becker et al., 2010; Crisp, 2005;
Mond et al., 2006; 2007

14

7
 ADHD and BED

About 30 percent of adults with
Other etiological causes of BED

binge eating disorder also meet may also be at play (i.e. early
criteria for a dx of ADHD trauma, dieting hx), but ADHD may
be the primary cause for binge

Thought to be related to a greater eating
response in the brain’s reward
system, not impulsivity; food or
Interventions may differ from
food images trigger the reward other groups with BED who do not
center of the brain at a higher have ADHD (i.e. more structure in
level than in people in who do not eating behaviors may be helpful
have ADHD for people with ADHD but not for
those without the dx)

ADHD and BED co-occurance may
also be related to reward systems
in the brain, such as the dopamine
system, and difficulties with
emotion identification, processing
and regulation

15

When does BED begin?

BED often begins in the late teens or early 20s, although it has been
reported in both young children and older adults. Hiding/sneaking
food often precedes meeting dx criteria

Forty-five percent of the subjects in one study reported dieting
preceded their first binge episode; fifty-five percent reported binge
eating preceded their first diet.

The group reporting having binged first had a younger age of onset
and a younger age at which they met diagnostic criteria.

This group of people with BED who reported an early onset and were
diagnosed at a younger age, also were more like to have had a history of
psychiatric problems.

It is likely that an early age pre-dieting onset is correlated with
environmental and genetic causal factors. This correlates closely with the
prevalence of C-PTSD.

While dieting is definitely associated with the disorder, for those with
pre-diet onset, dieting is more likely to be a reaction to binge
behavior, rather than a cause.

16

8
 The Lived Experience of BED

o “I come home and turn on my binge shows before I have a

chance to decide not to do it. I put on my loosest clothes,
turn off the phone, and eat. I want salty then sweet, in
that order, over and over. It’s the same pattern, every
time.”
o “Any time I am around certain foods, chips especially, I
will binge. They are a mainstay for me. If I’m buying
them, I know I’m preparing to binge. I just push down that
feeling of shame and eat, knowing (but not caring) that
the same shame will slam me when I stop.”
o “Sometimes, as I move toward a binge stash, I might
perceive a gentle, restraining hand on my arm, which I as
much as slap away, feeling, although not articulating
something adolescent like ‘Leave me alone! I’m doing
this!’”

17

Lived Experience: Secrets

“I hide food everywhere. Cookies in my car, chocolate

in the back of the desk drawer. I eat ‘perfectly’ in front
of people, always dieting. No one in my life has any
idea I binge.”

“No one knew about my binge days. I told people I was
sick, or there was a family emergency. I spun some big
tales to hide the truth.”

“No one at work has any idea I’m sitting in weekly staff
meetings obsessing about what to eat on my way
home.”

18

9
 Lived Experience: Isolation
from Other

“When I binge, everything in my life gets suspended. I
don’t have to think about how I’m being seen, or who I
may be disappointing.”

“When I binge, I don't answer the phone or email. No one
can get to me.”

“I am sitting across from friends, laughing and talking, and
all the while I’m stuffing myself to the point of pain.”

“It is a lot of work to be ‘on’; the food helps me get
through. I can’t say no to going out—because I might hurt
somebody’s feelings—so I go. My way of rewarding myself
is to binge at dinner.”

“It’s right in front of my partner, but she has no idea that
I’m bingeing. She doesn’t know I have been eating all day.”

19

Lived Experience: Profound

Ambivalence About Change

“Bingeing was a trail of breadcrumbs for me. I’m not sure how I
would have had the drive to heal from my past without having
something so distressing I had to confront.”

“I hate it and I am terrified to stop doing it. There are two parts
of me constantly at war. Neither wins, and both win.”

“Dieting was going to save me. Now what?”

20

10
 Lived Experience: Body Shame
and “Normative Discontent”

“I remember being in fourth grade
and my best friend told me she
wore a girl’s size 10. I was so
excited because I thought I was a
size 10 and now we were the same
in my head. When I got home that
day, I took my shirt off and saw a
size 12. I was crushed.”

“I was conscious, even as a little
girl that my mother was
embarrassed by her tummy (she
had borne 4 children). She never
seemed comfortable in her body.
She told me that she always
sucked in her stomach. I had no
idea what that meant, but it was
clearly an important part of being
a woman.”

“My mother told me not to be
friends with Donna. She was
petite, and standing next to her
made me look bigger.”

21

Is BED an “addiction”?

The dopamine theory (food increases dopamine levels as do

SUDs)

We are dopamine seeking creatures inherently. It is not
pathological, but hard-wired. We experience dopamine
surges in many ways, including listening to music/reading a
good book. Food and sex also naturally trigger dopamine
release. Thus, sugar is not intrinsically a substance, using
addiction parlance, any more than a hug from a friend
would be.

For most people with BED, there are other issues (anxiety,
depression, trauma histories, unmet needs of many kinds)
that drive them to seek ways to feel better. This is not
physiological addiction; it is a survival response to control
anxiety and shame.

