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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Trauma is unrelenting and pervasive; it bleeds into the present moments of daily life, often stealing joy, muting a person’s ability to fully connect and accomplish tasks of daily living. Starting with an overview of the internal family systems (IFS) model, this chapter discusses how IFS conceptualizes eating disorders (EDs) and approaches trauma treatment. IFS differs from other approaches to trauma treatment in several ways that we elaborate, especially eschewing the idea that stabilization and explicit skills training are necessary prerequisites for processing traumatic memories. Instead, IFS asserts that clients can learn to interact with the different parts of themselves without getting overwhelmed or needing the therapist to actively manage the process. The chapter uses case vignettes to illustrate how IFS achieves the goals of phase-oriented trauma treatment to heal EDs in a nonlinear, relational way.