It’s More Than About Food
An AIP Approach to Treating Eating Disorders and Body Image Disturbance
It is no surprise to most of us that in recent years there has been a concerning rise in the use of weight loss drugs and the proliferation of the diet industry. The diet industry was valued at $90 billion in the U.S alone in 2023 (market research blog). Almost daily, we hear pervasive societal messages that reinforce ideals around thinness and controlling one’s body size.
For the average person, this can cause dissatisfaction with their body, which may result in disordered eating behaviors. In the United States, 69-84% of women experience body dissatisfaction, desiring to be a lower weight than they currently are (Runfola, 2013). And for 9% of the US population, or 28.8 million Americans, this will turn into an eating disorder in their lifetime (Deloitte Access Economics, 2020).
As EMDR therapists, these issues may show up in our therapy practice whether this is our specialty or not. Our call is to assist clients in resolving the root causes of these issues while achieving lasting change that promotes life-giving attitudes and behaviors towards their bodies.
Understanding the Foundations: Past-Present Connections
Many of our clients may come to therapy with a long-seated history of body image dissatisfaction and disordered eating. Disordered eating refers to a wide range of irregular eating behaviors that may not meet the clinical criteria for a specific eating disorder but are nonetheless maladaptive. These behaviors include chronic dieting, frequent weight fluctuations, rigid food rules, guilt-fueled compulsive exercise and occasional episodes of binge eating and restriction. These behaviors negatively impact physical and emotional well-being, can get worse, and are an important focus of treatment.
Whether our client is struggling with disordered eating or a diagnosed eating disorder, our AIP conceptualization begins in the same place. First, we begin to explore the client’s current behaviors, beliefs and difficulties around food, exercise and their relationship to their body.
As EMDR therapists, we want to be curious about how these attitudes and behaviors have been used to manage trauma symptoms, which, from an AIP lens, is the root cause of the client’s eating problems.
One study found that 43.8% of individuals diagnosed with an eating disorder reported experiencing more than one traumatic event in their lives (Convertino and Blashill, 2022). Unfortunately, many lay people, medical professionals and clinicians alike, focus on symptoms such as binging, purging or restricting as the problem and believe that we can prescribe weight loss medications or basic behavior changes that will solely alleviate these symptoms. If only it were that simple.
If we don’t resolve the underlying trauma below the eating disorder, body image disturbance or disordered eating, relapse is bound to happen.
Our experiences with our body start from a young age. We begin to internalize societal messages, many of which are reinforced by significant attachment figures. Messages such as "thin is best," "food is comfort," “I must control my body,” and/or "I can’t trust myself with food" are common. These messages' origins can vary from family dynamics, cultural influences, and unresolved traumatic experiences.
As EMDR clinicians, we collaborate with the client to understand the past-present connections and the associated memories that contribute to emotional confusions, negative beliefs, and maladaptive behaviors.
The Dance of Treating Active Triggers and Resolving Past Confusions
EMDR therapy recognizes the delicate balance of addressing active triggers while simultaneously unraveling the past traumas that set the groundwork for the client’s relationship to their body. This client-centered approach will vary from person to person based on the client’s readiness for change and their capacity to confront difficult emotions and memories. Sometimes that means a more extended preparation phase to increase stability, ensuring that they can manage their emotions without relying on their disordered eating.
With a client of mine who has a long history of an eating disorder, the foundational memories of early childhood emotional neglect and household dysfunction were outside of her tolerance level at the onset of treatment. We needed to first work with the everyday triggers that were causing her high anxiety and daily functional impairment.
One example of this was the overwhelming fear she felt in approaching weekly grocery shopping. She had very rigid rules around what foods she was “allowed” to eat, and if this “safe” item was out of stock at one store, she was traveling to several stores to compulsively find this item.
We had a shared understanding of the history of this behavior, and she had the willingness to change it, however, the strong anxiety was a constant pull that she couldn’t quiet move past. We began by utilizing EMD to desensitize the feeling of panic she had as she saw an item was out of stock.
After we reduced some of the distress she had around this trigger, we went to the installation of the future template. Here, she was able to envision a positive response that was in line with her goals and increased her flexibility around her food choices. The next week, she returned to share that she was successful in responding positively and had significantly reduced anxiety around this situation.
Targeting these present-day fears and behaviors without uncovering the client’s painful childhood memories and associations helped stabilize her, as well as gave the client new experiences of feeling more in control and with a greater sense of confidence.
This gradual progression allowed the client to build more capacity for self-regulation and self-awareness, which is crucial for sustained recovery from eating disorders.