22

11
 Is BED an “addiction”?

The abstinence model is much like a diet model; diets increase the
reward value of food thus creating false perception of being “out of
control” when abstinence is “broken”

the effects of deprivation due to dieting are by far and away the
biggest contributor to increasing the reward value of food. Neither our
bodies nor our minds make a distinction between diet and famine.

In any food plan that requires making certain foods forbidden or

demands sustained hunger, we will be far more likely to think about
those forbidden foods, to seek them out, and to overeat them given
the opportunity. This is not addiction.

There is research that suggests when we are deprived and excessively

hungry, the hormones that signal fullness decrease (leptin) and the
hormones that signal hunger (particularly ghrelin) increase. It is our
bodies’ response to a perceived threat to survival. This is a completely
different chemical and neurological process than the physiological
dependence created by the use of narcotic drugs or alcohol.

23

Is BED an “addiction”?

Implications for treatment (abstinence vs.

permission; “powerless” vs. powerful)

BED is often a disorder of self mistrust; an
abstinence model perpetuates that belief

Abstinence model moralizes health and
perpetuates stigma and shame narratives
(“good” people are abstinent; the “best”
people aren’t “addicts”

Evidence suggests recovery focused on “course
correction without shame” is more resilient
over time

24

12
 BED and Complex Trauma

Complex (or Developmental) trauma is a

neuropsychological injury that results from
protracted exposure to prolonged social and/or
interpersonal danger in the context of dependence,
captivity or entrapment (a situation lacking a viable
escape route for the victim), which results in the
lack or loss of control, helplessness, deformations of
identity and sense of self, and both somatic and
affective accommodations as a result of adaptations
to the damage. It is a lessening of our ability to be
in the world, and to see its complexity and nuance.
We are looking through a lens of the past and
behaving somatically, emotionally and cognitively,
as though the tiger remains.”
From BED: The Journey to Recovery and Beyond (Routledge, 2018)

25

Attachment Trauma

Attachment security predicts almost every identified

indicator of positive functioning

Lack of adequate attachment (insecurity) is a factor in
almost every identified indicator of dysfunction,
including cognitive difficulties, issues with
focus/concentration, self regulation, ability to
prioritize, lack of resiliency, problems relating to
others, and affect/mood stability

“If we could somehow end child abuse and neglect, the
eight hundred pages of the DSM would be shrunk to a
pamphlet in two generations.” ― John Briere

26

13
 “A total of 83% of BED patients reported some form
of childhood maltreatment. A total of 59% of BED
patients reported emotional abuse, 36% reported
physical abuse, 30% reported sexual abuse, 69%
reported emotional neglect, and 49% reported
physical neglect. (Carlos M. Grilo and Robin M.
Masheb, 2011)

“In the National Women’s Study, the National

Comorbidity Survey Replication, and the National
Epidemiologic Survey on Alcohol and Related
Conditions the highest rates of lifetime trauma
among those with eating disorders were found to
be 54%, 100%, and 74% respectively. Another study
of young adults in the United States found that
those who experienced multiple forms of childhood
trauma were almost twice as likely to report
disordered eating behaviors compared to those
without a history of childhood trauma.”
(Brewerton, 2019)

27

“74% of 293 women attending residential

treatment (with binge behavior) indicated that
they had experienced a significant trauma, and
52% reported symptoms consistent with a
diagnosis of current CPTSD based on their
responses on a CPTSD symptom scale. These
symptoms are far less correlated with
restriction behaviors without binge eating
(about 15%).”

Timothy Brewerton, 2008

28

14
 “Food thoughts and planning a binge gave me a safe harbor when I
was afraid or lonely. It got me through my past, my divorce, and a
whole lot of pain I had no idea how to address.”

“I get up from wherever I am when feelings begin to overwhelm

me. I binge eat until I feel a bit more calm, or until guilt requires
me to put it away. I go back to where I was sitting or working, and
then, sometimes even moments later, I get up, walk into the
kitchen, open the cabinets, remove the rubber band from the
package and begin again. Spooning food into emotional upheaval
somehow brings momentary relief.”

29

How foundational safety should

happen…

Appropriate “good enough” co-
regulation by primary caregiver
(back and forth b/w infant/child’s
need and caregiver meeting need
most of the time) sets stage for
recognizing and maintaining
homeostasis

Slow shift from external to internal
regulation as child develops

Appropriate neurosequential
development and resulting ability to
regulate arousal and affect

30

15
 How foundational safety should
happen…

Healthy interoception develops (our ability to notice

internal somatic and emotional state and to assess our
level of safety, pleasure, excitement and threat)

Healthy exteroception develops (our ability to perceive,
make sense of and predict the outside world based on day
to day experience and incorporate new information)

Two combine (neuroception) to allow us to (most of the
time) form narratives that are congruent with the actual
situation including safe/not safe, fun/not fun, scary/not
scary, me/not me

When actual threat happens, we can respond effectively
and return to a feeling of basic safety once the threat has
passed. This signals appropriate limbic system development

