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This presentation invites the field to reconsider both conceptualization of eating disorder onset and traditional forms of treatment. Traditional ED pathology often emphasizes individual deficits, framing disordered eating as a story of maladaptive choices. This lens risks pathologizing the individual and overlooking the adaptive role ED behaviors may play within the context of maladaptive environments that create dysregulation. This presentation invites a paradigm flip: shifting away from an individualized behavioral deficit framework to one that views ED behaviors as adaptive responses to environmental and relational deficits. This talk will use the lens of Polyvagal Theory (PVT) and the framework of Dialectical Behavioral Therapy (DBT) to language this flip from pathology to adaptation. Rather than assuming ED behaviors as inherently pathological, the principles of PVT identify ED behaviors as attempts to regulate amid invalidating environments. The PVT principle of Neuroception explains the nervous system's consistent assessment of environmental cues of safety and danger and the behavioral and emotional response that autonomically occurs. This framing invites clinicians to consider how ED behaviors may be attempts to downregulate or soothe a system that feels under-resourced in overwhelming conditions. PVT shifts the clinical focus of ED treatment by inviting clinicians to identify the impact of systemic and environmental contributions to nervous system distress. DBT allows the therapist to create behavioral structure to help their patients identify and practice skills that can lead to both individual and environmental change. This shift allows DBT interventions to become increasingly collaborative and relational to encourage skill use to modify environments, build community, adapt individual responses to promote the felt sense of agency and choice to ultimately help patients create a life worth living. This talk will outline how therapeutic rapport built through the PVT principles can create an affirming space for patients to explore the complexities of ED behaviors and the nervous system's role in both the origin and maintenance of ED behaviors. This framework then offers the integration of DBT skills to support more than individual behavior change. The pairing of PVT and DBT can help a patient understand their nervous system's rhythms, identify the impact of specific environmental triggers (and glimmers), and how DBT skills can be utilized to empower a patient's felt sense of choice and agency. This interactive presentation will include didactic education reviewing these 2 modalities from the perspective of a RD and PsyD, experiential practices that highlight PVT techniques, and an overview of a case study to highlight the opportunities within this paradigm flip.
