We want to highlight National Eating Disorders Awareness Week. Eating disorders affect a person’s relationship to food and eating behaviors. There are many components to the development of eating disorders, including psychological trauma, emotional distress, feeling unsafe in an environment, messages regarding physical appearance from society and culture, and genetic makeup. EMDR therapy is a psychological therapy intervention to help clients with eating disorders.
We turned to EMDRIA member Marnie Davis, LMHC, CEDS-S, to shed some light on this topic.
Guest Blog Post by Marnie Davis, LMHC, CEDS-S
Tell us a little about you, your experience becoming an EMDR therapist, and your experience with clients who struggle with disordered eating.
My name is Marnie Davis. I am a Certified Eating Disorder Specialist, Supervisor, and EMDR Therapist and Consultant. I have been treating clients with eating disorders for the past 12 years. I love my work and find it both challenging and rewarding. I used EMDR early in my career, advancing my skillset over time. I learned to integrate standard and advanced protocols, resourcing, and parts work into what I call a dance with EMDR. I can’t imagine doing this work without the AIP model and EMDR. I am forever grateful for my training; I think my clients are too.
What is your favorite part of being an EMDR therapist with this population? ‘
I love watching the adaptive networks grow. As clients nourish their brains and bodies, they learn to be present and curious. As they reprocess negative life experiences that underlie the eating disorder and desensitize defenses, triggers, urges, and feeling states, they can begin to experience themselves, their bodies, and food differently; kinder, gentler, safer, more abundantly, and free of shame.
What issues would you say are the most common issues you’ve seen clients with eating disorders present to therapy with?
Clients with eating disorders often present with malnourished brains and bodies and a disconnected experience from themselves and their bodies. This can slow healing. They can carry complex trauma and attachment injuries, ongoing systemic oppression, and shame and suffer from weight stigma. Individuals with eating disorders can present with highly defended systems and dissociation. While seeking recovery, they must also engage in a world (and sometimes in a family and friend system) that continues to be consumed with the thin ideal, diet mentality, weight stigma, and fat oppression. Support groups can assist in-between sessions, creating a real-life circle of support resources that fosters connection, safety, and a body and food-respecting recovery mindset.
Clients with eating disorders present in various ways and all sizes of bodies. Clinicians can benefit from creating a safe, body-inclusive environment. Modeling curiosity and continually assessing and asking questions, allowing time and space for disclosure. I encourage all to continually notice our biases, including weight bias, to allow for accurate diagnosis and ethical, respectful, body-affirming care. A safe and affirming experience in the provider’s office can be an early opportunity to resource “I can feel safe when I am safe” and a body-affirming person/experience. I believe it is beneficial to take advantage of the many opportunities to include resource development installation (RDI) in the EMDR treatment process. It is exciting to watch the protective wall created by the eating disorder and shame dismantle as the individual’s authentic self emerges. The wise, guiding self can lead the parts in learning to use strengths, values, and adaptive resources to foster the system’s growth and explore kindness toward the body. Invite them to imagine it, imagine their recovered self. Tap it in.
The length of treatment for everyone will vary. The speed of recovery will vary. Recovery is not a linear process. The amount of outside support will vary. The complexity of the cases will vary, and co-occurring issues will present themselves. A team approach is necessary for ethical and comprehensive care for eating disorders. Regular appts with PCP are recommended due to medical complications related to eating disorder behaviors and diet history. At times, higher care options might be a necessary and appropriate consideration and recommendation. HLC includes intensive outpatient programs (IOP), partial hospitalization programs (PHP), and residential and in-patient programs. The APA has guidelines for levels of care for eating disorders. Many barriers limit and deny access to higher care and comprehensive care. In these cases, we collaborate and creatively find ways to create structure and safety and wrap the individual in care and support. Recovery is possible.
Are there any myths you’d like to bust about EMDR therapy and eating disorders?