31

What the world should feel like…

Have the experience of being loved while authentic in mind and
body (body as home, not billboard)

Relationship “waves versus deep water”; conflict happens
without activation

Have appropriate guilt, not shame, and learn from it

Loss of connections happens and can be survived

Self voice is gentle, compassionate, tender, protective (but not
suspicious)

Safe to be here and now

Body is trustworthy; somatic experiences are safe

Safe to dream, safe to fail

Pain is tolerable; it need not be avoided to be safe

Love is abundant

32

16
 Threats to foundational safety
in infancy and early childhood

Lack of adequate soothing touch/voice/nourishment (co-

regulation)

Lack of/inaccurate mirroring/lack of attunement

Contempt, impatience, shaming

Lack of holding emotional container; narcissism in caregiver

Lack of providing safety

“Legacy trauma”: caregivers consistently assessing for threat

Absence/loss of caregiver

Crossing physical boundaries/lack of body ownership

33

“Complex” trauma: when danger is in the

community

Basic physical safety

Poverty

Lack of access to basic resources (housing,
medical care, food deserts)

Lack of support system/community support;
Lack of adequate resources for family
leave/childcare

Unemployment/underemployment

Cultural narrative of worth connected to
performance/productivity; lack of work/life
balance

Impact of “rape culture”; women and girls
as objects; the vilification of the “feminine”

Weight stigma/body shame

34

17
 How Body Shame is traumatic…

• Asks us to put aside our

overall health and
authenticity for approval and
comodification.
• Asks us to accept a
disconnect between our
bodies and our relationship
with food and movement
• Tells us we are broken
• Reinforces
ostracism/judgment/bullying
with victim blaming
• Makes possible the blaming
of our bodies for the damage
we endure
• Preys on a fundamental
terror of abandonment and
rejection

35

“I was five when my

stepfather sexually abused
me. I needed him in my life so
badly, and my mom did too.
We couldn’t afford the rent
without him. I remember
clinging to him, begging him
not to leave, despite what he
did to me. I felt like a loser
my whole life because I
begged him to stay. What kind
of freak wants their abuser to
stay? What I didn’t realize is
that I was still shaming myself
for what he did to me. He is
still off the hook, and I’m
always in the wrong. Now I
know I had no other choice but
to blame myself and my body.
Everyone hates their bodies,
right?” -Allison

36

18
 The Limbic System

The limbic system is a complex set of structures that

lies on both sides of the thalamus, just under the
cerebrum.

It includes the hypothalamus, the hippocampus, the
amygdala, and several other nearby areas.

It appears to be primarily responsible for our emotional
life and the formation of memories.

These structures control the autonomic nervous system
(ANS) (sympathetic, parasympathetic, enteric) and thus
our somatic responses to danger.

37

Limbic System and Stress

Neural signals arising from any stressful situation activate the
amygdala, which subsequently processes the information and
activates the hypothalamus.

The hypothalamus sends sympathetic discharges to the adrenal
gland and facilitates the release of adrenalin into blood.

This in turn activates various autonomic responses to trigger the
fight/flight response (SNS activation).

After the initial adrenalin surge, the hypothalamus activates the
hypothalamic-pituitary-adrenal axis to suppress the sympathetic
discharge. (PNS activation)

In case of persistent stressful conditions, the hypothalamus
secretes corticotropin-releasing hormone and activates the
pituitary gland to release adrenocorticotropic hormone. This
hormone activates the adrenal gland and facilitates the secretion
of cortisol to keep the body on high alert. PNS is less effective as
the “brake”.

38

19
 Limbic System and
Repeated Stress

Consolidation and retrieval of a clear event memory is
compromised by SNS activation: activity in the
hippocampus (which processes experience PRIOR to its
being “remembered”) is inhibited under threat. At the
same time the prefrontal cortex is unavailable to
accurately witness the experience

This unprocessed raw data (called implicit memory) is
encoded in the amygdala. Feeling memories, sensory
memories, muscle memories, and autonomic memories
provide the record of what happened divorced from a
narrative that could explain them.

Since the amygdala is the brain’s “smoke detector,” the
result is sensitization to even subtle reminders of the
traumatic event. The more frequent/lasting the danger, the
more sensitive the “smoke detector” becomes.

39

“To become more efficient, we

develop “procedurally-learned”
habits of responding: we react to
all future experience with the
most adaptive combination of
automatic cognitive, emotional,
motor, visceral, and behavioral
reactions learned from past
experience.
The emotions, sensations, and
impulses triggered by traumatic
reminders, divorced from their
original context, are
misinterpreted as indicators that
the individual is still in danger,
still powerless or helpless. Though
the client may be safe now, the
body doesn’t know or believe it.”
-Janina Fisher, 2007

40

20
 Implicit Memory:
“I don’t know why I feel like this”

These “implicit” memories do not

carry the sensation of
recollection. “…we act, feel, and
imagine without recognition of
the influence of past experience
on present reality.” (Siegel, 1999)

Such memories essentially convert
the past into an expectation of
the future, “making the worst
experiences of our past persist as
felt realities.” (Ecker, 2012)

Implicit memory limits ability to
self-regulate and assess threat
effectively in the present

In IFS parlance: parts at time of
trauma come to hold the burden
of safety and the exiled
experiences of terror and shame
(managers, firefighters and exiles)

41

What happens when trauma-related

implicit memories are experienced?

