"Anorexics often don't have good pons level functioning. Most notably, people with pons level challenges may not be aware of when they are hungry. Lacking an accurate perception of hunger, anorexics cannot then respond appropriately to their need for food." 

—Bette Lamont

Anorexia and the Brain
The Link Between Neurology and Eating Disorders:
An Interview with Bette Lamont

By Cat Saunders

Seven out of ten people--around the world in every culture--suffer some amount of brain trauma just being born. After that, people may get hit on the head, fall off a bicycle, have a car accident, or perhaps just collide with a cupboard door so that they "see stars."

In addition to these mishaps, people may grow up in families where there is abuse, physical or emotional neglect, severe repression, or simply a lack of knowledge about what children need to grow and be healthy.

All of these factors can affect the development and functioning of the brain. In innovative research, scientists have been discovering more about how traumatic childhood experiences can actually alter the chemical makeup and synaptic functioning of brain cells. In addition, this research is revealing exactly how these alterations in brain function can, in fact, result in a wide variety of physical, mental, and psychological difficulties later in life.

Thus, many issues that people suppose to be purely psychological, can also have an important neurological component. Since the late 1970s, a form of therapy called Developmental Movement Therapy has begun to address this overlap between brain function and psychological health.

Originally begun in the late 1940s as a way to help people with significant brain injury, this work was pioneered by a neurosurgeon named Temple Fay and a nurse named Florence Scott, along with their associates in the fields of education and physical therapy.

Several people in the United States, including Florence Scott, have continued to develop this work. One such practitioner is Bette Lamont, who apprenticed with Scott for many years and later founded the Developmental Movement Center and Developmental Movement Consultants in Seattle (see end of article for contact information).

In the following interview, I asked Bette about her work with helping clients to restore full brain function through Developmental Movement Therapy, also called neurological repatterning work.

Initially, she answered questions about the basic functions of the lower brain (pons level) and the midbrain, including a discussion of the physical, mental, emotional, and spiritual issues associated with these different parts of the brain. After laying this groundwork, Bette then addressed some of the neurological issues specifically related to anorexia and the brain.

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In very simple terms, the work you do involves the brain stem or pons level, the midbrain, and the cortex. Would you talk first about how pons level problems can show up at the psychological level?

People who have brain stem--or pons level--dysfunction often don't have good self-caretaking skills. If you have pons level damage in the extreme, you will stop breathing and die. But pons level issues run on a continuum.

Frequently, people who have these issues may report that they don't know why they're alive, they may not feel very interested in being alive, they may feel isolated or alienated from other people, or they may have suicidal tendencies. They often don't have good life-preserving skills because they literally can't perceive what is a threat to them.

People without a good sense of physical pain often don't have a good sense of emotional pain, either. They may be in a horrible relationship, but not even realize they are in pain until they do neurological repatterning work. One of our basic functions neurologically is to be able to feel pain, and to then be able to take ourselves out of painful situations.

Healthy babies have a powerful knowing of their right to be here. They may not look very powerful because they are so tiny, but when you look at what they're doing, their actions are all life-preserving. Their brains tell them to cry when they're hungry, demand help if they are in some discomfort, or crawl to get away from danger. Everything about these babies says, "I have the right to be here. I deserve to live."

After I completed my pons level repatterning work, I noticed that I didn't have that previously pervasive "I'm not good enough" thought anymore.

By the time I found out about your work, I'd already done more than 20 years of work on myself using all kinds of therapeutic disciplines, bodywork techniques, and spiritual practices. Yet my underlying experience of not feeling "good enough" persisted until I got my pons level "hooked up."

Feeling "good enough" is about the fundamental right to be here. Pons level function can be disrupted--for all kinds of reasons--early in life, so people don't realize this foundation piece is missing, since it has been missing since the very beginning of their lives. But we all deserve this fundamental knowing of our right to be.

If our brains are fully functioning, the feeling of being "good enough" should be present without effort. We shouldn't have to work at it.

Another thing that fascinates me about the brain is its relationship to bonding. You described the bonding process to me in terms of three stages. When you're first born, you don't know the difference between yourself and your mother (or other primary caregiver). At first, there is no sense of separateness.

Then, sometime during the first year, you go through a separation stage--which causes a lot of anxiety--when you realize that you and your mother are separate. If you continue to get everything you need to develop in a healthy way, you will progress to the third stage of bonding, which involves the development of your capacity to perceive your separateness and still feel safe.

