Eating Disorder Treatment: Reducing Harm Instead of Causing It
Eating Disorder Treatment: Reducing Harm Instead of Causing It
Treating eating disorders has been the single greatest joy of my career. I firmly believe that so often our field totes “recovery” as almost this abstinence model where one day you’ll be free from every thought, feeling and behavior associated with the eating disorder. As someone who has been in active long-term healing (I prefer healing to recovery) and who became a therapist who works with eating disorders I have seen much greater, long-term, sustainable healing when I translated the harm reduction model to eating disorder healing.
The Harm Reduction Model was created to address substance use with the idea that we can reduce harm by creating safer options for substance use rather than seeking it fully eliminate behaviors. This is what I loving call, “meeting the client where they are at.” In this way we allow clients to explore the connection to their behavior the purpose it serves and honor that is once helped them cope even if in the end it caused harm. Reducing guilt, shame and stress around recovery usually makes recovery/healing a healthier, safer and more sustainable option.
According to the National Harm Reduction Coalition the principals of Harm Reduction includes:
We accept, for better or worse, that licit and illicit drug use is part of our world and chooses to work to minimize its harmful effects rather than simply ignore or condemn them.
Establishes quality of individual and community life and well-being — not necessarily cessation of all drug use — as the criteria for successful interventions and policies
Ensures that people who use drugs and those with a history of drug use routinely have a real voice in the creation of programs and policies designed to serve them
Recognizes that the realities of poverty, class, racism, social isolation, past trauma, sex-based discrimination, and other social inequalities affect both people’s vulnerability to and capacity for effectively dealing with drug-related harm
Understands drug use as a complex, multi-faceted phenomenon that encompasses a continuum of behaviors from severe use to total abstinence, and acknowledges that some ways of using drugs are clearly safer than others
Calls for the non-judgmental, non-coercive provision of services and resources to people who use drugs and the communities in which they live in order to assist them in reducing attendant harm
Affirms people who use drugs (PWUD) themselves as the primary agents of reducing the harms of their drug use and seeks to empower PWUD to share information and support each other in strategies which meet their actual conditions of use
Does not attempt to minimize or ignore the real and tragic harm and danger that can be associated with illicit drug use
If we replace the word drug, substance etc and replace it with eating disorders you might see where I’m going with this. What if we decided to no longer eradicate the eating disorder and accepted it wasn’t a demon to be exercised but instead a wounded part of the self that hasn’t been able to heal? If we focused on re-establishing a quality of life the person wanted and instead consulted with people affected by eating disorders imagine how much more healing we could see in our world.
One of the biggest problems in the eating disorder world is that our culture still prescribes to the stereotype of the cis-hetero, thin, white, frail, girl who is refusing to eat in order to be thin. While this stereotype is true it is only true 5% of the time or less we miss out the real picture of what an eating disorder is, looks like and who lives with it. In reality the average person with an eating disorder is at a weight ideal for their body or higher, is BIPOC, AAPI or Latinx, comes from lower middles class background, and has many other marginalized identities including being 2sLGBTQIA+, over 40, without social supports, may have a disability, be a single parent or caregiver, may have insurance that doesn’t cover treatment or can’t afford treatment at all. And so often these are the clients that are missed in the doctor’s office, that are breezed over in assessments at the therapist office, that will say key words that get overlooked.
Eating disorder treatment requires the very same non-judgmental approach that the Harm Reduction Model suggests. Imagine how much easier healing would be if we didn’t feel forced into recovery and instead were asked how we wanted our journey to look and how much we felt we could participate in it. I can remember my first time working in treatment and being told to tell a client they would be kicked out of they used a behavior. I cried on my way home that day and vowed I would one day learn how to provide empathetic, compassionate treatment that reduced the harm of having an eating disorder instead of further causing it through a “clinical boundary” that could have been much more supportive and healing.
I continue to wonder why harm reduction hasn’t been more fully embraced in the eating disorder world. I am not an expert and would never claim to be however I have spent 60 hours a week for almost 10 years working in this field across all levels of care and I have consistently seen how BIPOC, AAPI, 2SLGBTQIA+, Fat/High Weight and Disabled clients have been accommodated or not accommodated for. In this process one thing has been consistently clear, it takes less work and causes less harm to work toward harm reduction rather than abstinence. I think of how Health At Every Size (HAES) ®, Intuitive eating, Dialectical Behavioral Therapy, Art Therapy, and Mindful Self-Compassion all lend themselves to this model, are the treatments most discussed for eating disorders and have been the ones I have seen being most successful and all actively seek to reduce harm by the nature of their design.
Like with all things in this world no field is perfect and treatment is equally imperfect as all things human being are. And, we can do better, we can offer comprehensive treatment that affirms people’s gender, respects the inequities of race and disabilities, that allows people of all sizes to access the treatment they need and we can offer that very treatment from an evidence-based perspective while reducing harm.
***If you’d like to know more about eating disorder treatment equity access and how to help please visit theprojectheal.org and rainbow-recovery.org