Intrusive emotions out of proportion to the stimulus

(fear, anger, shame, dread)

Thoughts that predict threat or failure; intrusive,
contradictory or ruminative thoughts (OCD, food/weight
obsession)

Impulses to run, to hurt the body, to binge, to hide
(literally), to avoid going out

Attachment symptoms: yearning for contact, painful
loneliness, felt sense of abandonment

42

21
 The Body on Trauma: Somatic
symptoms of CPTSD

Extreme fatigue

Chronic pain

Muscle tension/freeze or flight sensations

Disconnection from basic somatic cues (hunger,
fullness, pain, arousal)

Insomnia/sleep problems

Immune system problems

Gastrointestinal problems

Anger/outbursts/ agitation

Numbness/dissociative symptoms

Blunted or extreme affect

Sense of confusion/inability to focus attention

Hyperfocused attention

43

Patterns develop over time…

Social behavior: difficulty making eye contact,

difficulty asking for or accepting help, difficulty
expressing feelings in words

“Default settings”: tendency to self-blame, shame,
anger, shutdown, dissociation

Behavioral responses: impulsive acting out (binge
eating), isolation and avoidance, inability to set limits

Emotional expression: emotional disconnection,
intrusive emotions

Interpersonal behavior: gets too close too quickly,
expects too much from others, becomes the caretaker,
avoids closeness for fear of dependency

44

22

A lack of foundational safety
results in deeply entrenched
stories of a lack of worthiness
of being protected. (The
child’s PFC creates narratives
to explain implicit memories)

Self exploration and self
development are hindered
(parts cannot develop
properly)

Psychological safety requires
preserving illusion of
connection with caregivers.
Requires significant self-
abdication, i.e., the forfeiture
of self- esteem, self-
confidence, self-care, self-
interest, self-protection,
physical self-awareness
(somatic cues), body trust

Shame narratives are
ultimately internalized by the
child as their own authentic
voice. They feel true.

45

Neural pathways expand into

a large complex network that
dominates mental activity,
driving profound anxiety, and
invoking shame just as it did
in our past.

Eventually, inclination
toward authentic self-
expression activates shame
narratives

Survivors may live in varying
degrees of this “emotional
flashback” much of the time

Soothing mechanisms like
binge eating develop in
response.

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23
 Resulting Underlying Beliefs

I caused this
I deserved this (and

whatever shame that

I am not lovable
comes my way)

I am defective (weight

Others are better/more
stigma narratives)
deserving than me

I am stupid

I will be hurt

I will be alone

I cannot survive pain/I
am weak

47

“My parents assigned chores, but no instruction or support was

ever provided to ensure successful completion. I tried, and from
my 7-year-old perspective, thought I did what was asked. Until I
was yanked out of my sleep and bed at 1 a.m. to look at the
‘half-assed job’ I did putting away the silverware. Did I put it in
the wrong drawer? I was sure I hadn’t. I looked at my Dad,
confused, which seemed to infuriate him further. ‘Look!’ he said.
I looked, still unsure what the problem was. Then, he pointed it
out. I had placed the spoons in their slot in the silverware
drawer, but I had not put them in so they were nesting against
each other. They were willy-nilly backwards and forwards, and
not spooning against each other the way my Dad thought they
should be. I heard all the time ‘How could you not know that?
How can you be this stupid?’ I can't remember ever feeling like I
was capable of doing a good job of anything."

48

24

“I am constantly going over what I did wrong, might do wrong,
will do wrong in the future. It might be being fat. It might be
being loud. It might be basically anything. Growing up, it could
have been anything, at any point. It just feels like reality to be
afraid.”

“Relationships always feel like a sheer cliff, or a tsunami. They
could shatter at any point. I am alone in this life. And ill-
equipped to be safe.”

“When Greg looks at me in the eye, I instantly am flooded with
shame.”

49

What if the fears are “right”?

Mom’s suicide when client came home on
later bus: “My mother’s depression was up
to me to fix. I read to her. I put cream on
her hands. I brushed her hair. When she
stayed sad, I tried even harder. I could
never leave her; I was terrified she
wouldn't be ok without my help.”

Legacy trauma (the black cloud

waiting to storm; if it happened
once, it can happen again (true)

Present environmental dangers

Work is to help clients deal with

dangers with their “now” resources,
not their “then” resources

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25
 Why Binge Eating “Works”: Some Possibilities

Some studies suggest that cravings for foods high in sugar and fat
may be connected to higher levels of cortisol production
associated with ongoing stress. These foods seem to lower the
production of cortisol short-term

Dopamine surges associated with” highly palatable foods” (may
be driven by impact of forbidden nature of these foods) lessens
experience of trauma activation

The hormone ghrelin (the “hunger hormone”) may play a role.
Increased ghrelin is produced during stress and thus may trigger
an increased desire to go to food to meet perceived “hunger”
cues.

