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 focuses on an interpersonal/relational psychodynamic approach to working with eating disorders (EDs), which illuminates the links between symptom and meaning, action and words, isolation and relatedness. The work of any treatment of EDs is an ongoing, complicated mixture of direct intervention with the symptom and exploration of what the intervention means to the patient, including the role the symptom plays in the patient’s intrapsychic and interpersonal world. Understanding this as it unfolds relationally allows the intersubjective experience of both patient and therapist to collide, mingle, and ultimately coexist. Thinking about working with patients with EDs from this vantage point means that the experience of conflict is a therapeutic gain, not obstacle. Multiplicity and the capacity for dissociation are seen as part of the manifestations of what happens with patients with EDs.