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1. UNDERSTANDING EATING DISORDERS
There are many components to a thorough understanding of eating disorders in our society and all knowledge that contributes to an understanding of this complex issue is valuable.
At EDQ we have a bio-psycho-social understanding of eating disorders where we see eating disorders as a complex interaction of mental health, developmental and familial experiences, trauma related experiences, genetic predispositions, social and cultural forces, and the interrelationship between these various factors. Eating disorders are complex issues that have significant impacts on a person’s emotional and physical health as well as impacting on those who care for and support the person.
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1. Eating disorders are maladaptive coping strategies that have been created and maintained by our society.
Our society plays a role in the incidence of eating disorders. We need to see eating disorders within the larger context of our social preoccupation with dieting and weight loss and socially approved body images and sizes6.
Eating disorders should be approached from a perspective that is informed by the broader social and cultural forces that encourage the objectification of bodies and that values specific body shapes and sizes rather than unique and diverse bodies.
2. Feminist approaches to understanding and working with people with eating disorders have provided an alternative understanding that is complementary to other approaches.
In the 1990s feminist therapists suggested that eating disorders were an expression of a greater problem for young women and these underlying issues give
rise to difficulties with eating. It was suggested that eating disorders were obsessions with food and these obsessions were designed to conceal a greater conflict in the person’s life 7 . Therefore, the eating behaviours could be seen as the solution the person had found to a greater problem in their life. There is now an undeniable evidence base within neurobiology for the practice principles that feminism has developed over many years of work with women with serious eating disorders 8 .
More recently, the feminist-relational model, which promotes the importance of relationships and connection, has been applied to the field of eating disorders 9 . Importantly, this perspective combines two overlapping spheres involving the relationship and political contexts within the social world 10 . This approach includes attention to connection, social support, voice, empowerment and feminist identity. A rich body of literature informs feminist approaches to understanding and working with eating disorders.
3. Eating disorders are adaptive coping strategies.
Eating disorder behaviours are designed to keep the person safe 11 . It is important to acknowledge that this is a protective part, despite the significant health implications of this issue. Eating disorders are the solution that person has found to assist them in coping with other life problems and will not shift until the person address the underlying issues giving rise to their behaviours 12 .
4. Issues of power and control are central to all forms of eating disorders.
A strong correlation exists between eating disorders and experiences of loss of power and control that a person has had in their life. For many people with an eating disorder, their eating behaviour allows them to feel in control of some aspect of their life. No matter how much others insist, they are in control of their eating.
Research has suggested that feelings of powerlessness are related to body image and eating disorders, suggesting it is important that interventions focus on empowering clients to take control of their lives 13 .
5. There is an established link between experiences of childhood trauma and the incidence of some eating disorders. Eating disorders cannot be fully understood without understanding the impacts of childhood trauma.
Substantial evidence exists to suggest a link between the experience of childhood trauma and the later development of eating disorders (Finlay, 2019; Trottier & MacDonald, 2017; Vanderlinden & Palmisano, 2019). Histories of childhood sexual abuse, childhood physical abuse and childhood emotional abuse have been studied intensively and are considered to be nonspecific risk factors for the development of eating disorders 14 .
As well as the trauma that may underlie an eating disorder, many clients report that the system designed to assist them with their eating disorder is both disempowering and traumatising. EDQ recommends a recovery-oriented approach where the client is seen as the expert over their own lives and has ultimate control of the healing process.
6. Eating disorders are different for every person and causation is multifaceted.
It is crucial that we take the time to understand each individual person’s experience of their eating disorder. We must see eating disorders within the broader context of a person’s life and what is and has been happening for them that has led to the development of their eating disorder. While similarities may exist, there is no single presentation or treatment for eating disorders 15 .
7. There is much we still do not know about eating disorders, but we learn more each time we listen to people share their stories and experiences with us.
This is a complex area of practice and there is much we still do not know. The knowledge base that informs practice at EDQ is based on respect for the individual’s right to share their own experiences in their own way and at their own pace. We work alongside the client and listen to their experiences and their goals rather than working with a prescribed view of the most appropriate pathway to recovery.
8. We work from a range of evidence based theoretical perspectives that inform our work including:
• Feminist Practice: This involves working in ways that are transparent and genuine to reduce power differentials in the therapeutic relationship; recognising the person we are working with as a whole person with skills, strengths and solutions to their own issues; providing information so that people can make informed decisions about the support they are looking for; recognising the personal is political – that we live in a patriarchal society where structures and institutions privilege men over women and there is significant inequality at multiple levels.
• Person Centred/Rogerian: Similar to feminist practice, we work from a base of empathy, genuine support and acceptance of the person we are working with; the person is seen holistically and is at the centre of the therapeutic relationship; we are working together to understand what each individual person wants and needs to live their own life.
• Cognitive Behavioural Therapy: This helps to explore connection between our thoughts, behaviours and emotions and the role they may place in the experience of eating disorders.
• Acceptance and Commitment Therapy: This is to enhance cognitive flexibility; acceptance and commitment to recovery-oriented change.
• Dialectical Behaviour Therapy: This is to develop specific skills for managing distress, uncomfortable feelings and interpersonal communication.
• Narrative Therapy: This is to explore an individual’s dominant story and provide space for re-authoring.
• Embodied Practice/Mindful Movement: This is used to nurture connection between the mind and the body.
• Expressive and Art-Based Therapy: This is used to explore alternative ways of expressing and communicating.