At that point, you will be able to love and be loved, without having to "merge” with the other person. You also mentioned that a disruption in these developmental stages of bonding could contribute to codependent behavior later in life. Would you say more about that?

There is no absolute distinction between neurologically based responses and psychologically based responses. It is a continuum. This is why we advise clients to be in therapy during the year to two years it usually takes to do their neurological repatterning work. Lots of feelings can come up when you do this kind of work, and people often need help to consciously sort through and express all these feelings in a safe way.

Other than brief appointments to check people's repatterning movements, we generally only see clients about every two months for reevaluations. Since their movement work is done daily on their own at home, it's helpful for people to have the support of a good therapist, especially one who is knowledgeable about developmental stages.

It is typical for dysfunctional families to have many levels of dysfunction happening simultaneously. Often, a child who grows up unable to bond will have grown up in with parents who do not know how to appropriately nurture the child because these parents may not have finished their own developmental integration. Such parents may be remote and unresponsive, have a "flat affect," or be disinclined to reach out to meet the baby's needs.

If the baby is herself neurologically compromised, she may not be asking for her needs to be met in the insistent way healthy babies do. When both parent and child are unable to go through the steps of bonding, some pretty profound disconnections can develop over time.

The capacity to bond is first of all a neurological process. You can have a wonderful family and still not be able to bond, if your neurological development has been impaired in some way--through a difficult birth, a head injury, emotional trauma, or a lack of developmental opportunity.

Babies who have gone through all of their developmental stages, including creeping and crawling, have a better chance to integrate healthy emotional responses. It is these movements that support healthy brain development, and it is these same movements--along with others associated with our first two years of life in particular--which are used in Developmental Movement Therapy to help clients restore full functioning of their brains.

If for any reason pons level development is impaired, we may not move out of the separation anxiety stage. If we don't get to the stage where we can be separate and safe, we may always be trying to return to the only kind of bonding we can remember, which is the "merged" kind of bond we experienced at the beginning of our lives.

Then, if we didn't learn to bond in a healthy way early in life, we will tend to repeat the pattern of wanting to "merge" in order to feel loved. This may show up later in life as the tendency to become enmeshed or codependent with partners.

The good news is that if there has not been actual physical damage to the brain, our brains retain the information we need to learn how to bond in a healthy way. We can complete the developmental stages anytime in our lives, through the same movements that infants use to "hook up" their brains, as I mentioned before. The result will be that we can then bond with partners in a healthy way.

Would you talk about how midbrain issues can show up psychologically?

The midbrain is responsible for how we make bridges to the world and how we make buffers from the world. When I work with adults with midbrain dysfunction, there can be lots of problems with processing stimuli. At the extreme, people may be agoraphobic-unable to leave the house because the world feels too overwhelming for them.

Stimuli issues arise from not being able to sort things out, or not being able to prioritize what's important and what isn't. This can manifest psychologically with confusion about questions such as, "What is important? What should I do now? Where do I begin?"

Midbrain issues therefore involve organizational and focusing skills. If the midbrain is working, we can see what we want, and we can go after it in an organic way, without having to think it out with our high brain, or cortex.

Some presenting concerns for people with midbrain issues might be procrastination, staying such in ruts, or not being able to get on with their lives, in terms of setting goals and following through with actions to reach them.

The midbrain also affects a lot of body "housekeeping" issues, such as body temperature and sleep regulation, weight set point, metabolic function, and the ability to respond appropriately to "enough" in terms of eating.

For example, people with only midbrain dysfunction may have the tendency to gain weight, whereas people with pons level dysfunction might experience weight loss, and even anorexia, if their ability to feel hunger--and respond appropriately to it--is neurologically impaired.

In terms of the midbrain housekeeping functions I mentioned, people with impairment at this level might experience a whole range of physical and psychological problems, since it's difficult to be in the world comfortably if you're constantly fighting to regulate physical processes that should take care of themselves naturally.

What about the relationship between the midbrain and so-called "boundary" issues that people so often struggle with in relationships?

Yes, boundary issues! The midbrain tells us, through very specific visual and sensory cues, where our bodies are in space and where the world is in relation to us. I have never worked with anyone who has boundary issues who accurately knows where their body is in space. In simple terms, they don't know where they end and the other person begins, so it's no wonder they have boundary problems!

As these people do their developmental work, and their midbrains begin to function naturally, they come back and say things like, "I'm saying 'no' more often," or "I'm setting better boundaries for myself."

