As a young dietitian working in an eating disorder treatment center, I often heard patients being described as “stuck” or “non-compliant.” Their providers (including myself) were frustrated because they couldn’t follow their meal plans or kept going back to eating disorder behaviors— despite endless support groups and therapy and nutrition sessions. When asked about their inability to progress in their recovery, they were often as confused as we were, because rationally they knew what was going to help them heal (in short, eating enough food and using coping tools), yet it felt impossible.

Once I was introduced to the role of nervous system regulation in recovery, these patients' struggles suddenly made sense to me. It became obvious that they were experiencing physiological, protective responses to perceived frightening threats that were impossible to rationalize away—and this was all happening outside of their conscious awareness. I realized that the missing piece to these patients’ progress was a felt sense of safety, both within their bodies and surrounding them, especially around mealtimes. Without this sense of safety, they were unable to take any more steps forward.

Research shows that nervous system dysregulation is common in people with anorexia, as well as among those with other eating disorder diagnoses. By becoming aware of what’s happening in your own nervous system, you can understand why and how dysregulation can lead to eating disorder behaviors, and use tools to regulate your system and find safety. “If someone has the tools to regulate their nervous system, they’re then able to make decisions about how they will respond in a certain situation, rather than feeling hijacked and simply reacting beyond conscious awareness,” explains dietitian Annyck Besso, MSc., RD, LDN. Read on to learn more about what the nervous system is, how it impacts eating disorder recovery, and how you can harness nervous system regulation to make mealtimes and other challenges easier.

What exactly is the nervous system?

The nervous system is complex: it’s a complicated network of specialized cells that coordinate all sorts of functions of the body, and there are two different parts of the nervous system—the central nervous system and the peripheral nervous system—both of which are further subdivided into more parts. In this article, I’ll be using the phrase “nervous system” to refer to the autonomic nervous system (ANS), a part of the peripheral nervous system that regulates involuntary bodily processes like heart rate, blood pressure, and digestion. Besso, who describes the ANS as “our personal surveillance system,” says the ANS is “constantly scanning our inner and outer environments and asking, ‘Is this safe?’ This scanning occurs beyond conscious awareness and control.” According to polyvagal theory, a concept developed by neuroscientist and psychologist Stephen Porges, there are three branches of the ANS: the sympathetic nervous system (SNS), the dorsal vagal pathway of the parasympathetic nervous system (PNS), and the ventral vagal pathway of the PNS.

If this all sounds extremely complicated and confusing, don’t worry—you don’t need to memorize the different parts of the nervous system to be able to reap the benefits of nervous system regulation. Let’s break down what these different parts do, and what it means for you.

The three nervous system states: fight-or-flight, freeze, and safety

First, let’s look at the SNS, otherwise known as your fight-or-flight system. The SNS triggers hyperarousal, which is when you’re super responsive and hypervigilant, meaning you’re extremely sensitive to potential threats or dangers. This can manifest in symptoms like clammy hands and feet, increased heart rate and blood pressure, flushed skin, anxiety, trembling, heightened senses, agitation, and aggression. “Think about how your body feels if you were to witness a car accident,” Besso explains. “Your heart rate would increase and you’d probably feel this strong urge to act.”

On the other hand, the dorsal vagal branch of the PNS causes hypoarousal (also known as the “freeze” response), which is when you feel shutdown or frozen and may experience symptoms like disassociation, flatness, numbness, isolation, exhaustion, or memory loss. Hypoarousal typically happens when a person feels extremely overwhelmed or chronically stressed, or following a traumatic event.

Both of the above states (fight-or-flight and freeze) are nervous system responses in reaction to a real or perceived threat. The third branch of the PNS, the ventral vagal branch, is the branch that helps us find safety—and the key to nervous system regulation. As Besso explains, the ventral vagal pathway is “responsible for bringing us back into an engaged, calm way of being. It’s what allows us to feel a sense of safety and connection.” This state is also described as being in your ”window of tolerance,” which is when you feel safe, present, stable, and connected, and are better able to function well and manage emotions. When you’re inside your window of tolerance, your heart rate, blood pressure, digestive processes, and breathing patterns are stable and running well.

Generally, when you’re not regulated (so, either hyper- or hypo-aroused and not operating in your window of tolerance), your nervous system tries to protect you the best it can. When you’re regulated (inside of your window of tolerance), you feel safe and connected with yourself and others. In this latter state, your body can tell the difference between an actual threat (like a speeding car approaching you) and a threat that’s only in your mind (like eating enough at breakfast, or a fear food).

How nervous system dysregulation can impact eating disorder recovery

In my practice, there's a common denominator in clients who have dysregulated nervous systems: they don’t feel safe living in their bodies. In eating disorder recovery, food is frequently associated with difficult emotions or trauma, so eating (often along with other factors like weight gain) can feel like a real threat. People with eating disorders often have weakened interoception (or the ability to understand how or what your body is feeling), so signals like hunger and fullness may be perceived as threats, too.

