This chapter offers ways to be an effective therapist for clients who suffer from both an eating disorder and trauma (ED&T). It describes the importance of therapeutic presence and how to facilitate safety and healing through the therapeutic relationship. The information provided is equally applicable to all phases of treatment. Therapy for ED&T clients involves providing safety, education, insight, and a corrective emotional experience, thereby allowing the client to rectify faulty thought, emotional, and behavioral patterns. Therapists need to use their training and the therapeutic relationship for this to happen. The author’s experience treating ED&T clients corroborates the need for therapy training programs to increase their focus on training therapists how to achieve therapeutic presence, establish a positive alliance, and use the relationship to put the client’s symptoms out of a job.

Overwhelming evidence exists that traumatic experiences leave traces in our minds and bodies. Traumatic experiences such as sexual, physical, and emotional abuse have a negative impact on our capacities to relate to and trust other people, but also on the neurobiological functioning of our brain and thus our mind. They also affect our immune systems. Hence, traumatic experiences make dealing with emotions, both positive and negative, quite challenging. In this chapter, a “state-of-the-art” review reveals the presence of a wide variety of traumatic experiences and their consequences in anorexia nervosa, bulimia nervosa, and binge eating disorder patients. Almost all studies investigated the association of retrospectively reported childhood abuse with current ED symptoms using cross-sectional designs. A special focus is on the presence of dissociation in ED patients, as it is one of the main characteristics in EDs with severe trauma.

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.

This chapter briefly discusses the interaction of trauma, attachment injury, and dissociation in treating eating disorders (EDs). What is it that causes some people to develop an ED, and others to manage eating behaviors in a relatively normal manner? The answer is anything but simple. EDs are a biopsychosocial illness. They are the result of a complex interplay of factors including genes, temperament, social interactions, early attachment, culture, and of course life experiences. These variables come together and affect each other in a perfect storm fashion and may result in ED psychopathology. The cycle of being flooded with early, unprocessed trauma upon remittance of ED symptoms, followed by relapse, reduces the foundation of treatment to shifting sand. Unless the trauma and the ED are treated simultaneously, treatment becomes futile at best: fraught with multiple relapses, behavioral substitutions, feelings of hopelessness, and premature termination.

Neurofeedback therapy is a modality that can help a stuck brain get unstuck and learn new and better ways to fi re and function. This chapter describes what neurofeedback therapy is, how it works, and how it can be a valuable part of treatment for eating disorders (EDs). Neurofeedback therapy, also called EEG biofeedback or neurotherapy, makes use of the brain’s capacity for change to reshape brain networks. Neurofeedback uses EEG information to provide feedback to the trainee. Neurofeedback is a powerful training tool that can be used within a comprehensive treatment plan to assist clients to begin to have more control over how their brain fires. Neurofeedback therapy shifts arousal in the brain, which helps clients to alter the state they experience and to create a new narrative about themselves and the world around them.

Eating disorders (EDs) are common chronic illnesses that most clinicians, regardless of specialty, will encounter at some point, and trauma is universal in those who have EDs. Trauma from physical and/or psychological injuries overwhelms the mind and body’s capacity to adapt, and can set off or perpetuate an already present ED. The nutritional support of an individual who struggles with an ED and is a trauma survivor can be one of the most challenging tasks a dietitian encounters. One of the most accurate ways to assess the nutritional status of the body is to do two types of tests: metabolic testing and body composition analysis. Physicians, dietitians, and nutritionists who treat EDs will be treating trauma. Physicians, specifically, have a critical role in diagnosing and treating EDs. Medical caregivers need to let the patients know that they will stay the course and support them for as long as it takes.

The chapter analyzes the gestaltists view, psychoanalytic view, feminist and sociocultural views, and tries to come to some understanding of where one might be going in promoting change from body image disturbance (BID) to positive experience. The gestaltists sought to recognize the incredible power of the mind to organize information, so that one can effortlessly make sense of all we take in via one’s senses. The psychoanalytic view greatly helped our understanding of BID in various forms of psychopathology. However, the denial of the traumatizing effect of sexual abuse, it also greatly limited the potential for care. For many disorders, treatment models followed the historical sequence from psychoanalysis to behavioral to cognitive behavioral. The treatment of BID in eating disorder drew in one more viewpoint in1970s, that of the feminist view. Finally, the cognitivists sought to explore the internal processing that links cultural influence and learning history to psychopathology.