Something I've been noticing recently is the relationship between spiritual work and the brain. I tell my clients that when they start working with powerful energy at the spiritual level, they better get a neurological evaluation to see if their brains are working properly.

My analogy is that if your house isn't wired properly, you won't be able to turn on a switch without worrying about blowing a fuse or starting a fire somewhere. On the other hand, if your house is wired right, you can run a lot more energy through it without any fear.

That's true! I hardly need to elaborate on that, but I can share a story from my own experience. Before I did this work, my life was focused on looking for something outside of me-a spiritual practice or a therapy. I'd leaf through the local resource publication and think, "Oh, that's what I need...or that...or that...out there." I didn't trust what I had inside myself.

When I did my own neurological repatterning, the transition wasn't immediate because the work takes some time, but I noticed at some point that I wasn't looking through the resource guide anymore. I had a sense of my own self-worth, and I didn't need anything "out there" anymore. I felt grounded, in touch with my own wholeness--or holiness--and in touch with my own god within.

We are always in the process of trying to make ourselves whole. The more you feel whole on the inside, the less you need from the outside to feel whole.

That's well said. Thank you. I'd like to switch our focus now to talk more specifically about anorexia and the brain. From your clinical experience working with all kinds of people over many years, what would you say are the main signs of neurological dysfunction that generally characterize anorexia?

In the areas that I test, anorexics often don't have good pons level functioning. As a result, they usually don't have good pain perception, and they often don't respond appropriately to heat or cold, because they cannot accurately perceive heat or cold. Some anorexics may also still have a grasp reflex, which is an infant-level reflex that I can talk more about later.

In addition, anorexics may have an eye that overconverges or rotates in, though this is not necessarily perceptible to the untrained observer. This occurs because the pons level also controls the muscles that pull the eyes out.

Because of this, the anorexic may have poor visual convergence and some depth perception issues that can be mild, or severe enough to make the client feel anxious going out into the world.

Most notably, people with pons level challenges may not be aware of when they are hungry. For example, I have clients who say they must force themselves to eat, or perhaps they go all day without eating because they don't feel hunger, so they forget to eat. Lacking an accurate perception of hunger, anorexics cannot then respond appropriately to their need for food.

Clinically, those are the main factors I check, but I also listen to the stories anorexics tell. Often, their stories have a lot to do with neglecting their own needs, feeling like they don't belong, or not paying attention to their own survival needs--physically or emotionally. These may be people who have a long history of accidents or other forms of harm. Sometimes it almost seems as if they draw a lot of hurts to themselves.

Maybe they've had five or six head injuries, and a car accident, and they've been hit over the head, and they've fallen down the stairs. They may have sustained so many traumas that you wonder how one person could have survived it all. This isn't typical of all anorexics, but it is one kind of story an anorexic might present.

My sense about this is that these people's life-preserving instincts are not very acute. If they had more acute survival skills, they would be more aware of danger signals or negative cues from their environment, so they would either avoid such situations, or they would get away from them sooner.

The pons level is the part of the brain that notices what's happening in the environment--both internal and external--and says, "I need to be alive. I need to notice those things that are a threat to me--and pay attention to them--so I can continue to be alive."

As I mentioned, anorexics are almost certain to have serious dysfunction at this pons level. In fact, I'm not sure it's possible to actually be anorexic without pons level impairment.

There is only one woman I have ever worked with who discussed anorexia, but who didn't have any pons level hurt. She came into my office and said that she had tried to be anorexic once for three weeks, trying to starve herself in order to be thin. But she said her body wouldn't let her do it. I thought that was fascinating!

She was the only client I have ever seen who talked about anorexia as an issue, but who had absolutely no symptoms at the pons level. I often work with clients with no pons level symptoms, but anorexics always exhibit pons level trauma, even if subtle in many cases.

The point is that this client couldn't' be anorexic even when she tried, because her body wouldn't allow it. Her brain was just too healthy to let her starve herself.

The more I work with anorexics, the more I discover psychic and emotional factors that may seem subjective, but which must be included in order to give a true representation of the whole picture. If I am only working clinically, I would simply check for these pieces: What are their eyes doing, how appropriate are their responses to heat, cold, pain, hunger, do they have a grasp reflex, and how do they crawl on their bellies?

For example, some people who are anorexic get down on the floor, and at worst, I see someone who looks like a little fish, flopping along with their hands down below their hips like little flippers. Their bodies flop back and forth, and their legs move as if they are hooked together, like a tail.