From my perspective, EMDR has often been underutilized in higher-level of care settings in the past. EMDR can be a beneficial modality for individuals in IOP, PHP, and Residential levels of care once the brain and body have had time to restore and experience consistent, respectful nourishment. With many clients, EMDR can assist with resource development, enhancement of strengths, installation of the positive treatment goal, Flash Technique, utilization of advanced protocols to decrease urges, desensitizing triggers, and collaborating and resourcing with parts and mindful selection of memories for standard protocol.
Any specific complexities or difficulties with using EMDR therapy in this population?
Advanced training, consultation, and continuing educational opportunities (EMDR and non-EMDR) are necessary to enhance ethical and competent care. Providing comprehensive and collaborative care is vital. Providers are encouraged to do their work and continually address their biases. I encourage providers and other helpers to enhance their understanding by seeking stories and wisdom of lived experiences, experts, and lay persons belonging to oppressed groups.
Are there specific multicultural considerations when using EMDR with clients struggling with disordered eating?
Multicultural considerations present themselves throughout the process. I will touch on just a few. Eating Disorders affect individuals across age, gender, race, ethnicity, sexual orientation, shape, size, faith/religious affiliation, and socioeconomic status. It is important to consider socio/cultural/familial ideals, beliefs, and behaviors related to body, weight, and food when listening to their story. Individuals may experience body ideals held by their culture, their family, and by their communities. They may also experience pressure from the ideals of the dominant group. Familial and cultural beliefs regarding therapy and the family’s involvement in therapy may impact treatment. The client’s access /lack of access to quality, affordable, comprehensive, and affirming care is another multicultural consideration.
Do you have any favorite free EMDR-related resources you suggest to therapists working with this population?
There is an upcoming event held through the National Alliance for Eating Disorders – Not One More Weekend, Feb 24 – Feb 26, including Day of Help on Friday, Feb 24, Day of Support on Saturday, Feb 25, including a support group marathon with 24 free, therapist-led, virtual eating disorder support groups offered in one day, and Rally for Recovery on Sunday, Feb 26. Check it out at https://www.notonemore.co.
EMDR Solutions Part II is not free but is helpful. This book, edited by Robin Shapiro, has a few chapters on EMDR and Eating disorders and is an excellent place for EMDR therapists to start. I keep it close at hand. R. Shapiro (Ed.), EMDR solutions II: For depression, eating disorders, performance, and more. New York: W.W. Norton & Company, Inc.
- International Association of Eating Disorder Professionals (iaedp), http://www.iaedp.com
- The National Alliance for Eating Disorders, https://www.allianceforeatingdisorders.com, is a wonderful organization that promotes help, support, and recovery for all including free, virtual and in-person eating disorder support groups (for individuals and loved ones). They also offer a provider database at www.Findedhelp.com
- Association for Size Diversity and Health, https://asdah.org/health-at-every-size-haes-approach/
Marnie Davis is a Licensed Mental Health Counselor, Certified Eating Disorder Specialist and Supervisor, Certified EMDR Therapist and EMDRIA Approved Consultant. Marnie also has specialized training in Brainspotting and Mindfulness Based Stress Reduction Program. She is the current Continuing Education co-chair for the Central Florida iaedp Chapter and has previously served as president along with other various board positions. Marnie is the owner of a private practice in Maitland, Florida, where she specializes in the treatment of eating disorders, body image distress, body dysmorphia, trauma, PTSD, anxiety, depression, and other co-occurring issues. Marnie has experience working in higher level of care settings and is a Health at Every Size practicing clinician; respecting body diversity and creating a body affirming, therapeutic environment. Marnie is a seasoned presenter and enjoys speaking to various audiences and engaging in consultation and supervision. Marnie finds great joy in providing advanced training opportunities to other EMDR and non-EMDR therapists on the treatment of eating disorders. Marnie contributed as a chapter author in the book, Trauma-informed Approaches to Eating Disorders, currently in its 2nd edition process. Marnie served as a board member for the Eating Disorders Network of Central Florida for over 10 years where she focused on community awareness and fundraising for treatment and support services. She joined with the National Alliance for Eating Disorders, as an Orlando Affiliate, to continue to fundraise, advocate, and promote help, support and recovery for all. Marnie is a volunteer for the Greater Orlando Trauma Recovery Network (TRN) and holds community service, social justice and hope for healing in high regard.