The enteric nervous system may play a role. Part of the limbic
system, the ENS is a complex of nerves that regulate the activity
of the stomach (sick to your stomach/”butterflies”). Overeating
may somehow impact our experience of ENS activation in times
of stress

Biological impact of overeating: both the PFC and limbic system
are temporarily less active when people overeat significantly as
the body is focused on digestion. Thus the “numbing” effect of
overeating on emotional and cognitive awareness.

51

“The moment I decide to binge, I’m

free. I can feel my body relax and
then kind of disappear. Then I see
the evening ahead of me. Just me,
the TV, and the food, then sleep. A
kind of sleep you can’t get without
bingeing. There won’t be room for
anything, or anyone, else. I won’t
think about all the things I’m going
to screw up tomorrow, or who
doesn’t like me, or who is going to
leave. Nobody can get to me here.”
-Allison

52

26
 Is it possible to heal BED
when trauma is present?

53

Kallie
"I was full of shame about an interaction I'd had with one of my
students that day. I was sure I had lost all credibility in her eyes,
and did not deserve to be a professor, much less a dean. I was
feeling failure and fear—just as I did years ago with my
judgmental father—when suddenly I noticed an amazing sunset out
my window. I was taken aback by its beauty and color. My shame
and fear, in that moment, were suspended by simply appreciating
the beauty of nature. That was all it took for me to realize my
shame was driven by a young, scared part of myself. It was not
actually in response to my life now. I knew my father was wrong
about me. He had had his own heart broken, and all he could see
was his own shame because he was never good enough. I needed to
learn to come back into my adult wisdom if I was going to address
and soothe this recurring shame storm. My father was not an
accurate judge of my ability. I am capable, even if I make a
mistake. I didn't get to this place in my career by accident or by
fraud. I got here by hard work, skill, and support from colleagues.
I deserve to be here. I just lost track of that for a moment. I was
ten again."

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27
 Common Roadblocks
with BED Treatment Approaches

Pathologize binge behaviors (called a “disorder”, not a
“damn good try at coping’)

Don’t dive deeply enough to allow pain and rage to be
safely expressed, and shame to be healed and released

Make the clinician the “expert” in the room

Define recovery principally behaviorally, using words like
“relapse”

Don’t incorporate teaching body trust

Don’t incorporate education on body shame and the thin
ideal as intrinsically built on misogyny, racism,
objectification and healthism

Encourage weight change as a treatment goal

Fail to explore the terror (or the grief) of letting body
shame go

55

The best models for treating BED and trauma allow

therapists to:

See our clients as survivors

Understand binge eating as a red badge of courage and help client develop
empathy for survival value; vilification of binge eating reinforces trauma
narratives

Recognize and challenge “recovery perfection” (the idea that going to food to
soothe should never happen again once recovery is ”reached”)

Teach curiosity and compassion as core recovery skills

Instead of/in conjunction with interpreting transference, offer education about
the impact of trauma on relationships

Incorporate the body as an ally, not a problem to be fixed, and help clients learn
somatic skills to recognize and lessen trauma activation

Recognize the “person in environment” as key to healing and resiliency

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28
 Internal Family Systems

Strengths based

Allows access to split off experiences safely

Heals shame narratives

Inherent compassionate re-parenting; brings the cure
directly to the wound (unlike a more psychodynamic
approach)

Allows a feminist lens

Allows for healthier boundaries in relationships

57

“We all know about those luminous moments of clarity and

balance, in our own lives and in those of our clients, which come
briefly now and again. However we get there, we suddenly
encounter a feeling of inner plenitude and open heartedness to
the world that wasn’t there the moment before. The incessant
nasty chatter inside our heads ceases, we have a sense of calm
spaciousness, as if our minds and hearts and souls had expanded
and brightened. Sometimes, these evanescent experiences come
in a bright glow of peaceful certainty that everything in the
universe is truly okay, and that includes us – you and me
individually – in all our poor struggling, imperfect humanity. At
other times, we may experience a wave of joyful connection with
others that washes away irritation, distrust, and boredom. We
feel that, for once, we truly are ourselves, our real selves, free
of the inner cacophony that usually assaults us.”
Richard Schwartz, Founder, IFS

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29
 Why IFS with BED?