It almost looks like there is a phylogenetic regression. This does make some sense, since the lower brain is sometimes called the "reptilian brain"--that part of us that links us to our ancestors on the evolutionary scale.

Overall, then, in answer to your question, those are some of the things I look for clinically: eyes, strong sensory skills, mobility of belly crawling, and hand function. In addition, I also listen carefully to the anorexic's story.

Would you say more about the grasp reflex?

Anytime you touch the palm of newborn babies, their hands will automatically grasp around whatever is touching them. This is a skill--a medulla and spinal cord skill. The next skill is that the baby can open her hand out, which is a pons level skill.

When under stress, some people who have pons level dysfunction may have their hands revert to that infant hand, the grasping hand curled into a little fist. The stress may be as simple as skipping, or being asked questions in a casual conversation.

This grasp reflex is typical for people who have pons level brain injuries; they are physically unable to release that grasp reflex. You've probably seen it in the tightly clasped hands of some stroke victims whose pons level has been affected.

But sometimes I see anorexics who have the tendency to close their hands into little fists, even when they are just talking with me in ways that would seem casual for other people.

Hmmm. I have noticed that in a couple of anorexic clients.

Yes. Neurologically, a doctor might notice it and say, "Yes, grasp reflex is present."

But I think the grasp reflex has many emotional ramifications in terms of the ability to open up. For example, at the stage where babies are starting to open up their hands, they are also starting to make much stronger connections to opening up to people and bonding.

I think the reflex ability to open the hand reflects that stage emotionally, too. When I work with kids who are unbonded, they do their belly crawling with their hands tightly closed into fists.

On a hypothetical scale of brain hurt form one to ten, with ten being high, where would you place anorexics?

I don't know if I can do a "one to ten" scale, but I can speak to the issue of severity of brain disorganization. The pons level is a place in the brain that cannot sustain much injury without death being the result.

But the brain is very complex. I think of the brain like a fan, with the small part of the fan representing the brain stem and pons level, and the upper, wide part of the fan representing the high brain, or cortex.

If a part of the wide, upper areas of the "fan" is hurt, it will only affect a small part of your experience. But if a part of the base of the "fan" is hurt, it can affect a significant part of your experience, since the base radiates up and out, and therefore affects a much greater area. Even small injuries at the pons level can have great consequences, both physically and psychologically.

I would say that anorexics have a significant level of brain dysfunction, compared to other clients and that of course all of our clients test at a different place on a continuum.

For example, one of our mutual clients (who is anorexic) has more pons level dysfunction than anyone I know who is not considered disabled. She is walking and talking and working a full-time job. And yet, if we were to consider just these kinds of people--people who have pons level injuries but who are still largely functional--I would say she is struggling at about an eight or a nine on a ten-point scale of brain disorganization.

That helps put it in perspective, because my sense is that anorexics' level of brain dysfunction is indeed quite severe. It's a tribute to the human spirit that these people can be walking around and living active lives despite their significant lack of brain support. I'm amazed that I did it myself through fifteen years of anorexia!

On the other hand, it's truly wonderful to see what can happen for anorexics when they start doing neurological repatterning work.

I want to say in all honesty that Developmental Movement work can be very difficult for anorexics. It plays a significant role in healing anorexia, but when anorexics begin doing even a small part of the work, it can stimulate so many deep emotions that it may be scary for them.

Also, when people have been that injured neurologically, it takes longer to complete Developmental Movement Therapy. This is not only because there is more extensive brain dysfunction to heal, but also because anorexics generally need to proceed more slowly due to the emotional repercussions I mentioned.

Even though it can be hard work I think neurological repatterning is an extremely valid way to work with healing anorexia, because it stimulates and heals the area of the brain that directly governs self-care and right-to-be issues.

I agree. For me personally, I'd succeeded in healing all the outward symptoms of anorexia before I found out about and then completed my own developmental movement work. But the deep, underlying thoughts and emotional patterns--or "crazy thinking" as I called it--did not dissipate until I did my brain work.

You mentioned earlier that you don't think it's possible for someone to be anorexic unless they have pons level hurt. Would you say more about that?

I should instead have said that it may be possible for someone to be anorexic without pons level involvement, but I've never seen that in my practice. There is definitely a psychological profile for anorexics, and I see that psychological profile when I work with them. However, it always appears to correspond to their neurological situation as well.