EMDR Protocol Adaptations for Eating Disorders and Body Dysmorphia:
Beer, R. (2019). Protocol for EMDR therapy in the treatment of eating disorders. In M. Luber, (Ed.), Eye movement desensitization and reprocessing (EMDR) therapy scripted protocols and summary sheets: Treating eating disorders, chronic pain, and maladaptive self-care behaviors (pp. 11-64). New York, NY: Springer Publishing Co.
Forester, D. (2009). Image is everything: The EMDR protocol in the treatment of body dysmorphia and poor body image. In R. Shapiro (Ed.), EMDR solutions II (pp. 165-174). New York, NY: W. W. Norton and Co.
Forester, D. (2019). Eye movement desensitization and reprocessing (EMDR). In A. Seubert and P. Virdi (Eds.), Trauma-informed approaches to eating disorders (pp. 165-178). New York, NY: Springer Publishing Co.
Seijo, N. (2019). EMDR therapy protocol for eating disorders. In M. Luber, (Ed.), Eye movement desensitization and reprocessing (EMDR) therapy scripted protocols and summary sheets: Treating eating disorders, chronic pain, and maladaptive self-care behaviors (pp. 143-194). New York, NY: Springer Publishing Co.
Seijo, N. (2019). The rejected self EMDR therapy protocol for body image distortion. In M. Luber, (Ed.), Eye movement desensitization and reprocessing (EMDR) therapy scripted protocols and summary sheets: Treating eating disorders, chronic pain, and maladaptive self-care behaviors (pp. 217-238). New York, NY: Springer Publishing Co.
Zaccagnino, M. (2019). EMDR therapy protocol for the management of dysfunctional eating behaviors in anorexia nervosa. In M. Luber, (Ed.), Eye movement desensitization and reprocessing (EMDR) therapy scripted protocols and summary sheets: Treating eating disorders, chronic pain, and maladaptive self-care behaviors (pp. 79-126). New York, NY: Springer Publishing Co.
Peer-Reviewed Research Articles – Note that not all are open access, but those that are should be indicated that way.
Balbo, M., Zaccagnino, M., Cussino, M., & Civilotti, C. (2017). Eye movement desensitization and reprocessing (EMDR) and eating disorders: A systematic review. Clinical Neuropsychiatry, 14(5), 321-329. Open access: https://www.clinicalneuropsychiatry.org/clinical-neuropsychiatry-volume-14-issue-5-october-2017/
Bloomgarden, A., & Calogero, R. M. (2008). A randomized experimental test of the efficacy of EMDR treatment on negative body image in eating disorder inpatients. Eating Disorders: The Journal of Treatment & Prevention, 16(5), 418-427. https://doi.org/10.1080/10640260802370598
Brewerton, T. D. (2018). An overview of trauma-informed care and practice for eating disorders. Journal of Aggression, Maltreatment & Trauma, 1-18. https://doi.org/10.1080/10926771.2018.1532940
Brown, K. W., McGoldrick, T., & Buchanan, R. (1997). Body dysmorphic disorder: Seven cases treated with eye movement desensitization and reprocessing. Behavioural and Cognitive Psychotherapy, 25(2), 203-207. https://doi.org/10.1017/S1352465800018403
Cardazzone, E., Gallucci, M., Callerame, C., Cussino, M., Gelo, O., Pasca, P., & Zaccagnino, M. (2021). Linguistic changes during EMDR sessions: A preliminary single-case study. Counselling & Psychotherapy Research, 12394. https://doi.org/10.1002/capr.12394
de Jongh, A., & de Roos, C. (2013). If memories are in the way. Modern Medicine, 3, 85-88.
