Familiarize with the program, meet the makers.

Introductory Foundations of Eating Disorder Treatment 10

Ethics in Eating Disorder Treatment 10

Cultural Diversity & Competency in Eating Disorder Treatment 11

Trauma-Informed Care 11

Adverse Childhood Experiences (ACEs) Questionnaire 15

Trauma & Eating Disorders 20

White Supremacy Culture Can Impact Eating Disorder Development and Recovery 23

WSC Characteristics to be Aware of 23

References 24

General Warning Signs of Eating Disorders 26

Psychological Warning Signs of Eating Disorders 26

Physical Warning Signs of Eating Disorders 26

Behavioral Signs of Eating Disorders 27

Eating Disorder Basics 28

9 Truths About Eating Disorders 28

Nine More Truths about Eating Disorders: Weight and Weight Stigma 31

Eating Disorder General Facts 31

Factors That Influence the Development and Maintenance of Eating Disorders 32

Emotional Neglect and Disruption in Primary Caregiving Relationships 33

General Concepts & Skills for Eating Disorder Treatment 35

Core Clinical Targets and Context 35

1) Impaired insight (denial of illness) 35

2) Ambivalence and identity/self-evaluation 35

3) Belonging, rejection sensitivity, and social context 35

Why the Eating Disorder “works” and “helps” (functional analysis) 36

“Roles” the Eating Disorder Occupies 37

Conditions that Enable Behavior Change 37

Therapeutic alliance and trust: 37

Personal growth and self-efficacy: 37

Functional understanding of behaviors: 38

Reduce isolation; increase corrective experiences: 38

Time and illness duration: 38

Family/partner support and unresolved grief/trauma: 38

Values and goals > ED symptom functions: 38

Emotion competency: 38

References 39

What is Weight Inclusivity and What is HAES®? 42

Original ASDAH HAES® Concepts: 43

History of Weight Inclusivity 44

Weight Centric Modalities Can Contribute to Eating Disorders 47

How do we collaborate with doctors who follow a conventional medical model? 50

Weight-inclusivity and Eating Disorder Treatment 51

A Critical Comparison to Traditional Treatment Paradigms 52

Grounding in Liberatory Frameworks 52

Patient Bodily Autonomy 52

Informed Consent 53

Compassionate Care 53

Critical Engagement with Weight Science 53

Competence in Caring for Fat Bodies 53

Provider Accountability 53

Non-Oppressive Tools for Healing 53

Addressing Anti-Fat Bias 54

The Science of Weight Inclusivity 55

Research Article: Weight Science: Evaluating the Evidence for a Paradigm Shift by Bacon & Aphramor (2011) 55

Weight-Inclusive Approaches to Nutrition and Dietetics: A Needed Paradigm Shift (Levinson, 2024) 59