I think that if the psychological component is present without the neurological piece, the person would make different choices. A person with pons level dysfunction without the anorexic psychological profile might have other kinds of self-care issues going on, but they wouldn't be anorexic. That's my best guess.

How do you tell the difference between stoicism and the inability to feel pain? For instance, when I first came to you and you did the "pinch test" to see how good my pain perception was, I couldn't feel anything until you were pinching hard enough to bruise me.

I thought this was because I grew up in a family where emotions such as fear, anger, or sadness were considered signs of weakness, so I figured I had simply become stoic so I wouldn't show pain.

However, you told me this wasn't true, that if it was just stoicism, you would have been able to see at least some change in my face--some indication that my body was feeling pain, even if I was refusing to show it. But you saw no change in my face, and in fact, that test showed that I was literally unable to feel the pain until it was extremely intense.

After you did the pinch test at my initial evaluation, I finally understood why my friends always used to ask me, before I did brain work, "Why do you always wait until you're practically dead before you get help?"

Because of this work, I realized I did that because I was neurologically unable to do anything different!

Fundamentally, I think the brain is a mechanism that wants us to survive. I honestly don't think our will alone is strong enough to suppress things that hurt us.

Some people may have a neurological tendency toward suppression, and that might be supported psychologically. We could do studies about these people, and say they don't feel pain because their family messages were all about not showing pain.

But I have met siblings from those same families who are very responsive to pain, because of what's happening in their neurological profiles. In other words, I think the neurological piece accounts for the difference between stoicism and physiological insensitivity to pain.

It is important to say that if somebody has a history of not being able to feel and respond appropriately to pain, that person should not only do brain work--they should also do their emotional work. Even if the original trauma was primarily neurological, a lifetime of inappropriate responses to pain will likely result in a lifetime of emotional patterns that will also require attention as the brain work unfolds.

That makes a lot of sense. If a family has given children overt or covert messages that say, "don't show emotions," that same family may also have given them more than just messages. The children may also have sustained actual physical, psychological, or sexual abuse.

Or perhaps the children were neglected in terms of not getting their basic needs met, or in terms of not being responded to appropriately when they were in physical or emotional pain. The neurological and psychological pieces get interwoven together along the way.

I think the worst case I've seen in that regard was a situation where the father said to his children, "Don't show feelings." Then he would put his kids underwater and threaten to drown them, meanwhile demanding that they not say anything or show any feelings about him threatening to drown them. It was so twisted!

That kind of crazy making, double-bind behavior on the part of parents can really hurt children at deep levels. I've heard similar stories, though with different details, from women who have grown up in anorexic family systems. What changes do you see in anorexics when they start to do neurological repatterning work?

Often fear comes up--the fear of feeling. For some anorexics, it's simply the fear that they will gain weight and get out of control. For other people, it's fear about feeling pain, or feeling life and all its sensations in their bodies. For others, it's the terror of feeling anything at all, even ecstasy. The fears are different for different people, but fear is usually the main issue for anorexics.

That matches my personal experience as well as my experience in working with anorexic clients. As with any serious addiction, anorexic behaviors may serve to keep intense underlying fears at bay, so the anorexic feels more in control.

In a way, then, it's actually good when anorexics begin to connect with their fear directly--even though this can be difficult--because at least this means they're feeling the fear instead of avoiding it. I think that old adage is true: "You can't heal what you don't feel."

I agree that it's a positive sign when anorexics begin to contact the underlying fear, because then it can be addressed. Also, it's important to understand that the repatterning work--which allows these intense feelings to come up--is the same work that stimulates a growing sense of core strength.

This can be particularly helpful for anorexics, whose pons level is so badly hurt that they struggle with things that most people take for granted--like eating a casual meal with their friends or lying down to rest when they're tired.

When anorexics do brain work, they often begin to feel a growing sense of personal power--a sense that they can take care of themselves. They may begin to feel closer to people and more able to share their feelings with others.

With Developmental Movement Therapy, anorexics generally develop a stronger sense that they can survive, and that they have a place in the universe. I think that's the core: They begin to realize not only that they can survive, but also that they have a right to survive.

In the context of being able to survive, then, you're saying it's essential to be able to feel fear since fear is a basic component of our survival mechanism. Would you talk more about the relationship between fear and the brain?

The pons level is the part of the brain that says, "PAY ATTENTION! RED ALERT! DANGER! GET OUT OF HERE!"

