Inclusive and Trauma-Informed Care Enhances Eating Disorder Treatment Outcomes

In the field of eating disorder treatment, there is a growing recognition that a one-size-fits-all approach simply doesn’t work.

The complexity and dynamic nature of eating disorders requires that professionals move beyond traditional treatment methods and embrace more comprehensive, inclusive, and trauma-informed approaches. By addressing the unique experiences, genetics, and needs of each client, therapists, dietitians, and coaches can provide much more effective, compassionate care that leads to better outcomes.

Practitioners in therapy, nutrition therapy, and health coaching should deeply understand how trauma and cultural context intersect with eating disorders.

Trauma Matters in Eating Disorder Treatment

Eating disorders often develop in response to a combination of biological, psychological, and environmental factors, with trauma playing a critical role for many clients. Research shows that individuals with eating disorders are more likely to have experienced trauma, including emotional, relational/attachment, physical, or sexual abuse, neglect, or significant adverse life events.

Trauma-informed care is more than just treating the eating disorder itself. It recognizes and addresses the underlying trauma that may contribute to its development. Clients who have experienced trauma often use eating disorder behaviors as coping mechanisms, and without addressing these root causes, recovery can be more challenging and less sustainable.

By integrating trauma-informed approaches, clinicians can help clients understand the connection between their past experiences and current behaviors, providing a pathway to recovery that is not only about symptom management but also about developing insight and healing the deeper wounds that fuel disordered eating.

Principles of Trauma-Informed Care in Eating Disorder Treatment

Trauma-informed care, in general, is grounded in several key principles that guide clinicians in creating a safe, supportive environment for their clients. The folowing are examples with very brief explanations. There is so much more to say about each of these, and there’s not enough space here to comprehensively achieve this!

• Education:

  Clinicians can seek out continuing education, specifically trauma-informed treatment modalities. This also includes skill-building, and more deeply understanding how to work with clients whith trauma histories. One example of this would be to recognize that having clients verbally process through traumatic experiences may actually be re-traumatizing, and other methods are needed to process and heal trauma (e.g., EMDR, Somatic Experiencing, etc).

• Safety:

  Ensuring both physical and emotional safety is paramount in providing trauma-informed treatment. For clients with eating disorders, creating a space where they feel understood and safe to say anything without judgment is critical for recovery. This also includes focusing on building trust and establishing the therapeutic alliance as a priority.

• Trustworthiness and Transparency:

  Building trust with clients is of utmost importance, particularly for those who have experienced any type of trauma. Clinicians must be clear and transparent about treatment goals, processes, and expectations, allowing clients to feel secure in the therapeutic relationship. This assertive and warm style also offers tremendous role modeling for clients, who may struggle to effectively express themselves, and use eating disorders behaviors instead.

• Peer Support:

  Helping your clients experience a “me too!” moment in a group therapy setting or referring them to books, podcasts, articles, or other resources (that you have thoroughly vetted) can be transformative in silencing shame, which often is a fuel for needing eating disorder behaviors to cope. Encouraging connection and support between others who have faced similar challenges can be a powerful tool in the recovery process. Group support fosters a sense of belonging and reduces feelings of isolation, which is so common for folks with eating disorders.

• Collaboration and Autonomy:

  Trauma-informed care emphasizes working collaboratively with clients and the full treatment team. Clinicians should honor and encourage their clients’ autonomy (when safe) with their voices and experiences being central to decision-making.

• Empowerment, Voice, and Choice:

  Empowering clients to take ownership of their recovery is powerful in eating disorder recovery. This means providing them with choices in their treatment and helping them rebuild a sense of sovereignty over their lives, which is often lost due to trauma or disordered eating behaviors.

• Cultural, Historical, and Gender Inclusivity:

  Understanding how a client’s identity — including body size, race, gender, socioeconomic background, and cultural experiences — intersects with their eating disorder is vital. Inclusive care recognizes these factors and integrates them into the treatment approach to create a more holistic treatment plan to recognizes systemic oppression.
  

The Role of Inclusivity in Eating Disorder Treatment

Eating disorders do not discriminate.

They affect people of all body sizes, races, genders, and backgrounds. Unfortunately, many traditional eating disorder treatment approaches reflect societal biases, ignoring and perpetuating the challenges suffered by marginalized people. Traditional eating disorder treatment has often centered a narrow understanding of eating disorders, failing to account for the needs and experiences of clients who have multiple marginalized identities.

An inclusive approach to eating disorder treatment ensures that all clients, in all bodies, of all cultures receive care that respects and honors their individual experiences. This includes:

• Addressing Cultural Factors:

  Cultural attitudes toward food, body image, and health vary widely across different communities. Clinicians must be aware of how cultural norms can influence disordered eating behaviors and integrate this understanding into treatment.

• Challenging Weight Stigma:

  Weight stigma is pervasive in both society and healthcare, and it can be insidiously harmful to individuals with eating disorders. An inclusive approach rejects weight-centric models of health and promotes body acceptance, ensuring that clients of all sizes receive respectful, compassionate care.

• Gender-Affirming Care:

  Individuals of all genders experience eating disorders, yet treatment has historically been geared toward cis-women, leaving men, transgender, and non-binary individuals underrepresented in research and care. Inclusive care actively affirms and supports clients’ gender identities, ensuring their experiences are fully acknowledged and respected.

Trauma-Informed, Inclusive Care Enhances Eating Disorder Treatment Outcomes

When trauma-informed care and inclusivity are integrated into eating disorder treatment, the results can be transformative.

1. Building Anti-Oppressive Trust and Safety

2. Reducing Shame and Isolation

3. Addressing Root Causes

4. Tailoring Treatment to the Individual

5. Fostering Long-Term Healing & Sustained Recovery

Incorporating Trauma-Informed and Inclusive Care into Your Practice

Add the Inclusive Eating Disorder Specialist (IEDS) Certification to your credentials, and receive a comprehensive, trauma-informed, evidence-based, and inclusive eating disorder training and certification.

Adopting trauma-informed, inclusive treatment practices into your work with clients can tremendously affect recovery sustainability. We know that relapses in eating disorder recovery happen and are often unavoidable. However, we hope to shake up the traditional eating disorder educational world with the IEDS Certification training, and help clinicians to provide more effective care.

The certification training from IEDE will teach you what you need to know to treat the full spectrum of eating disorders from an inclusive, trauma-informed perspective. It is entirely online, 45 hours of video, includes a ~900 page clickable PDF Manual, and lots of engaging activities, culminating in the IEDS credential and certificate of specialty.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

Galmiche, M., Déchelotte, P., Lambert, G., & Tavolacci, M. P. (2019). Prevalence of eating disorders over the 2000–2018 period: A systematic literature review. The American Journal of Clinical Nutrition, 109(5), 1402-1413. https://doi.org/10.1093/ajcn/nqy342

Substance Abuse and Mental Health Services Administration (SAMHSA). (2014). Trauma-informed care in behavioral health services (Treatment Improvement Protocol (TIP) Series, No. 57). Rockville, MD: SAMHSA.

Legal Disclaimer:

The content provided by Inclusive Eating Disorder Education, PLLC is for educational purposes only, aimed at helping clinicians and professionals learn about eating disorder treatment. This information is not a substitute for clinical supervision, professional training, or medical, psychological, or nutritional advice. Clinicians should always rely on their professional judgment and consult relevant healthcare providers when treating clients. IEDE assumes no responsibility for any errors, omissions, or outcomes related to the use of this information in practice.