Trauma-Informed Approaches to Eating Disorders is clearly a much needed and long overdue book about treatment, written by a diverse group of clinicians and carefully edited to focus on the needs and strengths of clinicians. The complexities and challenges that undergird, surround, and even haunt the nature, diagnosis, treatment, management, and understanding of eating disorders (EDs)-in-relation-to-trauma are so great, even for veteran clinicians, that they can leave practitioners at any level of experience feeling helpless and exhausted. This book, in a way that would be appreciated by practitioners of acceptance and commitment therapy, accepts the reality of those feelings and is committed to improving treatment, understanding, and compassion. The book is designed to foster respect for complexity and link it to humility in the presence of tragedy, tribulations, and suffering, framed all too often by our own shortcomings as healers. EDs are dangerous, ubiquitous, usually chronic in nature, and difficult to treat. Anorexia nervosa (AN) has the highest fatality rate (4%) of any mental illness. Bulimia nervosa reveals a fatality rate of 3.9%. EDs offer an enormous challenge to therapists because of their complexity, which includes severe medical risk, co-occurring anxiety, depression and personality disorders, an addiction component, and body image distortion—all of this within a mediadriven culture of thinness in which starving and purging can for some become lifestyle choices. This complexity is further exacerbated by the presence of painful life experiences or trauma. The book elucidates the connection between trauma and EDs by offering a trauma-informed phase model, as well as chapters describing the ways in which various therapeutic models address each of those phases. It offers an in-depth exposition of a fourphase model of trauma treatment.
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This chapter provides an overview of recovery and beyond: dealing with triggers and setbacks. Recovery means holding tight to foundational ways of living that were learned in treatment and generalized into daily life during the healing process. Recovery can be inconsistent and unpredictable at times, demanding strength and courage to continuously redefine ne one’s self-story and live from one’s authentic self. Negative life events, whether they are large or small traumas, can act as powerful triggers, leading to the return of the eating disorders (ED). Stressful life events and daily life stressors can easily disturb unprocessed traumatic material, activating memory networks and causing pain and suffering, along with adding new traumatic material to the brain and body system. In the end, the therapist supports and celebrates the unique image of recovery that is self-defied, value-based, inclusive of fractures and imperfections, and created by the client.
This chapter presents a guide for assessing comorbid eating disorders (EDs) and trauma in a way that shapes and directs treatment. It draws together a combination of assessment tools and principles from the fields of EDs, trauma, and generic mental health, as there is limited literature available on this specific area of assessment. The chapter summarizes various aspects of assessment into distinct sets of guidelines, to help steer the clinician and client through a vast maze of information toward a meaningful formulation and treatment plan. It provides a road map to facilitate comprehensive assessments that lead to the construction of insightful formulations and the delivery of engaging treatment plans. The authors believe that trauma-informed ED assessment guides safe and effective treatment, shining a beacon of light on the road toward transformation and healing.