Dziegielewski, S., & Wolfe, P. (2000). Eye movement desensitization and reprocessing (EMDR) as a time-limited treatment intervention for body image disturbance and self-esteem: A single-subject case study design. Journal of Psychotherapy in Independent Practice, 1(3), 1-16. https://doi.org/10.1300/J288v01n03_01
Erguney-Okumus, F. E. (2021). Integrating EMDR with enhanced cognitive behavioral therapy in the treatment of bulimia nervosa: A single case study. Journal of EMDR Practice and Research, 15(4), 231-243. http://dx.doi.org/10.1891/EMDR-D-21-00012
Halvgaard, K. (2015). Single case study: Does EMDR psychotherapy work on emotional eating? Journal of EMDR Practice and Research, 9(4), 188-197. Open access: http://dx.doi.org/10.1891/1933-3188.8.131.52
Janssen, H. (2012). A special case (series): EMDR treatment of early childhood trauma in a client with an eating disorder. Tijdschrift voor Psychotherapie, 38(1), 21-37. [Dutch] https://doi.org/10.1007/s12485-012-0003-3
Kazen, M., Baumann, N., Twenhofel, J. F., & Kuhl, J. (2019). When do anorexic patients perceive their bodies as too fat? Aggravating and ameliorating factors. PLOS ONE, 14(2), e0212612. Open access: https://doi.org/10.1371/journal.pone.0212612
Meneguzzo, P., Garolla, A., Bonello, E., & Todisco, P. (2021). Alexithymia, dissociation and emotional regulation in eating disorders: Evidence of improvement through specialized inpatient treatment. Clinical Psychology & Psychotherapy, 29(2), 718-724. Open access: https://doi.org/10.1002/cpp.2665
Seijo, N. (2012). EMDR and eating disorders. Revista Iberoamericana de Psicotraumatologia y Disociacion, 4(2). [Spanish] Open access: https://www.revibapst.com/volumen-4-numero-2-2012
Seubert, A. (2018). Becoming known: A relational model utilizing Gestalt and ego state-assisted EMDR in treating eating disorders. Journal of EMDR Practice and Research, 12(2), 71-86. Open access: http://dx.doi.org/10.1891/1933-3184.108.40.206
Yasar, A. B., Abamor, A. E., Usta, F. D., Taycan, S. E., & Kaya, B. (2019). Two cases with avoidant/restrictive food intake disorder (ARFID): Effectiveness of EMDR and CBT combination on eating disorders (ED). Turkish Journal of Clinical Psychiatry [Klinik Psikiyatri Dergisi], 22(4), 493-500. DOI: 10.5505/kpd.2019.04127 Open access: http://www.klinikpsikiyatri.org/jvi.aspx?pdir=kpd&plng=tur&un=KPD-04127
Yasar, A. B., Usta, F. D., Abamor, A. E., Taycan, S. E., & Kaya, B. (2017). EMDR therapy on trauma-based restrictive eating cases. European Psychiatry, 41, S560-S561. https://doi.org/10.1016/j.eurpsy.2017.01.811
Zaccagnino, M., Cussino, M., Callerame, C., Civilotti, C., & Fernandez, I. (2017). Anorexia nervosa and EMDR: A clinical case. Journal of EMDR Practice and Research, 11(1), 43-53. Open access: http://dx.doi.org/10.1891/1933-3220.127.116.11
Cooke, L. & Grand, C. (2009). The neurobiology of eating disorders, affect regulations skills, and EMDR in the treatment of eating disorders. In R. Shapiro (Ed.), EMDR solutions II: For depression, eating disorders, performance, and more (pp. 129-150). New York: W.W. Norton & Company, Inc.