Recognizes our fundamental “unbrokenness”

De-pathologizes binge eating

Empowers clients to realize they are fundamentally
healthy and lovable (Self and body are just right, as
is)

IFS is fundamentally collaborative, “Self as expert”

Empowers clients to cherish and protect their bodies
from weight stigma and cultural narratives in Self

Helps clients regain access to delight, hope,
resiliency; to feel a “transcendence” from trauma
and their eating disorder

59

BASIC ASSUMPTIONS OF THE IFS MODEL

• It is the nature of the mind to be subdivided into an indeterminate
number of subpersonalities or parts.
• Everyone has a Self, and the Self can and should lead the individual's
internal system.
• The non-extreme intention of each part is something positive for the
individual. There are no "bad" parts, and the goal of therapy is not to
eliminate parts but instead to help them find their non-extreme roles.
• As we develop, our parts develop and form a complex system of
interactions among themselves; therefore, systems theory can be
applied to the internal system. When the system is reorganized, parts
can change rapidly.
• Changes in the internal system will affect changes in the external
system and vice versa. The implication of this assumption is that both
the internal and external levels of system should be assessed.
• Connection to Self best enables us to connect with others; we feel “part
of something bigger”; creates space for compassion and empathy

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30

OVERALL GOALS OF IFS THERAPY
• To achieve balance and harmony within the internal
system
• To differentiate the Self so it can be an effective leader
in the system
• When the Self is in the lead, parts will provide input to
the Self but will respect the leadership and ultimate
decision making of the Self.
• All parts lend talents that reflect their non-extreme
intentions. All are valuable and welcome.

61

The Relief of IFS

Clients are typically awed and greatly relieved at the idea of Self; they have often felt very
alone

Self automatically brings compassion and curiosity to parts; this relationship heals shame
and fear narratives more quickly and directly than healing through transference

Working to develop relationships b/w parts makes for resilient change (all parts are on the
same team)

Parts don’t want to have an eating disorder. Parts lead where they need Self to go; there is
little need for clinical interpretation, thus keeping the client’s Self as the source of wisdom
and change

Unblending helps clients distance from the drive to restrict or binge, and address the drive
as a part in an extreme role

No need to disclose to the therapist

Trauma can be truly healed by “changing the ending” and bringing exiles to the present

Clients reclaim more of their ”best lives” by helping protectors change roles. “If the part
knew it could ease back on its job a bit and Self would be there, what else would it like to
do (i.e. who is this part without the job laid onto it by trauma)?

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31

SELF
• Different level of entity than the parts -- often in the center of the
"you" that the parts are talking to
• When differentiated, the Self is competent, secure, self-assured,
relaxed, and able to listen and respond to feedback.
• The Self can and should lead the internal system.
• Various levels of experience of the Self:
• When completely differentiated from all parts (Self alone), people
describe a feeling of being "centered."
• When the individual is "in Self" or when the Self is in the lead while
interacting with others (day-to-day experience), the Self is
experienced along with the non-extreme aspects of the parts.
• An empowering aspect of the model is that everyone has a Self

63

Self

Is fundamental

Is undamaged by the past

Is indestructible

Is an active, gentle, powerful
leader

Is able to safely navigate
relationships outside the
internal system

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32
 The 8 Cs of Self

Calmness - The ability to react to triggering situations
mindfully.

Clarity - The ability to perceive situations clearly,
without distortion caused by fears/schemas. Able to
remain objective in situations where you have an interest
in the outcome.

Curiosity - A strong desire to non-judgmentally explore
and learn something new about a topic, situation or
person. To have a sense of wonder about life, permission
to be a student.

Compassion - Being open-hearted, present, and
appreciative of others -- without feeling the urge to fix,
change distance or judge.

Confidence - The ability to stay fully present in a
situation. Internalized growth comes from healing past
traumas and an understanding that life includes making
mistakes.

Courage – The ability to face threats, challenges or
danger effectively; taking responsibility for one's actions
without taking on what is not ours, and being willing to
reflect and improve.

Creativity - A flow state, where imagination is capable of
producing ideas and expression spontaneously; a state of
pleasure from immersion in the activity at hand.

Connectedness - Feeling connected to others, allow
companionship; being a part of a team, community,
organization, or group.

65

Connection to Self

Meditation (“coming back to the mat”)

Visualization/writing/ Pathway meditation

Breath work

Artwork/Music (as participant or consumer)

Time with animals/nature

Important work

Joyful movement

“Where are you simply you, unaware of any other
possibility?”

Help others in need

Self’s Board of Directors (who would your advisors
be?)

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33
 Loss of Connection to Self:
The Impact of Early Trauma

Trauma requires a great deal

of Self-abdication, i.e., the
forfeiture of self- esteem,
self-confidence, self-care,
self-interest, self-protection,
physical self-awareness
(somatic cues)

Connecting to Self is often
the biggest challenge in IFS
work for people with CPTSD
and BED; parts are often
terrified to ease back and
allow Self to take the lead

67

Jenniee described a sense of panic at the idea of cleaning out old papers and
magazines from her house. Despite her husband’s frustration (and hers too)
at her hoarding behaviors, every time she approached the task, she felt
overwhelmed with fear and shame. As she and I examined this reaction, it
became clear she reacted from a young part, from dangers of early
childhood. She remembered the erratic nature of her mom’s rage; her
mother blamed her for all kinds of things she could not possibly have caused.
My client's "good kid" part told her it must somehow be her fault that her
mother was so angry—after all, she could not consider her mother might be
wrong or dangerous, as my client's survival was dependent on her. This old
fear and shame was triggered by the risk throwing things away in the
present. Suppose she threw away the one thing she might need, the one
thing that would allow her to get it right? Throwing something away felt
dangerous. So, she avoided the task at all costs, and continued to hoard
objects which one day might save her from rejection. In the present day,
even thinking about the idea of clearing out these objects activated a hijack,
and my client would find herself, instead of making progress on the
reorganization, grazing through the cupboards for something sweet. As we
worked to connect Jenniee to Self, this part began to feel it might have a
better advocate than it had ever known, and that it might be safe to let go
of having to predict everything in order to survive.

