When Understanding and Logic Can Only Go So Far with Giuliana Hazelwood MS, LAc
There is SO much information out there on therapy, eating disorders, and self-help therapy resources that you could spend endless amounts of time reading and learning… but what do you do when you’ve learned so much, and your life STILL isn’t changing the way you’d hoped?
Giuliana Hazelwood is the owner of Sense of Self Somatics. She’s an acupuncturist who also does coaching. She does a lot of somatic therapies – she specializes in eating disorders, but works with a whole host of other health challenges, like anxiety, depression, and trauma. Her work is informed in part by Internal Family Systems (IFS – we’ll talk about this a bit in this post).
Giuliana is the perfect blend of art and science. She is the creator of Bedside Manner Universe, which is a really cool place to discuss and learn more about the art of medicine and how the arts relate to science. She also has a podcast there – it’s pretty awesome.
What we’re talking about today is so important. When you listen to podcasts, read books, or scroll through blogs (ahem), I know you’re trying to learn new information to improve your life. So why then does nothing actually change more often than not?
Listen to the Episode Now
This is because increased awareness, understanding, and self-help therapy can only take you so far. Obviously, I'm going to be the first person to tell you that these things are important. But if we keep it in our brains and don’t actually move that into our body and incorporate it into our actual life… then what’s the point?
Today’s post is about how understanding, logic, and self-help therapy can only take you so far, and what the heck to do after that. So let’s jump right in!
Giuliana’s Understanding of Eating Disorders
Giuliana looks at eating disorders in what we call a bio-psycho-social context.
Meaning, first, there’s something biologically that’s going on that makes disordered behaviors and thoughts and patterns feel adaptive and self-protective.
Secondly, there’s something social that encourages or allows those behaviors to occur.
Finally, there’s something psychological that plays into the development and maintenance of disordered eating. In total, it creates a perfect storm that allows eating disorders to develop.
Giuliana explains that she came to this profession after suffering from OCD and later, life-threatening anorexia herself. She is grateful for that experience, because it helped her understand people a whole lot better. She gets the folks who read all the books and listen to all the podcasts and there is still something that seems to make no sense causing them to slip back into the same old behaviors.
During her own recovery, she was very into meditation and holistic health. She was doing acupuncture as a teenager and trying herbal remedies. She came to the conclusion that when you address issues on a physical level – not just on a psychological or emotional level – something does change because your body is experiencing things differently.
She then went to acupuncture school to start working clinically with people. She wanted to understand more about the biological context of disordered eating behaviors.
This led her to do more research about modalities other than acupuncture that she felt were more scientific in their approach. What she discovered is that while the research is really limited, there are certain biological and genetic markers for eating disorders.
There’s no eating disorder gene, but there are certain things genetically that are predictable for certain types of eating disorders. Interesting, right? Some of this is just biology we’re working with.
We’re NOT saying things are hopeless – we’re saying that although we can’t rewire your genetics, we CAN work with the neural system in a pretty powerful way to help some of these causes and symptoms.
Genetic Profiles for Restrictive-Type Disorders
So how exactly do genetic profiles connect to eating disorders?
Giuliana says it’s different depending on the type of eating disorder.
In a broad sense, for people who have restrictive-type disorders, there’s a common theme she sees with serotonin. Serotonin is a neurotransmitter that makes us feel calm and happy when it’s balanced, but when it’s too high it actually increases anxiety.
Based on the reward pathways of the brain and the way we synthesize and clear serotonin, it’s very common that people with restrictive-type disorders have a glitch in the way that the brain deals with serotonin. They’ll have chronically high levels of anxiety and one of the ways the brain deals with that is by not eating – by suppressing the urge to eat.
You’ll hear people say that after prolonged periods of not eating, they’ll say they don’t feel hunger anymore. Yes, that’s partially because the digestive system has slowed down, but that’s also because at a certain level in the brain, it’s actually rewarding to suppress hunger because it’s actually mitigating that super high serotonin level.
There are even theories that the ability to suppress hunger was an evolutionary thing. There had to be someone who could deal with famine – be able to travel long distances, not be distracted by berries on the trail as they travel, and be able to recognize weight loss in others so they can hunt for them.
All of this is just a theory – but also a way of seeing that there could have been a social, biologically, and psychological reason for this behavior.
Genetic Profiles for Binge- or Purge-Type Disorders
In a very broad sense, there’s also a glitch in the brain system for people with these types of disorders that rewards the pursuit of food. It’s usually linked to dopamine.
You’ll see this a lot in people with ADHD. That’s very often a case where physiologically, people don’t feel satiated or calmed by food, and the brain keeps rewarding eating past a level of comfortable fullness.
Or, the hormones in their body that make them feel hunger are WAY ramped up – so their hunger is not just emotional or a response to something psychological; it’s literally physiological.
Keep in mind, this is all one way to look at this and it’s never super clear-cut. There are so many other elements at play, especially anxiety or other stressors.
What Do We Do with This?
An analogy Giuliana uses is “the window of tolerance.”
We’re basically looking at your brain and body as having a certain capacity of tolerance for life. You can either open the window because it’s too hot and need fresh air… or you can close it down to rest and recover.
Throughout the day, you have the capacity to either open the window or close the window. Draw the blinds or open the blinds.
If you’re in a good spot and feeling good, your window of tolerance is pretty open. You can do a lot, considering all of the factors in your environment.
