The last week in February is National Eating Disorders Awareness Week, a time to raise awareness about the realities of eating disorders and the importance of a well-rounded treatment approach, including trauma treatment. We asked Cassie Karjewski, LCSW, to tell us more about EMDR therapy and eating disorders.

Can EMDR Therapy Treat Eating Disorders? 

Guest Blog Post by Cassie Krajewski, LCSW 

Traditionally, eating disorder treatment has focused on cognitive and behavioral interventions to reduce and eliminate eating disorder symptoms. However, in recent years, trauma and adverse life experiences have been recognized as common comorbidities alongside eating disorders (Moroshko, et al., 2025; Convertino et al. 2022, Brewerton 2023; Zelkowitz et al., 2021; Brewerton 2018; Keski-Rahkonen et al., 2016; Forman-Hoffman et al., 2012; Swanson et al., 2011). Additionally, studies reveal that trauma and adverse life experiences are associated with more sever eating disorders (Backholm et al., 2013; Scharff et al., 2021; Tagay et al., 2014) as well as client disengagement or early termination from treatment (Anderson et al., 1997; Carter et al., 2006; Rodríguez et al., 2005). 

As a result, trauma therapy approaches, including EMDR therapy, have become more integrated within eating disorder treatment (van der Starre et al., 2025; Brenner et al., 2025; Hatoum et al., 2024; Rossi et al., 2023; Balbo et al., 2017; Bloomgarden et al., 2008). As the rates and severity of eating disorders continue to increase, EMDR therapists are encountering more clients who have disordered relationships with food behaviors, body image, and exercise. This results in asking an important question for both clients and clinicians: Can EMDR therapy be used to treat eating disorders? 

To answer this question, we first need to understand what eating disorders actually are, what drives them, and what EMDR is designed to do. 

Anything but simple

Eating disorders (EDs) are often deeply misunderstood, oversimplified, or judged. To those who have not lived with an eating disorder, it can seem simple: Why are you doing this to yourself? Why not just eat? Can’t you see how that’s harming you? Can’t you just stop?  

But for someone who has lived with an eating disorder (or for those who have supported someone who has one), they know that eating disorders are anything but simple.  

Eating disorders are complex mental illnesses that have significant impacts physically and psychologically. It is well established by research that EDs are known to be one of the most fatal mental disorders, second only to opioid use disorder (Auger et al., 2021; Deloitte Access Economics 2020; Smith et al., 2018; Arcelus et al., 2011). Eating disordered related deaths can be due to suicide or due to the medical impact of the eating disorder itself. EDs have significant medical consequences to physical wellbeing–every organ system in the body is impacted. 

Eating disorders commonly have co-occurring conditions such as anxiety disorders, mood disorders, dissociative disorders (Brewerton et al. 2024; Rabito-Alcón, et al, 2020; La Mela et al., 2010; Waller et al., 2003), obsessive compulsive disorder (Herrin et al., 2013), attention deficit and hyperactivity disorder (ADHD) (Yates et al., 2009; Biederman et al., 2007; Wentz et al., 2005), substance abuse and dependence (Mellentin et al., 2022; Eskander et al., 2020; Bahji et al., 2019; Piran, et al., 2007; Merlo et al. 2009; Harrop et al., 2010), personality disorders (Zanarini et al., 2010; Sansone et al. 2011), chronic pain (Sim et al. 2021), chronic illnesses (Scheuing et al., 2014; Quick et al., 2013)., and post-traumatic stress disorder (PTSD) (Keski-Rahkonen et al., 2016; Swanson et al., 2011). 

For many, the disorder results in disrupted embodiment and fragmented relationship to one’s internal experience. Research suggests that people with eating disorders frequently experience alexithymia, dissociation, and difficulties with emotional regulation, including difficulty identifying and responding to emotional states (Meneguzzo et al., 2021).  As a result, behaviors around food, weight, or body shape often emerge as strategies to manage overwhelming emotions or create a sense of control. While these behaviors may provide temporary relief, they ultimately reinforce disconnection from one’s body and emotions, making recovery a process of gradually rebuilding awareness, trust, and adaptive ways of responding to internal experience. 

Challenging eating disorder myths and stereotypes

Eating disorders do not develop in isolation but need to be understood within the sociocultural context in which they emerge. The highest rates of eating disorders are seen within Western cultures which are steeped in weight stigma, anti-fat bias, appearance pressures, body objectification, and moralized ideas of health and worth (Chen et al., 2022; Stice et al., 2020; Puhl et al., 2015;  Puhl et al., 2009). The pressure for achieving thinness has only intensified in recent years due to the promotion of GLP-1 medications for weight loss (originally type 2 diabetes drugs like Ozempic and Mounjaro). In today’s weight-obsessed culture, social media buzz, celebrity endorsements, and widespread prescribing of these medications have amplified the public attention on weight loss more than ever. 