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34
 What is a “part”?

Parts are little “beings” inside of us with thoughts and feelings
and their own experiences. When they ‘blend’ with us – ie, take
over our whole system – then in that moment it can ‘feel’ like
that’s who we are.

Protective parts:

A manager is a proactive part. They like to manage your life to make
you look good; they often use that ‘should’ voice inside your head.
Your inner critic is an example.

The reactive protector parts are your firefighters. When an exile is

‘triggered’, to protect you from becoming engulfed by shame, your
firefighter part may become enraged, or use drugs, alcohol, food,
shopping, or other activities, to distract you from the emotional pain.
Firefighter parts often don’t make us look good, so managers will get
on their case. They are often polarized.

Vulnerable parts: these sensitive parts are called exiles. They’re

the parts of you holding distressing feelings and/or beliefs. For
instance, it’s very common to have a part that believes it is not
good enough. It has been shamed, and carries that burden. These
parts are often young and frozen in the past. Manager parts may
decide that the best way to protect this kid is to always be
perfect, so they don’t get criticized again.

69

Impact: The Burdens Parts

Carry

Survive instead of thrive; we must work to be safe
in the world.

The danger is a way of life.

Sense of threat does not pass and get neurologically
encoded as “over”.

When trauma occurs early/often, we typically deal
with it in two discreet ways:

Live in “yellow alert”, trying to stay safe by
acquiescing to others

Disconnect from the felt sense of pain, fear, shame,
rage

In IFS terms, these coping strategies become the
“burdens” carried by young parts who split off to
protect the system from threats, and hold the pain,
shame and rage

These parts are referred to as Managers,
Firefighters and Exiles

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35
 Getting to Know Parts: The
Six Fs

Find

Focus

Flesh Out

Feel Toward

(Be)friend

Fears

71

“Blended”: what it feels like

when burdened parts speak

Somatic reactions to places, smells, touch that seem
out of place

Going over and over a conversation, looking for
“mistakes”

A big reaction of shame to mistakes

Feeling tension or holding your breath around others;
social anxiety

Body shame/obsession; shame and anger if you “blew
it”

The impulse to binge

The impulse to avoid, to check out

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36
 Managers: A Review

Managers are responsible for maintaining a functioning level of consciousness
in daily life by warding off any unwanted or counterproductive interactions,
emotions, or experiences resulting from external stimuli triggering an exile.

Sanctioned by the dominant culture

Highly reactive; their motto is “never again” to shame, humiliation,
fear/terror

Managers are concerned with staying on top of things, keeping others happy,
avoiding conflict, fulfilling the expectations of others, and of the social or
cultural milieu. Often called the “Critic”

Judgment is the most dangerous thing of all

They are focused on planning, controlling, and achieving, keeping things
going. They can be good organizers, but when there’s trauma, they are stern
taskmasters, critical and people-pleasing.

The more intense the affect of the exiles, the more extreme the tactics of
the Managers.

Typically admit to being exhausted

73

BED: Managers

In BED, this is the dieter/restrictor part; the

“Critic”; “changing my body will make me
safe, lovable”.

Holds body shame, buys into diet culture
and the cult of weight stigma. Managers are
highly susceptible to diet culture and thin
privilege

Believes that being in the right body will
redeem the exile(s). This belief provides
safety, and will not easily be relinquished

Others come first; managers are terrified of
conflict and judgement

Narratives are validated by both legacy
burdens and the current culture of body
shame and weight stigma

Rejecting the manager (“stinking thinking”)
minimizes the value of it’s role in survival;
it must be met with Self-led compassion,
not rejection

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37
 Lived Experience: Client
Writings

“I decided when I was in

college, at the height of my
eating disorder and at my
lowest weight, that I could
never have children. I saw
what happened to the
stomachs of my colleagues
in the nursing program. I
could never let all my work
be for nothing. I really
believed that having a baby
was less important to my
wellbeing that having a flat
stomach.”

75

Firefighters: A Review

Firefighters serve as a distraction when exiles break free

from managers. In order to protect the consciousness from
feeling the pain of the exiles, firefighters prompt a person
to act on impulse and engage in behaviors to dissociate,
distract, comfort, numb or check out.

Firefighters do not care about aftermath (that is the job of
the manager). Firefighters, as they name suggests, simply
act to mitigate pain, rage, shame.

Pathologized by the dominant culture

Their extreme roles are due to trauma, and not who they
really are

Firefighters, when trauma is resolved, typically serve as
appropriate “sentries” in relationships, advising Self as
needed. They no longer exist to avoid or distract from the
pain, shame or fear of the exiles.

