
Dr. Joy Zelikovsky
Eating disorders are complex mental health conditions that affect individuals from all walks of life. Eating disorders are the number two killer of all mental health diagnoses and impact people of all shapes and sizes, all genders, all sexual orientations, all ethnicities and races, and all incomes. However, while the symptoms associated with these disorders can be severe and have a profound impact on an individual’s physical, emotional, and psychological well-being, many individuals cannot or do not want to access traditional treatment programs for a variety of reasons.
More frequently clients have started to describe that treatment has been a traumatic experience for them, that they felt discriminated against due to their size, race, ethnicity, gender, or sexual orientation, and therefore were not able to fully get their needs met in treatment. Often, individuals in traditional treatment programs will explain that if they come from a marginalized culture their food was not represented in treatment or even villainized in treatment as less nutritious or “bad” for them. These experiences have left clients feeling like treatment programs are not viable options for their recovery if they need help with their eating disorders.
Finally, traditional treatment programs are prohibitively expensive for many people. Not all of them take all insurances or any insurance, or worse, insurance will often drop clients mid-treatment meaning they either have to leave or find a way to privately finance their treatment, which is not possible for most. This assumes that individuals can take the time off of work to attend treatment and have family or support to watch kids or pets if they have any and continue to pay any bills in the interim. There is often little to no financial support for those who want to recover in higher levels of care but need to continue to work to support themselves or keep their insurance benefits. Some treatment centers have begun to accommodate this and allow individuals some work and school time while in treatment, but often it is not enough.
An additional barrier to traditional treatment approaches is that they focus on complete abstinence from disordered eating behaviors. Many people find that while they want to reduce behaviors or the intensity of behaviors, they are not ready or are unwilling to pursue abstinence from their eating disorder, which for many, has been the only thing keeping them safe or functional. Therefore, the idea of going to a traditional treatment program where they will be asked to stop all eating disorder behaviors and will not be given certain privileges until they do so seems highly unappealing. So what is the alternative?
Harm reduction is an emerging practice, that while has been prominent in substance abuse treatment for many years, has not been as prominent in eating disorder treatment as a viable modality. However, it is a promising alternative approach that offers compassionate, non-judgmental support to individuals struggling with eating disorders.
Why is there a stigma around harm reduction in eating disorders?
One of the main reasons for the stigma surrounding harm reduction in eating disorders is the misconception that harm reduction strategies encourage disordered eating behaviors. This is simply not true. Harm reduction strategies aim to reduce the harm associated with disordered eating behaviors by promoting safety, dignity, and respect for individuals struggling with eating disorders. It is a process of meeting individuals where they are and working collaboratively to identify and address the underlying causes of disordered eating behaviors, harm reduction strategies offer a pathway to healing and recovery. By doing this, clinicians can help retain clients in treatment, foster motivation, and help clients make better decisions for their help and seek higher levels of care when and if they are ready.
Why is harm reduction important in eating disorders?
Harm reduction is important in eating disorders for several reasons. First and foremost, it acknowledges that complete abstinence from disordered eating behaviors may not be realistic for everyone and that progress toward recovery can take many different forms. Recovery is going to look different for everyone, it is important that clients feel like the door to recovery is not closed to them because they cannot access abstinence or do not want abstinence from behaviors. By offering judgment-free support and guidance, harm reduction strategies help individuals to feel empowered and motivated to work towards recovery at their own pace.
Harm reduction also promotes safety and reduces the risk of serious health complications associated with eating disorders, such as malnutrition, heart failure, and organ damage. By explaining to clients how to protect their dental health, heart health, and many other safety precautions they can take, we can safely re-engage clients in the medical system, as well as foster trust and safety with their teams. If clients choose to pursue more recovery at some point they are now engaged and have a support system available to them.
Finally, harm reduction emphasizes compassion and empathy, which are critical components of effective treatment and recovery. By prioritizing the needs and experiences of individuals struggling with eating disorders, harm reduction creates a safe and supportive environment for healing and recovery to take place. Before offering harm reduction work, clients were often met with ultimatums and being told their providers can no longer work with them. This did not motivate most clients to access higher levels of care. All it did was leave them without a team and continue to engage in dangerous symptom use. By openly discussing and engaging in harm reduction, it allows clients to access resources and stay with their teams so that they continue to have support and make positive changes at their own pace if they choose.
In conclusion, harm reduction is an important alternative approach to treating eating disorders that promotes healing, safety, and compassionate care. By breaking down stigma and offering non-judgmental support, harm reduction strategies offer a promising pathway to recovery for individuals struggling with eating disorders.
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