In the face of these perceived threats, people with eating disorders often turn to disordered behaviors that provide momentary relief and safety (a false window of tolerance). Besso explains that these behaviors “serve as ways to temporarily regulate the nervous system. They’re protective responses that help manage and respond to the discomfort.” But in reality, the relief they provide is short-lived, and this pattern only helps strengthen the eating disorder and sabotage recovery.

Remember, your nervous system’s threat responses bypass the logical thinking processes in your brain’s prefrontal cortex—which is why just having conversations about harmful food and body beliefs and behaviors often aren’t enough to let them go. “It’s so important to remember that rationalizing with someone who is in recovery from an eating disorder is typically not effective,” Besso adds. “The ANS perceives a threat where there isn’t one, but the response is as if someone asked you to walk alone at night in a dark alley.”

How hyperarousal leads to disordered behaviors

When you’re hyperaroused, behaviors and tendencies like restriction, eating past fullness, excessively exercising, rigidity and rules, obsessive thinking, purging, and bingeing may be present, along with physical symptoms like diarrhea, malabsorption and constipation.

“Decreased production of saliva and digestive enzymes accompanied with a fight-or-flight state can make eating even harder for clients in recovery, and can potentially lead to more discomfort in the digestive system like bloating, gas, distention, and irregular bowel movements,” explains dietitian Maura Fowler, MPH, RDN, CPH. “Having anxiety about body, food, or movement can then exacerbate the fight-or-flight state, feeding into the cycle.”

How hypoarousal leads to disordered behaviors

When you’re hypoaroused, on the other hand, typical responses look like checking out and numbing through behaviors and feelings like only wanting “safe” foods, a desire to disappear, food avoidance, difficulty making food-related decisions, disassociation, flatness, or people-pleasing around meals. Fowler adds that being hypoaroused can also make it hard to engage in recovery groups, therapy, and nutrition counseling. Physically, it can lead to slowed digestion, exhaustion, and prolonged disconnection from hunger and fullness cues.

“Pairing a low appetite with intense fatigue and purchasing, prepping, and eating five-plus times a day can be a big challenge,” Fowler says. “Dissociation can really complicate food procurement, prep, and eating, including the potential danger of cooking and leaving the stove on.” She also explains that being in either dysregulated state can make it difficult to connect with others and build safe relationships, which are an important part of recovery.

The good news is that learning how to regulate the nervous system and live in your window of tolerance can lead to lasting recovery. Besso says that when she works with clients on nervous system regulation, her goal is to help them “recognize and understand signals in their body that indicate their nervous system is dysregulated, and incorporate strategies to help them feel more regulated without engaging in disordered behaviors.” When I’ve witnessed clients being in their windows of tolerance, I notice they’re better able to access their “wise mind” and act in alignment with their values. It’s easier for them to affirm themselves, eat adequately, digest well, self-soothe, and use tools we developed together.

How to regulate your nervous system during and outside of mealtimes

In eating disorder recovery, having the awareness and ability to tend to your nervous system is like having a superpower, because it helps you understand why you use behaviors and how to help yourself find real safety within your skin.

According to dietitian Gina R. Mateer, RD, some of the benefits of regulating your nervous system during eating disorder recovery include:

• Improved digestion (leading to an easier time with eating)
• increased ability to connect with others and improve relationships
• Increased ability to move your body in a way that supports your nervous system
• Less difficulty letting go of eating disorder behaviors
• Improved ability to nourish your body adequately (and maybe even pleasurably)
• Building a more trusting relationship to food and your body

Plus, understanding that your nervous system has been trying to keep you safe can soften any judgement towards yourself for past or current behaviors.

9 strategies for nervous system regulation

Nervous system regulation can be a journey, just like recovery, but it’s worth it. Beyond the recovery-supporting benefits above, having a regulated nervous system can also help you throughout life, improving your ability to manage life’s challenges and connect with the people around you. Below are some expert-endorsed ways to begin regulating your nervous system:

1. Get to know your own system. First, take some time to explore what it feels like within your own system to be hypoaroused, hyperaroused, and regulated—a process typically best guided by a therapist. They can help you identify eating disorder behaviors and physiological reactions that occur when you’re dysregulated and explore ways to find safety and help you connect to how this feels physically, emotionally, and mentally. My favorite book to help you get to know your nervous system is Anchored by Deb Dana.

