Nourishing the Malnourished Brain
How Art Therapy Supports Eating Disorder Recovery
For individuals with anorexia nervosa (AN), healing goes far beyond food. Malnourishment impacts not only the body but also the brain itself, altering cognitive functions, emotional processing, and body awareness. Art therapy offers a unique and powerful approach to address these neurological and psychological complexities, helping individuals reconnect to their bodies, emotions, and sense of self.
Understanding the Malnourished Brain
Malnourishment profoundly disrupts brain function, affecting nine key areas linked to emotions, memory, decision-making, and body perception (Misluk-Gervase, 2021). These areas include:
Amygdala – The brain’s fear center, constantly on high alert in AN, perceiving food and weight gain as threats.
Hippocampus – The brain’s memory center, which becomes disorganized and struggles to store new information.
Somatosensory Cortex – Responsible for body awareness; malnourishment here contributes to the intense body image distortions common in AN.
Prefrontal Cortex – Key to decision-making, planning, and flexible thinking, which become impaired as malnourishment progresses.
Insula – The region responsible for sensing internal body cues, leaving individuals with AN disconnected from hunger, fullness, and emotional sensations.
These changes help explain why traditional talk therapies often struggle to fully engage individuals with AN. The brain’s very wiring has been compromised, meaning more embodied, sensory, and creative approaches can offer important healing opportunities (Misluk-Gervase, 2021).
Introducing the Nourishment Framework
To address these challenges, art therapist and researcher Eileen Misluk-Gervase developed the Nourishment Framework — a structured, art therapy-based approach tailored for individuals with AN (Misluk-Gervase, 2021).
The framework applies the Expressive Therapies Continuum (ETC) (Hinz, 2009) to select art materials and activities that match a client’s readiness across phases of treatment, from early refeeding to later recovery. Each stage supports the brain’s healing, helping clients rebuild sensory awareness, regulate emotions, and develop new self-narratives.
The 6 Components of the Nourishment Framework
1. Perceptual Component – Finding Calm in Visual Order
Early treatment focuses on simple, structured activities like mandalas or collages, which offer external organization for the malnourished brain.
These tasks engage the prefrontal cortex and hippocampus, helping reduce anxiety while promoting a sense of order (Misluk-Gervase, 2021).
2. Kinesthetic Component – Moving Through Tension
As clients tolerate more sensory input, they engage in physical, repetitive art-making such as clay work or large, whole-body painting.
Movement-based art helps discharge anxiety and rebuild body awareness, engaging the somatosensory cortex (Misluk-Gervase, 2021).
3. Cognitive Component – Externalizing Inner Stories
As thinking becomes clearer, clients use art to tell personal stories, blending words and images to explore self-concept and challenge rigid beliefs.
This activates the prefrontal cortex and supports cognitive restructuring (Misluk-Gervase, 2021).
4. Affective Component – Exploring and Tolerating Emotions
Through layered, expressive processes like tissue paper collages, clients identify, amplify, and discriminate emotions they may otherwise avoid.
These tasks engage the amygdala and cingulate gyrus, areas linked to emotional processing and social connection (Misluk-Gervase, 2021).
5. Sensory Component – Reconnecting with Body Sensations
Clients explore different textures, materials, and sensations — for example, creating origami with textured papers — while practicing guided visualization techniques.
This supports interoception (internal body awareness) by re-engaging the insula and somatosensory cortex (Misluk-Gervase, 2021).
6. Symbolic Component – Integrating Meaning and Identity
In the final stage, clients create personal symbols — such as carving a block print representing their recovered self — integrating insights from their therapeutic journey.
This process draws on the hippocampus, prefrontal cortex, and symbolic reasoning centers, blending memory, creativity, and meaning-making (Misluk-Gervase, 2021).
Why Art Therapy Works for the Malnourished Brain
Art therapy uniquely supports healing in individuals with AN by:
Engaging underactive brain areas, like the hippocampus and insula.
Creating a safe space for body-based exploration without overwhelming the client.
Combining cognitive, emotional, and sensory processing, fostering integration across brain networks.
Promoting self-expression and meaning-making, which are key to long-term recovery (Misluk-Gervase, 2021).
References
Hinz, L. D. (2009). Expressive Therapies Continuum: A framework for using art in therapy. Routledge.
Misluk-Gervase, E. (2021). Art Therapy and the Malnourished Brain: The Development of the Nourishment Framework. Art Therapy: Journal of the American Art Therapy Association, 38(2), 87-97. https://doi.org/10.1080/07421656.2020.1739599