It also says things like, "You're hungry--eat something!" If you get really hungry without eating anything, the pons level will get louder and say, "Get something to eat NOW! Take care of it or you're going to DIE!"

It's definitely essential to be able to feel fear or hunger or pain, so you know where that boundary is. That's the only way you'll do something about it.

That's another thing I often see with anorexics. They don't know where the pain boundary is, so the pain boundary gets trampled a lot. If you know where your pain boundary is--the line where you start hurting--then you're less likely to do things that might hurt you.

On the other hand, if you don't know where your pain boundary is, you won't feel fear appropriately when you approach your limits, so you won't have a warning to stop before you get hurt. This is true both physically and emotionally. In other words, if there is pons level impairment, you won't be able to say "no" to physical or emotional pain very well.

I remember something you once said about crawling on our bellies--the first kind of forward movement we do as babies. Is its purpose to help us get away from something we don't like?

Yes. Babies initially begin crawling to "get away from" something. You know, that little pons level baby is very powerful! If they sense that something is a threat, they crawl to get away from it. Eventually, they use crawling to go toward something, but initially, the purpose of belly crawling is to get away from danger.

We don't lose this piece of brain function, either. It's not like a baby tooth that falls out. Hopefully, we get more and more sophisticated layers of upper brain function, but that lower brain is still there, shouting out. It needs to always be alert and paying attention.

It's essential that we remain capable of getting away from pain or danger. This is a basic pons level function.

What you're saying is that if an anorexic has pons level hurt, she won't have the instincts or the reflexes to get away from situations she that might be harmful for her, whether those situations are related to her physical or emotional well being.

For the most part, that's true. She can get away, but often doesn't.

There are a lot of anorexics who were seemingly healthy in early childhood and who then became anorexic after a significant stressor in their lives, such as the onset of puberty. Can you explain how that might happen?

It's possible for stress to bring up neurological injuries or the underlying neurological dysfunction. Sometimes the high brain--the cortex level--has been compensating for the lower brain functions for a long time.

When a major physical or emotional stressor arises, the underlying dysfunction may then make itself apparent, if the high brain can no longer compensate for the lower brain functions plus do its own job.

Another possible explanation is that the person may have had some kind of neurological injury in the intervening time since early childhood, such as whiplash from a car accident.

Since there is often some degree of sexual abuse in the background of many anorexics, would you talk about how sexual abuse can impact the brain?

I'm very interested in that, but I can't give you a linear, cause-and-effect answer. I do have a lot of thoughts about it. Recently, I've been reading a book that explores what kinds of characteristics are common among children who have been sexually abused.

I believe there is likely something going on for these children neurologically. It is possible that some of the children who get abused already have more neurological dysfunction, which makes them more vulnerable.

For example, such a child might not put up good boundaries if they don't know how to recognize and appropriately respond to hurt. Maybe they don't know how to stand up for themselves and say, "Don't touch me or I'm going to kick and scream."

If they don't know their boundaries, another person could more easily abuse them. This is not to say that these children are inviting the abuse, or that they are somehow responsible for it. I hate that kind of thinking! However, there is some piece of truth in the idea that a child who doesn't have a good sense of boundaries might be more vulnerable to abuse.

Another answer to the question of how sexual abuse might affect the brain revolves around the issue of early development. We have this great mechanism within us that makes sure we do everything we need to do to help our brain develop, so we can be healthy, whole human beings. But sometimes there is violence in the household. Sometimes there is physical or emotional or sexual abuse that threatens the baby.

Infancy and childhood need to be safe and joyous in order for this internal mechanism to develop fully. However, if the environment is threatening in some way--if the baby is physically or emotionally battered or her needs neglected--she may withdraw. If this continues, the baby may not play, crawl, roll around, and do the kinds of movements she needs to do to develop neurologically.

In this way, the abuse could impact her neurologically and keep her from growing. It could even keep her from growing physically, because a baby who is deeply withdrawn from a scary environment might shut down and not want to eat.

This question of the relationship between sexual abuse and brain dysfunction is very complicated. We could talk for days about it and uncover all kinds of related issues. But overall, those are two of the main ways I think abuse is related to brain dysfunction.

In the first scenario, a child who is already neurologically impaired may not have strong enough instincts to ward off--or escape from--inappropriate behavior by others. Again, this in no way means that the child is responsible for the abuse.

The other way abuse can negatively impact the brain is when a child is denied a safe enough environment so that she can freely move and explore, and thus do the physical movements necessary to complete the brain's developmental stages.