If you’re feeling really triggered or stressed out, it means you’re outside of that window of tolerance. When you’re on the end of the window, you’re hyper-aroused, or overstimulated. Your nervous system is taking in too much sensory input.
In those cases, the trick is to take away some of the stimuli. It’s like drawing the blinds.
If you’re really maxed out in the OTHER direction, the trick is to figure out how to open the window and tolerate it.
What Giuliana does is focus on what is the body’s physical reaction to being outside of the window of tolerance, and what can clients do with her in session to explore that in a way that is contained, safe, and exploratory.
What Does a Session Look Like?
Specifically, if Giuliana notices someone is outside of their window from either direction, what would it look like to help someone come back inside?
If you’re on the high-end fringe of the window, you will feel super anxious, explosive, angry, hyper-vigilant and alert, and that’s when a lot of compulsions will come out. Your heart may beat faster and experience sweating.
On the other end, the body shuts down to protect itself from anxiety. That might look like disassociation, excess sleepiness, and brain fog.
The work that Giuliana does helps people understand what their capacity is from moment to moment so they can take better care of themselves. So, the session help will look different depending on where they are in their window.
Let’s say someone comes in and they want acupuncture. Giuliana will have them lie down with a weighted blanket, so the brain knows where the body is in space. No matter what end of the spectrum they’re on, they usually will start here.
From there, it just depends on what people are working on. For example, if someone is dealing with the compulsion to weigh themselves, what she’ll usually do is walk them through a guided visualization. They will imagine themself in the moment they’re about to step on the scale. They’ll track their body and slow down their thought process. They’ll ask themselves what they’re going through physiologically in each part of their body… because when you’re at home about to step on the scale, you’re not aware of your body; you’re only aware of your thoughts. And we all know where that ends: back in the old patterns you want to break.
She helps people slow this process down and use very descriptive words to describe what’s happening in their physical sensations. With enough practice and coaching, she helps them realize they don’t feel good when they do this… so if they’re stepping on the scale to get some relief from their anxiety, this exercise will help them realize stepping on the scale will actually increase their anxiety.
In this way, the physical and somatic experience will now inform their higher-level thinking brain in a different way, because the truth is, the part of the brain that is rational can communicate and be really intellectual… but that part of the brain doesn’t talk to the part of the brain that feels things really emotionally.
In sessions, Giuliana helps people make a bridge in their brain to connect these parts.
If you physically get the body in a place where it’s more willing to cooperate from a neurological perspective, then you can bring in other things that are more emotional or psychological, or address the social context of the eating disorder.
IFS
When the body is ready, she very often will incorporate Internal Family Systems (IFS).
When the brain stops getting in the way the way, it becomes a lot easier to access parts of your personality that get developed through socialization and life experience. Often, these parts crowd out what is called the Self in IFS.
The way Giuliana likes to think of it is that you have a TRUE self that doesn't identify with the eating disorder. But there are parts of you that still act like someone with an eating disorder. So understanding what those parts are and what they’re trying to do – and having respect for them – make it easier to have a conversation with those parts.
I.E., asking those parts of yourself: What are you trying to tell me? And is there a better way to go through life?
Those conversations are easier to have when that window of tolerance is open. We have to be curious, rather than judgemental – and then, we can gather SO much information that allows us to make different decisions.
How Does This All Help?
First thing: it can be tremendously relieving to realize that you didn’t CHOOSE to have a disorder.
Your body has one goal: to stay alive. And sometimes, the body can be predisposed to use disordered behaviors to relieve stress.
This can happen for any number of reasons. But it can be relieving to know an eating disorder can have roots way beyond your responsibility. Of course we’re not saying to throw your hands in the air and say “it’s not my fault” and avoid doing any work. What we are saying is that by knowing this information, you’re armed with the knowledge that helps you focus your efforts in a more effective way. (Ahem, get offline and into therapy.)
So as much as we’d all like this to be true, you can’t think you’re way out of an eating disorder.
Tweetable Quotes
“It’s very common that people with restrictive-type behaviors have a glitch in the way that the brain deals with serotonin. They’ll have chronically high levels of anxiety, and one of the ways the body deals with that is by not eating – by repressing the physical urge to eat.” – Giuliana Hazelwood, MS, LAc
“The truth is, the part of the brain that is rational can communicate and be really intellectual… but that part of the brain doesn’t talk to the part of the brain that feels things really emotionally… so, what I do in session is help people make a bridge.” – Giuliana Hazelwood, MS, LAc
“If you physically get the body in a place where it’s more willing to cooperate from a neurological perspective, then you can bring in other things that are more emotional or psychological, or address the social context of the eating disorder.” – Giuliana Hazelwood, MS, LAc
Resources:
More From Rachelle
Hey there! I’m Rachelle, the host of the Understanding Disordered Eating Podcast. As a Licensed Mental Health Counselor, I work with clients to make sense of life’s messy emotional experiences.
I believe in the power of deep work and its positive impact on your life in the long term. Learn more about how we can work together here.
Sign up for my weekly newsletter for even more!
You can connect with me on Instagram, through my website or email me directly clicking the links below.
Subscribe & Leave A Review!
If you enjoyed this episode, you can show your support by leaving a review, subscribing, or sharing with someone who may need help. Click here to open this show in iTunes and leave a five star rating and review.