Forester, D. (2009). Treating bulimia nervosa with EMDR. In R. Shapiro (Ed.), EMDR solutions II: For depression, eating disorders, performance, and more (pp. 151-164). New York: W.W. Norton & Company, Inc.
Forester, D. (2009). Image is everything: The EMDR protocol in the treatment of body dysmorphia and poor body image. In R. Shapiro (Ed.), EMDR solutions II (pp. 165-174). New York, NY: W. W. Norton and Co.
Gross, L., & Ratner, H. (2002). The use of hypnosis and EMDR combined with energy therapies in the treatment of phobias and dissociative, posttraumatic stress, and eating disorders. In F. P. Gallo (Ed.), Energy psychology in psychotherapy: A comprehensive sourcebook (1st ed., pp. 219-231). New York, NY: W. W. Norton
Lidov, C. (2009). Desensitizing desire: Nonverbal memory and body sensations in the EMDR treatment of eating disorders. In R. Shapiro (Ed.), EMDR solutions II: For depression, eating disorders, performance, and more (pp. 183-192). New York: W.W. Norton & Company, Inc.
McGee, J. (2009). Addressing retraumatization and relapse when using EMDR with eating disorder patients. In R. Shapiro (Ed.), EMDR solutions II: For depression, eating disorders, performance, and more (pp. 175-182). New York: W.W. Norton & Company, Inc.
Scholom, J. (2009). Integrating eating disorders treatment into the early phases of the EMDR protocol. In R. Shapiro (Ed.), EMDR solutions II: For depression, eating disorders, performance, and more (pp. 114-128). New York: W.W. Norton & Company, Inc.
Schulherr, S. (2005). Exiting the binge-diet cycle. In R. Shapiro (Ed.), EMDR solutions: Pathways to healing (pp. 241-262). New York, NY: W. W. Norton & Company, Inc.
Seubert, A. (2009). The why of eating disorders. In R. Shapiro (Ed.), EMDR solutions II: For depression, eating disorders, performance, and more. (pp. 109-113). New York: W.W. Norton & Company, Inc.
Seubert, A. & Lightstone, J. (2009). The case of mistaken identity: Ego states and eating disorders. In R. Shapiro (Ed.), EMDR solutions II: For depression, eating disorders, performance, and more (pp. 193-217). New York: W.W. Norton & Company, Inc.
Seubert, A. & Virdi, P. (Eds.). (2019). Trauma-informed approaches to eating disorders. New York: Springer Publishing Company.
Zaccagnino, M., Cussino, M., Callerame, C., Civilotti, C., & Fernandez, I. (2017). EMDR in anorexia nervosa: From a theoretical framework to the treatment guidelines. In I. Jauregui-Lobera (Ed.), Eating disorders – A paradigm of the biopsychosocial model of illness (pp. 195-213). Rijeka, Croatia: InTech. DOI: 10.5772/65695 Open access: https://www.intechopen.com/books/eating-disorders-a-paradigm-of-the-biopsychosocial-model-of-illness/emdr-in-anorexia-nervosa-from-a-theoretical-framework-to-the-treatment-guidelines
Boghosian, J. (2020, Oct 29). Complex-PTSD, eating disorders, and the role EMDR plays. Eating Disorder Hope. https://www.eatingdisorderhope.com/blog/complex-ptsd-eating-disorders-and-the-role-emdr-plays
Cameron, V. L. (2013). EMDR: Promising treatment for co-occurring eating disorders and childhood sexual abuse [Masters thesis, St. Catherine University]. Retrieved from https://sophia.stkate.edu/msw_papers/160/
Savage, J., & Sundwall, M. (Hosts). Episode 60: EMDR and disordered eating with Dr. Kucharski. In Notice That Podcast. Patreon. http://emdr-podcast.com/ep-60-emdr-and-disordered-eating-with-lori-kucharski/?utm_source=rss&utm_medium=rss&utm_campaign=ep-60-emdr-and-disordered-eating-with-lori-kucharski
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