I appreciate your repeated mention of the fact that a child's neurological impairment and increased vulnerability does not make her responsible for any abuse that is perpetrated on her. The danger of "blaming the victim" can be particularly acute in the case of anorexics, because they may already blame themselves.

Anorexics tend to be overly responsible--sometimes to the point of thinking everything is their fault. They might think they are somehow to blame for the abuse, since they didn't know how to communicate their boundaries better, or avoid that kind of person better, or fight off the abuse more effectively once it began.

Because of this tendency toward self-blame, I want to join you in reiterating that no matter what shape a person's brain is in, the responsibility for any and all abuse rests squarely on the shoulders of the abuser. Period.

Yes. There are definitely people who will hurt anyone, no matter how good the other person's boundaries are.

And abuse can and does affect and hurt a healthy brain.

That's right. It's also important to understand that the younger a person is, the more any abuse will impact the health of her brain.

The biggest cycle of growth happens when the brain is first developing. If you think of development like a spiral, then birth to six or eight years is the first big cycle. Then we work through these stages again and again.

The first main cycle is the one I work with, from birth to six or eight years. But every time you replay that cycle--at whatever stage you're in--abuse can retard your growth at that stage of development as well.

Say you're 14 years old, and you're starting to reach out to the world in a sexual way, and that's when you get abused. That abuse can impact your growth neurologically, because many functions that relate to social skills and judgment are maturing at this age.

If there's a healthy brain underneath the stress of abuse at that time, then I think it's more likely that the person will recover from the abuse as a teenager. However, we spoke earlier about what might happen if there isn't a healthy brain underneath.

That is, if there is a significant stressor later in life and the brain has already been hurt, then the stressor may cause the underlying dysfunction to make itself more apparent or become more pronounced.

Is there any kind of ballpark figure you could give for how long it might take an anorexic--say, one who is pretty severely impaired neurologically--to heal her brain doing Developmental Movement Therapy?

I'd say that if the person were willing to work really solidly for three years, she would be through most of it. But the only answer I really have is that the person would have to keep working until she has "paid her brain debt."

I know that may not be a very satisfying answer. For most functional adults who are doing developmental work, it generally takes two to three years for them to complete the work. But for people who are anorexic, who have so many psychological components to their work, it may take longer because so much comes up for them emotionally.

It's important to note that I do work with people who have pons level dysfunction who don't feel hungry and who don't take good care of themselves very well around food. These people will do the program and start feeling hunger.

At that point, they simply begin eating again, because they don't have the underlying emotional patterns attached to issues of self-care. These people often get over their starvation issues in three to five months, because there is no emotional processing to do.

I don't know if you'd call these people anorexic, because they don't have the fears surrounding food, or any of the other psychological issues commonly associated with anorexia. I don't know if that's classic anorexia, do you?

I wouldn't call it that. I realize the term "anorexia" can be used to describe a basic medical condition of not eating. However, the kind of anorexia I'm talking about with you here is an extremely complex illness that arises from an interplay between physical, emotional, neurological, familial, environmental, sociological, and spiritual factors.

I wonder if you'd talk more about this issue of people having pons level hurt to the point of not taking good care of themselves around self-care issues such as eating, yet they don't become anorexic in terms of its classic psychological profile.

I've noticed that this situation shows up more often in men than in women. Sometimes it happens for women, but in my experience, it shows up more often in men. For people with severe pons level dysfunction who don't fit the psychological profile of anorexia, their brain dysfunction may simply manifest as them not taking good care of themselves in other ways.

For example, they may simply "forget" to eat because they don't get proper hunger signals, as mentioned before. They may take unnecessary risks that put them in danger. Or they might not have good self-care around survival issues such as keeping a roof over their heads.

That's interesting. I've thought a lot about why the vast majority of anorexics are women. Again, I'm talking here about anorexics who also have its psychological profile, as opposed to using the term to describe only the medical condition of not eating.

Although I think anorexia is very complex--and therefore ultimately mysterious--I do appreciate the importance of unraveling whatever components we can discern, so these issues can be addressed and hopefully healed.

It's no secret that males and females are treated very differently in our culture. Starting at birth--maybe even while they're still in the womb!--people are bombarded daily with various messages about what it means to be a girl and what it means to be a boy.

As you know, these messages come from parents and relatives, from schools and churches, from peers and the media, from various ethnic groups, from the government, and from the culture as a whole.