From there, we began to work on foundational memories, related to attachment wounds from her primary caregivers, that resulted in present-day concerns. Even still, we danced, shifting between the use of EMDR techniques for stabilization during difficult weeks for the client or periods of relapse, and then times when we could transition back into more long-lasting EMDR psychotherapy when we had more footing. The result was creating an enduring recovery that incorporated increased self-esteem, freedom and flexibility around food, and an ability to fully connect to those around her.
Recognizing Adaptive Functions and Readiness for Change
Central to the AIP model is the recognition that maladaptive behaviors, such as those used in eating disorders and disordered eating, often serve protective functions for the client. These behaviors may have provided a sense of control or comfort during times of distress or trauma. They worked for a time, and like other addictions and compulsions, the behavior takes on a life of its own, which makes it more difficult to change.
Acknowledging the positive functions without judgment and facilitating a compassionate understanding of a client's relationship to food and their body reduces shame and helps us to foster healthier coping strategies going forward.
Early in the life of the client I spoke about above, she learned that ‘staying small’ and following rigid rules made her family life run more smoothly and seemingly kept her from her mother’s rage. This ‘staying small’ started by not using her voice, not having opinions or needs. In her adolescence, her eating disorder became a way to physically ‘stay small’ and gain a sense of connection that she otherwise didn’t believe she was worthy of.
Understandably, there was much ambivalence, if not fear, in giving up these adaptations that were both familiar, safe and necessary for a time. The fear and ambivalence for change became our next target. This allowed us to work closer to the client's goal of having a sense of self outside of her eating disorder as well as connecting to others safely while taking up space.
Clinicians’ Awareness of Their Own Relationships with Body and Diet Culture
Unfortunately, even as clinicians, we are not immune to these harmful societal messages about food, exercise and body image. Try as we may not to subscribe to these rigid standards, as EMDR therapists, our own relationship to food and our body will most certainly inform how we show up in our work with these clients.
It is paramount that we examine our biases and attitudes towards weight, food, and beauty standards to avoid inadvertently reinforcing harmful beliefs in clients. Without this awareness, we lack the perspective to effectively help our clients consider their maladaptive patterns and the potential impact on their lives.
Over my 15 years working with this population, I have needed to examine my own relationship with diet culture. I have found this journey to be both personally and professionally beneficial, yet arduous at times. As an adolescent, disordered eating behaviors were widely used and shared amongst my peer group. And true to the developmental stage, my focus was on gaining acceptance and fitting in. While my behaviors were minor, the lasting mental impression of needing to maintain a rigid body shape and size took years to dismantle.
Examining my thin privilege, removing worth from body size and shape and learning to experience the joy of movement has been central to this personal transformation. Learning to see all bodies as good bodies not only assists me in appreciating the function of my own body but also allows me to work from this perspective with my clients.
We can each do this work through self-examination and study, engaging in our own therapy, or in seeking EMDR consultation. Through these measures, we create a more effective therapeutic environment where the client’s issues do not become a parallel process to our own. This ongoing self-reflection not only enhances our professional competence but also underscores our commitment to providing compassionate and ethical care to those we serve.
The journey toward recovery from an eating disorder has never just been about food— it’s about unraveling deep-seated beliefs about oneself and reprocessing unresolved traumatic experiences through a compassionate adult understanding.
As EMDR therapists, we embark on a transformative path with our clients that honors each of their unique experiences and paves the way for lasting healing. And like much of our work with our clients, we hold up our own mirror and commit to doing our own work as well.
Reach out to me at maraeca@hoperebuilt.com if you’d like to learn more about EMDR consultation with eating disorders and disordered eating.
Look out for another blog on body dysmorphia and the age of weight reducing drugs.
Notes:
Market Research Blog
Deloitte Access Economics. The Social and Economic Cost of Eating Disorders in the United States of America: A Report for the Strategic Training Initiative for the Prevention of Eating Disorders and the Academy for Eating Disorders. June 2020. Available at: https://www.hsph.harvard.edu/striped/report-economic-costs-of-eating-disorders/.
Convertino, A. D., Morland, L. A.; Blashill, A. J. (2022). Trauma exposure and eating disorders: Results from a United States nationally representative sample. International Journal of Eating Disorders, 55(8), 1079–1089. https://doi.org/10.1002/eat.23757
Runfola, C. D., Von Holle, A., Trace, S. E., Brownley, K. A., Hofmeier, S. M., Gagne, D. A., & Bulik, C. M. (2013). Body dissatisfaction in women across the lifespan: results of the UNC-SELF and Gender and Body Image (GABI) studies. European eating disorders review: the journal of the Eating Disorders Association, 21(1), 52–59. https://doi.org/10.1002/erv.2201