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38
 BED: Firefighters

Binge eating often precedes

dieting when trauma is present

FF feel unstoppable, and out of
control; they needed to be to keep
the client safe

FF may use binges to numb, or to
express, rage and pain

FF can feel like a “teenager” to
many clients

Heroes of the system; despite
being rejected both inside the
system and by others/culture, it
keeps trying to push back against
annihilation by Managers

77

Lived Experience: Client Writings

“When I finally do decide

to binge, it feels like the
fight is over. That fight is
exhausting, and for a
moment, I’m actually
relieved.”

“When I get too close, I am
terrified. Binge eating
keeps everything at bay.”

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39
 Exiles: A Review

When a wounding experience occurred in the past, our internal system
“exiles” the wounded part. This enables us to continue to function,
rather than being overwhelmed or paralyzed by the pain contained in
the vulnerable part.

Managers and firefighters prevent exiles from reaching conscious
awareness, so that some level of functioning is possible. Despite this
however, exiled parts are rarely very far from conscious awareness

An exile is the age of the person when the wounding circumstance
occurred. They are living in the past. Their “present” experience is the
circumstance of the trauma they hold. Thus, shame and fear narratives
are still being “lived”. Exiles are thus desperate for care and safety.

Typically not tolerated by the dominant culture and/or the family
system

IFS enables us to bring exiles out of the past and into the present,
where they can release their burdens and take back their essential
qualities.

Most of all, exiles want to tell their stories and be believed

79

BED: Exiles

Hold experiences of extreme

shame, terror, helplessness

SA/PA/abandonment

Bullying (often weight related;
70% of those with BED have been
weight shamed)

May have faced death (or feared
it); hold existential terror

Can show up as severe body shame
(which is culturally reinforced)

Feel despair, hopelessness, shame,
terror

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40
 Lived Experience: Client
Writings

“I know that when the dancing

stops, there will be no chair for
me.”

“I am the booby prize; my brother is
the gold medal.”

“There is no way back from this. No
matter what I weight, how much I
make, how many letters behind my
name, the dark shows.”

81

Healing the BED Cycle

Help clients connect to Self

energy

Facilitate relationship between
Self and parts involved in the
binge cycle

Work with the polarization;
help parts trust Self and body

Unburden protectors and exiles

Provide psychoeducation about
body shame, weight stigma,
weight and health

Build body trust and intuitive
eating skills

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41
 The Unburdening Process in
IFS

83

84

42
 Finding a Part: A Brief
Exploration

85

Set Self-led Intentions with Food

and Movement

All foods are welcome; learn how foods impact the body,
and what works best

Learn to recognize who is driving a need to eat?

Is it a part leading the decision making, or the body? Learn to
determine the difference:

Where do parts live somatically?

When are they most triggered to eat?

Pause for parts; what do they need you to know?

Develop a place to listen

Food is an ok choice, but allow Self to explore other options with
the part(s) and to look at the consequence to the body

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43
 The Power of Self to Heal Body Shame

Self knows body shame is wrong. If you feel body

shame, you are feeling a part.

The goal of IFS is for parts to increasingly be safe,
have their voices heard, truths told, loved “as is”

The Goal of IFS is NOT to help the system succeed at
weight loss, dieting, or anything that promotes body
shame

Body shame is always coming from a burdened part

Body shame (including weight stigma) is an
internalized sociocultural construct; it is never an
authentic part of the inner system.

87

“It is much easier for

me to hate my body
than to hate my boss.
When I get mad at work,
I focus on losing weight.
Then I go home really
upset about work, and I
binge. Then I get up the
next day and hate my
body even more. My
boss gets away with
harassment and sexism,
and my body pays. It’s
the most familiar, safest
target of all.” -Erin

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44
 Mission Critical:

Self naturally is body compassionate, non-judgmental,

and trusting; body is not valuable because of its
appearance, but because it is home.

BIG help for clients to know when they feel body
shame, it is not a “truth”; it is coming from a scared
manager looking for a solution to being not good
enough.

Letting go of body shame means allowing the pain of
trauma to be present; it is scary to let shame go

Thus, clients can meet body shame with compassion
and curiosity, not shame it further by calling it
“stinking thinking”

Self needs the education and the data to help
Manager ease back. This psychoeducation is
imperative to treatment success.

89

“What have you done for me lately?”

A Self-led body-trust meditation

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45
 Helping Clients who Really,
REALLY want to lose weight

Explore what parts hold this desire most

(typically a manager)

What do they believe will change if the weight
is lost (typically an exile will be quieted)?

Help clients understand how this part’s fear-
led desire to lose weight is actually going to
increase shame narratives and trigger the
firefighter (i.e. increase binge eating)

Help clients be Self-led in their understanding
of weight stigma and body shame

Help client be Self-led in allowing their grief
for time spent in body shame and diet
mentality

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Allison: A Trailhead

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46
 You deserve to do your own
healing…

93

Thank you!

www.thebodywiseprogram.com

www.center4ed.org

[email protected]

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NOTES
NOTES