2. Embrace co-regulation. In my practice, co-regulation (where two or more people support one another’s emotional regulation) is often one of the first ways clients learn to find safety around mealtimes. Being in safe relationships with your providers and people in your personal life can significantly support nervous system regulation. So, lean on your trusted providers and loved ones when you’re feeling dysregulated, and ask them for what you need during and around meals. Perhaps it’s a listening ear, a dining companion, help with naming emotions, a hug, or simply their nonjudgemental presence.

3. Increase external safety. Your body has an unconscious surveillance system, called neuroception, that’s constantly assessing risk and safety around you, according to polyvagal theory. By bringing soothing elements into mealtimes, you can increase your sense of safety during a time when your nervous system is likely to sense a threat. Some examples include discussing soothing topics, listening to calming music, bringing objects that evoke safe and comforting memories (like a rock or shell from an experience in nature or a souvenir from a recent trip) to the table, having a beloved pet within petting distance, wearing a soft piece of clothing or weighted blanket, or looking at photos of things or people you love during meals. Besso also recommends “being in an environment that is visually calming and appealing” by decluttering the table and setting it with a nice tablecloth or cutlery.

4. Use mindfulness practices. Mindfulness practices, including breathing techniques and meditations, can be effective ways to regulate your system. When you're hyperaroused, try using an extended exhale breath, where you exhale about twice as long as your inhale. Fowler recommends diaphragmatic breathing (or belly breathing), as it “slows down breathing that may have become quick or rapid during peaking anxiety, helping regulate the nervous system.” When you’re hypoaroused, try an energizing breath practice (my favorite is breath of joy). For overall regulation, Mateer recommends starting with five minutes of meditation using guided resources (see below), and considering yoga nidra, or yogic sleep, which is a deep relaxation technique using guided imagery and body scanning.

5. Incorporate mindful movement. Before sitting at the table, it could be helpful to try some activating movements like shaking, jumping, pushing your hands together, dancing, or singing, all of which can help you upregulate from a state of shutdown or expel extra energy from fight-or-flight. Practicing yoga can also foster a sense of safety within your mind and body.

6. Try grounding practices. Grounding practices help bring you into the moment and back to your body when your mind has taken you away and left you feeling dysregulated. If you’re feeling hyperaroused at the table, help yourself get regulated by engaging your five senses and naming (to yourself or aloud) five things you can see, four things you can touch, three things you can hear, two things you can smell, and one thing you can taste. “Sensory check-ins are another way to focus away from any anxiety you may be having from food,” Fowler adds. If you’re feeling hypoaroused, engage any of your five senses and see what helps you feel regulated. It may be smelling an essential oil like lavender or focusing on your dog’s fur as you pet them.

For another grounding practice at the table, try feeling your feet, seat, and back connection to your chair and floor, and from there gently pressing your feet into the ground and your hands into the table. Outside of mealtimes, spending time in nature (and this could be as simple as putting your bare feet in the grass or sand) is another grounding way to nourish a dysregulated nervous system.

7. Use cold water. There’s a reason why some people love cold showers, and it’s likely because of the regulatory effect cold water has on the nervous system. In fact, cold water directly stimulates the vagus nerve, supporting physical, mental, and emotional regulation. Try using an ice pack or splashing cold water on your face if you, like me, aren’t a fan of cold showers.

8. Look for glimmers. According to polyvagal expert Deb Dana, glimmers are micro-moments that signal safety and connection to the nervous system, which can help build bigger foundations of safety and regulation over time. They’re joyful moments you intentionally seek out throughout your day, such as watching a sunrise, listening to birdsong, stopping to smell a flower, or savoring your first sip of coffee or tea.

9. Check in often. When you’re learning your nervous system, checking in regularly helps you gain awareness and understanding of what’s happening inside you. Take a few minutes before, during, and after each meal to see where you are in your nervous system. Start by putting your feet on the ground and noticing your breath, then ask yourself a few questions: “Am I regulated, hyperaroused, or hypoaroused? If I’m dysregulated, what do I need to do to find safety?”

Go at your own pace as you get to know your nervous system and learn which tools help and don’t help you, and know that it takes time and repetition to show your nervous system new ways of approaching eating experiences. Eventually, practicing your tool (or tools) regularly will greatly improve your ability to regulate in hard moments. Remember, nervous system regulation in eating disorder recovery is about finding what helps you feel safe enough to nourish your body, make choices that support your well-being, and move forward on your recovery path.

Resources for nervous system regulation

If you’re interested in learning more about nervous system regulation to support your eating disorder recovery, or the recovery of a loved one, here are several resources to explore:

• Anchored: How to Befriend Your Nervous System Using Polyvagal Theory by Deb Dana
• Polyvagal Card Deck by Deb Dana
• Free Nervous System Meditations on Insight Timer
• Safe & Sound Protocol Podcast Episode 20: “An embodied Approach to Eating Disorders with Rachel Lewis Marlow”
• The Embodied Healing Workbook by Catherine Cook-Cottone