While it is true that thin white young females are the most likely to be diagnosed with an eating disorder, statistics compiled by the National Association of Anorexia Nervosa and Associated Disorders (ANAD) reveal that eating disorders affect people of all sizes, shapes, ages, genders, race, class, abilities, and neurotype. Unfortunately, due to bias and stereotyping of the eating disorder “look,” many people’s struggles with food, body, and movement are overlooked and left untreated.  These stereotypes also obscure what eating disorders actually are and why they persist. 

What causes an eating disorder?

The etiology of eating disorders is difficult to precisely identify, though the data inform us that it is likely a combination of factors, including: 

  • Genetics 
  • Hormones 
  • Parent’s relationship with food 
  • Family history of eating disorders 
  • Dieting/chronic dieting 
  • Bullying or Teasing 
  • Weight stigma and anti-fat bias 
  • Temperamental traits 
  • Trauma and chronic stress experiences 
  • Abuse, neglect, or abandonment as a child 
  • Identities (sexual orientation, gender, body size, race, ethnicity, immigration status, etc.) and marginalization based on those identities 

Studies clearly point to the reality that the number one risk factor for developing an eating disorder is dieting, revealing that 35% of “normal dieters” progress to pathological dieting and 20-25% of those individuals develop eating disorders (Shisslak et al., 1995).  

The relationship between traumatic experiences, early attachment injuries, emotional neglect, and chronic stress is clearly indicated for most people with eating disorders (Moroshko, et al., 2025; Behar et al., 2016). The risk is even higher for those who experience chronic stress as a result of being in under-resourced or historically unrepresented groups such as Veterans (Murray et al., 2023; Masheb et al., 2021; Bartlett et al., 2015), Black Indigenous People of Color (BIPOC) (Moreno et al., 2023; Uri et al., 2021; Cheng et al., 2019; Marques et al, 2011), LGBTQIA+ (Milson et al., 2021; Parker et al., 2020; Duffy et al., 2019), disabled (Cicmil et al., 2014; Gross et al., 2000), men (Andersen et al., 2022), older adults (Hadland et al., 2014; Gagne et al., 2012), and those living in larger bodies (Sutin et al, 2015; Lipson et al., 2019; Rodgers et al, 2016; Sonneville et al, 2018; Darby et al, 2007). 

Trauma and body trust

Contrary to what diet culture would have us believe, eating disorders are not born from a lack of willpower, knowledge, or motivation. No one sets out to develop an eating disorder. While issues related to food, exercise, and negative body image may be the most commonly associated or “visible” symptoms of an eating disorder diagnosis, eating disorders are about so much more than food. Instead, someone’s relationship with food often becomes a symbolic medium that expresses the inexpressible: the loss of body trust. Body mistrust is at the core of how eating disorders develop and thrive.  

Trust in one’s body can be disrupted by many things, including and not limited to trauma, oppression, illness, and social constructs of gender, race, sexuality, beauty, health, and weight. These experiences can become stored in the brain and body in ways that become stuck in the nervous system and are not easily accessed through logic or insight alone.  

To only understand eating disorders at the level of food, body, and movement misses the root of the problem. More accurately, eating disorders should be understood as coping strategies, ways the nervous system learns to survive and cope with overwhelming experiences by avoiding, numbing, or overriding the body and its messages. The body becomes an adversary to monitor, control, or modify via food behaviors.  

Eating disorder as protective

At some point in someone’s life, these ED-related strategies “worked.” Eating disorder behaviors can offer a substitute for some of the missing needs and tools that should have been, but weren’t, supplied in someone’s life. The goals of ED strategies can be seen in this light as efforts to:  

  • Create a sense of agency or control 
  • Provide comfort and soothing 
  • Numb overwhelming emotions or distract from distress 
  • Disconnect from experiences that feel too intense or unsafe 

Understanding eating disorders in this way helps us ask a more appropriate and helpful question, moving from “Why won’t they just eat?” to “What is the eating disorder protecting them from?”  

When disconnected from the body, these food-related behaviors may have helped someone feel safer, soothed, or more in control in an environment that was unpredictable or unsafe physically, emotionally, and/or relationally. Over time, however, what was once helpful and adaptive for survival transforms into harmful and maladaptive, consuming more physical energy, mental space, resources, and time. The same behaviors progress, becoming increasingly rigid and difficult to stop, even if someone desperately wants to change or stop the behaviors. 

Seeing beyond food

If eating disorders are coping strategies, then treatment must address what the nervous system is trying to survive. This trauma-informed lens illuminates a path to effective, more long-lasting healing beyond the symptoms of food and body image.  

