6 minute read
Eating Disorders Queensland
FOREWORD
I was honoured when Belinda Chelius, CEO of Eating Disorders Queensland (EDQ) asked me to provide this foreword. I have had the benefit and privilege of working with and alongside EDQ for almost twenty years. During that time, I have observed many changes in name, venue, programmes, leadership and staffing. But there are some things that, thankfully, have remained the same. These include a dedication to social justice and community engagement, a systemic and feminist perspective, a trauma informed approach, and a nonjudgmental, safe, personcentred approach to helping those struggling with eating issues.
Advertisement
I have learnt much from EDQ over the years. I have watched a peer workforce grow and flourish. I have seen the benefits of a welcoming, safe, nonthreatening community environment for those suffering from eating disorders. And I have seen a wonderful variety of community-based actions to address the toxic social and cultural factors that cause and perpetuate eating disorders and stigma around weight and shape.
Many times, I have stood alongside people with lived experience, supported by EDQ, as they helped me deliver training to doctors and other clinicians. As these clinicians hear about the lived experience of those with eating, I often see, within minutes, years of misunderstanding and stigma dissolve before my eyes. Thanks to EDQ, I have seen carers helping carers, survivors helping those in recovery, and authentic, highly-skilled and sensitive clinicians from EDQ opening the minds and hearts of other clinicians. I look forward to a long, continuing relationship with EDQ, and I highly recommend these thoughtful, comprehensive, contemporary, and beautifully person-centred guidelines to you.
A/Prof Warren Ward MBBS FRANZCP FAED
Director, Queensland Eating Disorders Service (QuEDS)
ACKNOWLEDGEMENTS
The staff at Eating Disorders Queensland (EDQ) devoted a great deal of their time and energy to generating the content for these guidelines. They participated in multiple workshops, recommended research and literature, read copious drafts and were always available to answer my many questions. Working with such an inspiring group of dedicated practitioners has been the highlight of this project for me.
Thank you all for your commitment to ensuring these guidelines are a true reflection of the high-quality work you do at EDQ.
Thank you to the CEO of EDQ, Belinda Chelius, who had the vision to initiate these guidelines. Belinda has gently guided the process and has provided me with constant support throughout the project. Thank you to the EDQ Board who supported this idea and made the project possible. A special thanks to the senior workers Christophe, Melissa, Emma and Rohie for their extra assistance with editing the drafts of this document.
Thank you to several other people who were involved in the production of this document: Kristen Young for undertaking the initial literature review; Sandra Hogan for her work in editing the final document; Lisa Kelly for her beautiful art work and illustrations; dtb! Advertising for the design and formatting of the final document.
I would also like to thank the Blue Knot Foundation for their internationally acclaimed Practice Guidelines for Clinical Treatment of Complex Trauma. These guidelines have provided much needed information on trauma informed practice, and we have drawn guidance and inspiration from them in the creation of these guidelines.And finally, I would like to acknowledge the many clients and carers / key supports and loved ones who have accessed the service since its inception in 1996. These guidelines are the culmination of our learning over these years, and it is our hope that they will make it more possible for other workers and organisations to embrace this approach to working with people with eating disorders.
We would like to respectfully acknowledge the Traditional Owners of the land on which Eating Disorders Queensland operate, and their Elders past, present and emerging.
We honour the women elders in diverse communities of which we are a part and we celebrate the extraordinary diversity of women’s bodies, genders, sexualities, capacities and relationships that we all represent. We pay our respects to all the people with a lived experience, carers / key supports and loved ones who have shared their recovery wisdom with us.
INTRODUCTION
Eating disorders are serious and complex mental health issues that have strong medical and psychological components. In fact, eating disorders have the highest mortality rate of any mental health issue. While we previously considered the impacts of eating disorders primarily on young, white women, we now know that eating disorders can affect people regardless of gender, age, race, ethnicity, body shape and weight, sexual orientation, and socio-economic status. Despite the seriousness of eating disorders, we now know that recovery is possible. We also know a great deal more about a variety of causation factors and a wide range of effective interventions.
Eating Disorders Queensland (EDQ) has been at the forefront of therapeutic intervention for the treatment of eating disorders for over 25 years. We have pioneered therapeutic approaches to individual therapy, therapeutic group work, support programs for carers / key supports and loved ones, peer support and mentoring programs, psycho-educational group work, advocacy and social change. In all of these areas we have highlighted the value of incorporating the lived experience of people who have had eating disorders and have recovered.
One of the defining features of the work of EDQ has been our focus on feminist and trauma informed approaches to understanding and working with eating disorders. This work began at the Women’s Therapy Centre in London in the 1980s when many young women were presenting with serious and complex eating disorders. The highly gendered nature of eating disorders drew the attention of feminist therapists and through this work, the connections between experiences of childhood trauma, especially experiences of sexual violence, became clear. Interestingly, there is a now a firm evidence base for this early work as the neurobiology of trauma has shown us the devastating effects of trauma on the brain and body. Feminist approaches combined with trauma informed approaches continue to inform the work of EDQ, along with a very substantial knowledge and skill base informed by a range of other therapeutic perspectives.
Current clinical guidelines for the treatment of eating disorders in Australia are aimed at treatments for medical and psychiatric care in line with the DSM-5 and International Classification of Diseases (ICD-11). The EDQ clinical guidelines presented here have been
specifically developed to inform clinical therapeutic practice with clients who have eating disorders, rather than to manage their medical and psychiatric care. The work of EDQ exists on the continuum of care and these guidelines sit alongside a range of medical and psychiatric interventions.
There is increasing recognition that a range of treatments for eating disorders are important in overall recovery and that treatments that only focus on medical care are often ineffective for client recovery. We now recognise that many clients with eating disorder presentations have histories of complex / developmental trauma and therefore guidelines that address trauma informed practice responses are long overdue.
These clinical guidelines have been generated from the ongoing experiences of practitioners at EDQ in addition to the growing research and literature base about eating disorders, feminist therapy and trauma informed practice. They are designed to share the range of approaches developed by EDQ over many years and it is our hope that colleagues, new and known to us, will take this opportunity to explore a diverse range of practice approaches to recovery for clients with eating disorders and those who care for them.
This includes other health professionals, social workers, psychologist, private practitioners, dieticians, youth workers, sexual assault counsellors, general practitioners, psychiatrists, teachers, school health nurses, guidance officers and any other professional working in this complex area.
Finally, it is important to address the issue of use of language. EDQ has traditionally rejected the term ‘eating disorders’ instead preferring to talk about ‘eating issues’. In these clinical guidelines we have chosen to use the term ‘eating disorders’ because this is the language of our sector. We also wish to ensure there is no confusion about what is being discussed and to ensure that the severity of these issues is not minimised by using a different, less known, term.
However, it is important to note that we do not regard eating disorders as ‘disorders’ but rather as social issues that result from a range of complex factors in our society but that manifest within individuals as a response to these factors.