For women, it seems like there is a pervasive barrage of messages--both blatant and subtle--that denigrate womanhood or the feminine in one way or another.

Men are also exposed to messages that can be equally destructive to their physical and emotional well-being. However, men are generally not taught to consider themselves "second-class" citizens, and they typically have more leeway in regard to the size and shape of their bodies.

In terms of familial and cultural conditioning, at least, I think it's much less likely that men in American society would struggle with the same psychological issues many anorexic women struggle with, such as extreme body fears or the need to be "invisible" and not take up space.

Men do have a lot more latitude about their bodies. In fact, for men, being bigger is often considered better, stronger, and more male-and being more male is considered a good thing in our culture. So I agree that men will generally not experience the same psychological ramifications that women do in regard to their bodies.

On the other hand, pons level dysfunction in men may result in other kinds of self-care issues, some of which anorexic woman might have in addition to their eating disorder.

For example, men with pons level impairment may be more accident-prone than people with a healthy pons, because they don't recognize danger signals and/or because they don't realize when they've been hurt. They might accidentally get their hands cut up doing some task, but not notice until much later-and then they might wonder how it happened in the first place.

I have a question about anorexia versus bulimia. Do you see anything different in regard to brain issues for these two kinds of eating disorders?

I see both anorexia and bulimia as arising from the same pons level hurt. Most people who have bulimia tend to have that same kind of neurological profile. I don't know why they make a different choice in terms of behaviors, though.

One person who was bulimic said she would eat a lot, but not know that her stomach was hurting for a long, long time. You know those uncomfortable feelings that happen when you overeat? This person said she wasn't even aware of any discomfort. I think that's in the same category of not being able to feel and respond to pain or distress, which is a pons level issue.

I was bulimic for 8 years in my late teens and early 20s, at the beginning of my 15-year voyage through anorexia. When I binged, I remember that I could eat a ton of food before I felt uncomfortable, and then I would throw up so I'd feel completely empty. I went from one extreme to the other.

When you say that, it reminds me of people who cut themselves on their arms with razor blades, just to be able to feel, because their pain threshold is so impaired.

I've thought about cutting in regard to the brain, too, because that behavior does feel somehow similar to my own past experience with various forms of self-abuse.

As I think about everything we've talked about and everything I've learned from you over the years, I continue to be stunned by the profound impact of brain hurt in relation to anorexia.

I've often said to friends and colleagues that I sometimes want to scream when I hear people say--on talk shows or in the media--that anorexics just need to eat more. That's like telling someone with diabetes that they just need to process sugar better. Not only is this kind of statement uncompassionate, it's downright ignorant!

I wish you could be on Oprah to talk about the neurological component of anorexia, so people could understand that there is a "missing link" piece that very few people understand or even know about in regard to eating disorders.

Many of the other factors that give rise to anorexia are being increasingly well researched and addressed, I think, including the mind-body connection. But hardly anyone recognizes that the mind-body connection is not just a metaphor--it's literal!

Everyone's piece of the puzzle about anorexia is important, in terms of unraveling and healing the complexity of issues related to eating disorders. It's just that the neurological piece is not getting enough press time yet. That's why I'm interviewing you and that's why I've been such a mouthpiece for brain work.

As I've said many times, neurological repatterning work is the single most important work I've done in 30-some years of work on myself. And that's coming from a longtime counselor who values all the other forms of healing work that are helpful in overcoming eating disorders or any other debilitating psychological condition.

I now know that if my pons and midbrain had been intact instead of compromised, there's no way I could have become anorexic at age 17. Now that my pons and midbrain are "hooked up" from doing brain work, there's no way I could be bulimic or starve myself again. My body simply wouldn't allow it.

Yes. I think about what would happen if a woman in our culture had serious pons level hurt, but was never shamed or abused as a woman, never treated as a second-class citizen, and never encouraged to discount her own needs in order to take care of others.

If womanhood was honored and celebrated in all its fullness, I think there would be very little incidence of anorexia as a psychological disorder.

You can read more about Cat's personal healing story and witness her recovery process in pictorial form by viewing the free online version of her deck of 64 drawings called "Shadow and Light: Images of Change and Transformation for Women in Recovery."

For more information about neurological repatterning work, please contact Bette Lamont care of Developmental Movement Consultants at 206-417-1072 or blamont@serv.net.

Feel free to contact Cat for additional resources, referrals, and consultation support.