Because these experiences are stored in the nervous system, insight alone is often not enough. This is where the necessity for trauma-focused therapies, like EMDR, can be particularly helpful. 

When EMDR is helpful and when it is not

EMDR therapy and an AIP-informed approach offer a compassionate framework for eating disorder treatment. In the initial stages of history taking and treatment planning, EMDR therapists are trained to understand how their clients’ symptoms “make sense” given the context of their past experiences. So instead of exclusively focusing on ED symptoms and behaviors, the EMDR therapist works to identify the source of the present day symptom by treating the past “stuck” experiences that made the eating disorder necessary. As these underlying drivers of the ED are addressed through EMDR approaches, the rigid reliance on the eating disorder for coping softens as the nervous system no longer needs the eating disorder in the same way. 

That said, EMDR is not appropriate for everyone at every stage of eating disorder treatment. EMDR targets what our bodies and brains have learned from past experiences, not physical or medical problems. Healing one’s trauma does not address the physiological impact of an eating disorder.  EMDR nor any other psychotherapy can heal a malnourished brain and body—only food can do that. Untreated medical complications from an eating disorder can be severe and life-threatening, and so medical monitoring and nutritional support are an essential component of treatment. 

Medical stability and adequate nourishment are essential for EMDR to be effective (note: body size is not a reliable metric for nutritional status). When the body is malnourished, the brain perceives danger and can go into “famine mode,” making it harder to regulate emotions, tolerate distress, and process past experiences. 

The best practice within eating disorder treatment recommends incorporating a multidisciplinary team that includes medical care, nutrition support, and trauma-informed therapy (Woodruff et al., 2024; American Psychological Association 2020; Monteleone et al., 2019). Many people will see the most benefit when EMDR is integrated into a holistic treatment plan that includes a specialized eating disorder informed registered dietitian, physician, and psychiatrist. 

EMDR does not offer a quick fix, and it is not a treatment that should be entered prematurely. For some, EMDR reprocessing may need to come later in treatment, once basic safety and stabilization are established. For others, it may be introduced earlier in treatment, with careful pacing and preparation. 

What to expect from EMDR in eating disorder treatment

Healing from an eating disorder is a deeply personal and transformative journey. For those considering EMDR within the context of ED treatment, it is important to choose a therapist who has training in eating disorders and using EMDR for eating disorders. 

Given the pervasive nature of eating disorders and their impact on the body, mind, and nervous system, it makes sense that moving through the eight phases may not be straightforward or quick. My experience confirms that EMDR therapy in ED treatment is typically nonlinear and slower paced. Skilled EMDR therapists will invest adequate time in building safety, strengthening affect regulation skills, and establishing an honest and trusting therapeutic relationship before moving into memory processing phases of EMDR. In eating disorder work especially, the pacing matters. Healing in EMDR therapy happens at the intersection of what is safe and manageable for that person. 

Many EMDR therapists trained in working with eating disorders will spend significant time on stabilization skills, motivation for change, affect tolerance, somatic awareness, resourcing, and building trust before beginning memory reprocessing. This is essential to ensure that the work feels manageable rather than overwhelming. 

Importantly, skilled EMDR therapists approach eating disorder behaviors with respect. These behaviors are not treated as “the enemy,” but as signals of unmet needs and unresolved experiences. This compassionate stance is often deeply relieving for those who have felt judged or misunderstood in the past. 

 EMDR therapy can provide a compassionate and more comprehensive picture of what eating disorders are, why they exist, and how to heal from them. EMDR therapy offers something powerful and often missing in traditional eating disorder treatment: a way to heal that honors both the body and the story it carries, helping recovery feel possible, real, and long lasting. 

 

Cassie Krajewski, LCSW, is a therapist and consultant in private practice in Denver, Colorado. Her work sits at the intersections of trauma and dissociation, eating disorders and body image, sex and intimacy, and addictive processes. Krajewski is an EMDRIA Approved Consultant™, AASECT Certified Sex Therapist, Licensed Addiction Counselor, and a Certified Body Trust® Practitioner. While the AIP Model is her homebase, she also integrates ego state therapy, somatic therapy, clinical hypnosis, and liberation psychology into her practice. In addition to her work with clients, Krajewski is co-founder of IRIS Training Collective, a professional training group, where she develops and provides trainings and retreats and hosts the podcast Taking Up Space, exploring themes of embodiment, healing, and body liberation. 

 

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Date
February 23, 2026

Contributor(s)
Cassie Krajewski, LCSW 

Topics
Eating Disorders/Body Image

Audience
EMDR Therapists

Language
English

Content Type
Blog/Blog Post

Access Type
Open Access

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