How to help with emotional dysregulation and an eating disorder

Whether your child is refusing to eat, binge eating, purging, or using other eating disorder behaviors, emotional dysregulation may be at the heart of it. And the good news is that emotional regulation skills can be built. These skills are key to reducing stress and anxiety at the table and helping your child relax enough to eat (and hopefully enjoy!) food.

Emotional regulation is part of our neurobiology, which is the biology of the nervous system. Recent scientific advances have revealed that the nervous system is incredibly complex and influences everything we think and do. The breakthroughs we’ve made in neurobiology have been led by the invention of the functional magnetic resonance imaging (fMRI) technique in 1990, which has driven a startling amount of progress in understanding our brains and nervous systems. This technique facilitates many insights into emotional dysregulation, and helps us understand why certain eating disorder behaviors show up. 

People used to think eating disorder behavior was driven by the mind, something called top-down thinking. This is best shown by the common accusation that having an eating disorder is a vanity-driven choice – it’s not! Instead, what we’ve learned is that most disordered behavior comes from the bottom-up. It begins in the nervous system, which is constantly scanning the environment for threats and triggering emotional dysregulation when threats are detected. 

Emotional dysregulation and eating disorders

Emotional regulation is a state in which we feel calm, engaged, and in balance. In this state, we have a healthy appetite, are happy to eat a variety of foods, and are pleasant dinner table company. However, when our nervous system perceives a threat, all that goes out the window. Instead of being emotionally regulated, we become dysregulated, which makes us either over-active (fight/flight) or under-active (freeze/shutdown).

A person who is dysregulated may feel nauseated and have no appetite. They may be sobbing uncontrollably. They may be disassociating with food and not even notice how much and how fast they’re eating. You can try to force them to eat or tell them to stop eating, but it’s unlikely you’ll be successful. Because until your child is emotionally regulated, they’re going to have a really hard time eating well.

Emotional dysregulation is both a cause and a symptom of an eating disorder. People who are frequently emotionally dysregulated are more likely to develop an eating disorder. But also, once an eating disorder develops it becomes a way to cope with emotional dysregulation. Thus, eating disorders and emotional dysregulation can grow together in a feedback loop.

Signs of emotional dysregulation

Most people describe someone in a regulated state as calm, confident, and engaged. This is when we get along with people and feel pretty good in our bodies and about ourselves. Eating is easy and delicious in this state and we are in tune with our hunger and fullness cues. When we become emotionally dysregulated, we either go to fight/flight or freeze/shutdown state. Here’s what this looks like:

Fight/Flight

Freeze/Shutdown

*If you or your child are feeling unsafe or in crisis, please call, text, or chat the 988 Suicide and Crisis Lifeline to communicate with a trained professional.

What causes emotional dysregulation?

Our nervous system is attuned to internal and external threats. Threats can come from inside or outside of the body. When a threat is detected, our nervous system signals the amygdala, raises cortisol levels, and triggers emotional dysregulation. This is a physiological response meant to protect us from bodily harm. 

We get activated into a fight/flight state when our nervous system drives us to run from or fight off a threat. And we go into a freeze/shutdown state when our nervous system drives us to hide to avoid a threat. This system was developed to protect us from predators, enemies, and natural disasters. However, in our modern world it’s more likely to sense threats in less-dangerous things like a food we don’t like or a situation that makes us uncomfortable.

People with highly sensitive nervous systems are more likely to be triggered into emotional dysregulation. Everyone can learn to get better at emotional regulation. However, people with a highly-sensitive nervous system who don’t intentionally build emotional regulation skills will tend to get more emotionally dysregulated over time.

Here are the benefits of having better emotional regulation skills:

• More balanced and calm state of mind 
• Able to cope with worry, negative thoughts, and difficult emotions 
• Greater self-awareness 
• Able to think more clearly and make better decisions 
• Greater emotional balance 
• Able to respond rather than react in stressful situations 
• More fulfilling relationships 
• Greater self-acceptance and self-compassion 
• Less embarrassment and shame

Also, when a person is emotionally regulated, they are able to eat regular, healthy meals and snacks to fuel their bodies and minds. Eating well both improves emotional regulation and is improved by emotional regulation.

Foundations of emotional regulation

Physical health is a foundational requirement of emotional regulation. Your child needs to meet their basic physical requirements to achieve emotional regulation: 

• Enough food, regularly throughout the day (every 2-4 hours) 
• Not weight-suppressed 
• Enough sleep based on the guidelines for their age 
• Emotional connections with others 
• Not sick

Even though it is harder for someone who is emotionally dysregulated to eat, it is also part of their recovery to eat. It will be very hard for your child to be emotionally regulated if they aren’t eating enough food regularly throughout the day. 

If this is an issue, increase the number of structured meals and snacks, which will reduce massive physiological spikes and dips. If your child is currently weight suppressed, then weight restoration is a priority.

Improving your child’s emotional dysregulation

If your child is in therapy, their therapist will teach and model emotional regulation skills like reframing thoughts, naming feelings, having self-compassion, and more. 

Your child can also improve self regulation skills with activities like meditation, yoga, breathing exercises, and other things that connect the mind and body and develop a felt sense of safety. My emotional regulation worksheets also help your child build these skills.

Best of all, your nervous system has shaped your child’s nervous system, so you are deeply attuned and responsive to each other. If you learn skillful co-regulation, you can help your child build their emotional regulation skills. This will make mealtimes much less stressful and help your child get the healthy nutrition they need. You can learn to more effectively co-regulate with your child to support them as they build emotional regulation skills.

When we co-regulate with children, we help them to feel safe, and to tolerate and make sense of their sensations and basic feelings.

Dr. Mona Delahooke

See Our Guide to Emotions And Eating Disorders