EMDR Therapy Quarterly

This book delves into the relationship between trauma and eating disorders (ED). It discusses the presentations and differences between many forms of eating disorders, including anorexia nervosa, bulimia nervosa, binge eating disorder and other specified feeding or eating disorders such as, bulimarexia and orthorexia. Written by different contributors, the book stands out for its unique approach to reviewing the literature. I found this approach very informative, and although the information overlaps slightly in some sections (presentation, dissociation and treatment focus), I do not feel this made the material repetitive.

There is no specific focus on one treatment approach, making the book accessible to a wide range of practitioners. Unlike other ED treatment books, this covers not only treatment approaches but also the medical factors and concerns that can be integral to safely supporting those with EDs. The medical explanations are clear and provide insight into the risks, such as amenorrhoea (loss of menstrual cycle), hair thinning and decline in concentration or focus. For those with minimal experience supporting clients early in their recovery, this information is invaluable.

This second edition has been updated to include additional sections (the impact of COVID-19, racism, LGBTQ+IA, neurodiversity and working with children and young people). The racism section explores the systemic challenges facing those who do not align with the concept of a ‘thin white ideal’. There is a focus on racism and the body for BIPOC (Black, Indigenous and People of Colour) and understanding racial trauma. As a white woman, I connected with this section as it helped me understand the experiences of those in marginalised groups, what shapes their experiences, the impact of generational racial trauma, and how that may impact their relationship with food and their bodies. It is widely recognised that this population is underrepresented in services and often does not receive diagnoses. It is good that this section increases awareness of the various challenges these individuals can face.

An area of particular interest to me is neurodiversity. I am neurodivergent, so I was pleased to see this included in the second edition. Many neurodivergent clients present with interpersonal, relationship and friendship challenges, and this section helps practitioners understand how their relationship with food and their bodies is also affected. Often, these clients begin to explore how being neurodivergent has impacted their eating behaviours. Due to their experiences not matching what is an expected presentation of an ED, they can face challenges in accessing appropriate mental health support. The section highlights the challenges that can arise when working with a client group that may have atypical feeding behaviours as part of their ASD diagnosis, such as those with sensory sensitivities and links to avoidant/restrictive food intake disorder. The book identified that a barrier to receiving support is a lack of informed practitioners. I think this section goes some way to helping understand accommodations that might benefit neurodivergent clients, but this likely depends on the modality of the therapist.

I have always had an interest in working with people with EDs and disordered eating. Still, as someone who works solely in private practice, I found it challenging to find continuing professional development (CPD) that supported me in working with this client group. I found a lot of CPD lacked what felt like a human approach to healing and often focused on the medical model or NHS approach. This felt like quite a narrow focus when working with such a diverse client group.

Different writers discuss their clinical experience and scientifically backed approaches, and I believe this information would have helped me when starting to treat clients with these presentations, to build confidence in my approach to working with this client group. That isn’t to say I haven’t gained valuable insights from reading the book now – I certainly have. I can, however, recognise that I could have benefitted hugely from reading it years ago. One of the things I learnt was about the differences between restrictive EDs and binge eating in terms of dissociation. The research showed that bingeing episodes were seen as dissociative, whereas restrictive eating is suggested to be less dissociative. This understanding of the literature has provided me with a useful talking point when working with clients and an understanding of how an eating disorder feels for them; many of them agreed that for them it was a way to ‘disappear’.

The book explores various non-EMDR methods of working with clients, such as dance and movement therapy, neurofeedback, psychodynamic therapy, trauma focused-CBT, internal family systems and ego state work. A four-phase model of trauma-informed treatment is explained, covering assessment and treatment planning, preparation, trauma processing and relapse prevention, revaluation and integration. It is possible to identify where different modalities fit into these; for example, the eight phases of EMDR are easily incorporated into the four distinct phases of the model.

The book’s strength lies in the wealth of experience of its contributors, providing readers with a profound understanding of the subject matter and the breadth of content covered. I have worked with clients with EDs for several years and have read widely, and I feel this book is by far the most comprehensive because it covers the realities and practicalities of working with those with EDs. I think the combination of approaches of reviewing the research and the lived experience of working with this client group has a balanced feel, making the content more accessible.

A downside to the book is its price, as it is more expensive than many other books about working with EDs. Nevertheless, the extensive research and valuable insights make it a worthwhile investment for those interested in the field. The book is not currently available as an audiobook but is available on Kindle. Another point for consideration, that perhaps wasn’t explicitly discussed in the book, is the difference in working with this client group in a multidisciplinary team versus private practice – perhaps future editions could include a section on this.

In conclusion, ‘Trauma-Informed Approaches to Eating Disorders’ is an essential read for individuals working with ED clients. It offers a wealth of knowledge, practical guidance and diverse perspectives. For therapists and practitioners, this book provides valuable insights and practical applications for working with this client group.