Weight Change over the Lifespan 60

Adulthood 62

The BMI associated with the lowest mortality increases with age. 63

Does social class predict diet quality? 72

Summary 73

References 73

Introduction to Eating Disorder Recovery 76

The Addiction Model is Contraindicated in Eating Disorders 76

The Recovery Model is Central 77

Recovery Phases: A Perspective on Eating Disorder Recovery 77

1. Symptom Development 77

2. Continued Need for Eating Disorder Behaviors Despite Distress 77

3. Decreasing Reliance and Habits of the ED: Insight and Skill Building 78

4. Identity Shift and Relapse Resilience 78

Supporting Research & Evidence 79

Stages of Recovery: A Perspective on Eating Disorder Recovery 79

1. The Learning Stage 80

2. The Changing Stage 80

3. The Anticipating Stage 81

Conceptualizing Eating Disorder Recovery 82

Foundational Tenets of ED Recovery 82

1. Non-linear and Ongoing 82

2. Individuality in Recovery 82

3. Internal and External Factors 83

4. Systemic Oppression Shapes Trajectories 83

Recovery Domains to Attend to in Treatment 83

1. Physical Stability 83

2. Psychosocial Functioning 84

3. Quality of Life 84

4. Identity beyond the Eating Disorder 84

External and Systemic Factors Affecting Recovery 84

External / Proximal (direct, day-to-day) 84

Systemic / Structural (context, policy, culture) 85

Characteristics Common in Recovery 85

Translating Framework Into Practice 86

Recovery Concepts: A Brief Introduction 86

Integration 87

Embodiment: Coming Home to One’s Body 87

Mindfulness and the Present Moment 87

Reconnecting with Pleasure and the Lived Body (vs. Self-Objectification) 87

Note on ARFID 88

Stillness, Tolerance, and Interoceptive Trust 88

From External Rules to Internal Guidance 88

Body Liberation 89

A Working Definition of “Recovered” 89

RD–Specific Recovery Concepts 89

Physiological Restoration and Metabolic Recovery 89

Sufficient Energy Availability and Intake Patterns 90

Normalized Eating Behaviors and Cognition 91

Body Acceptance and Identity 91

Movement and Rest 91

The “Invisible” Metric: Cognitive Bandwidth 91

Therapist–Specific Recovery Concepts 92

Cognitive and Identity Expansion 92

Emotion, Insight, and Behavior 92

Family of Origin (FOO), Trauma, and Core Beliefs 92

Meaning, Presence, and Somatic Connection 93

Understanding ED Urges and Rituals 93

More Notable Recovery Concepts & Goals 93

Relapse Prevention 94

Overview and Epidemiology 94

Normalizing Lapses and Relapses 94

Behavior Chains 95

The Core Links (what to map) in Behavior Chains 95

A 10-Minute in Session Script: Behavior Chain Mapping 96

Transdiagnostic Relapse Prevention 97

Common High-Risk Relapse Contexts 97

Eating Disorder Specific Relapse Risks: Acuity 98

Habit-Focused Relapse Prevention in Anorexia Nervosa (AN) 98

Clinician Tools & Examples to Use Now 99

Core Components of an ED Relapse Prevention Plan 100

Anticipation Stage Expanded: Planning for the Future 101

Statistics on Prevalence, Relapse, and Recovery 101

Prevalence and occurrence 101

Who is being missed (treatment gap and preventable mortality) 101

Recovery rates 102

Relapse and chronicity 102

Weight status during/after illness 102

Migration/crossover among diagnoses 102

Mortality, hospitalization, global improvement 103

Practical implications 103

References 104

What are Eating Disorders? 3

General Risk and Mortality 3

Eating Disorder Diagnoses 5

Anorexia Nervosa & Subtypes 5

Types of Anorexia Nervosa 8

Anorexia Athletica 8

Atypical Anorexia Nervosa 8

Restrictive Type Anorexia Nervosa 8

Binge-purge Type Anorexia Nervosa 9

Orthorexia Nervosa 9

Bulimia Nervosa 10

Types of Bulimia Nervosa 11

Exercise Bulimia 11

Diabulimia 12

Binge Eating Disorder 13

ARFID - Avoidant Restrictive Food Intake Disorder 14

OSFED - Other Specified Feeding or Eating Disorder 15

UFED - Unspecified Feeding or Eating Disorder 16

Rumination Disorder 17

Pica 18

Night Eating Syndrome 19

Purging Disorder 21

Severe and Enduring Eating Disorders (SEED) 22

Common Co-occurring Diagnoses 27

Obsessive-Compulsive Disorder (OCD) 27

Obsessive-Compulsive Personality Disorder (OCPD) 27

Borderline Personality Disorder (BPD) 28

Generalized Anxiety Disorder (GAD) 28

Major Depressive Disorder (MDD) 29

Substance Use Disorder (SUD) 29

Post Traumatic Stress Disorder 29

General Risk Factors for Eating Disorders 30

Identifying Functionality of EDs in Treatment 31

Eating Disorders in Boys and Men 32

General Facts about Men & Boys Eating Disorders from Academy for Eating Disorders (AED) 32

Understanding and Addressing Eating Disorders in Boys and Men 36

Understanding Differences in Eating Disorders Among Men and Women 37

Summary of Eating Disorders in Boys & Men 39

LGBTQIA+ Considerations for Eating Disorders Treatment 39

“Body Mass Index Requirements for Gender-Affirming Surgeries Are Not Empirically Based” 39

“Understanding the Nutritional Needs of Transgender and Gender-Nonconforming Students at a Large Public Midwestern University” 41

“Higher Rates of Lifetime Traumas and Current PTSD Among Sexual and Gender Minority Individuals in Residential Eating Disorder Treatment” 43

“Eating Disorders and Disordered Eating Behaviors in the LGBT Population: A Review of the Literature” 45

Trans and Nonbinary Experiences of Conformity, Coping, and Connection in Atypical Anorexia 47

“Transgender and Other Gender Diverse Adolescents with Eating Disorders Requiring Medical Stabilization” 49

Neurobiology & Eating Disorders 52

Medical Aspects of Eating Disorder Treatment 55

When To Worry? 56

Eating Disorder Treatment Guidelines 58

“Atypical” Anorexia Nervosa (Gaudiani, 2018) 59

Special Medical Considerations (Gaudiani, 2018) 60

ED Treatment Considerations (Medical Perspective) 62

Gastroenterology 63

Obstetrics and Gynecology 65

Psychiatry 65

Pediatrics 66

Sports Medicine 66

Extreme Presentations - Eating Disorders 66

Eating Disorder Behaviors: Symptoms & Indications 71

Further Medical Considerations Regarding Eating Disorders 74

Resources 82

Levels of Care: ED Traditional Treatment 83

Outpatient Level of Care 83

Intensive Outpatient Programs (IOP) 84

Partial Hospitalization Programs (PHP) 88

Residential Level of Care 91

Inpatient Hospitalization 94

Importance of Stepping Down Through Each Level of Care

Caution! Traditional Eating Disorder Treatment May Not Be For Everyone

Potential Barriers for Vulnerable Populations Seeking HLOC

Assessment 100

Assessment Items

Eating Disorder Examination Questionnaire (EDE-Q 6.0)

References 104

Nutrition Counseling Introduction 3

Common Misconceptions Dietitians May Have About Nutrition Therapy 3

Activity 4

Countertransference 5

Scope of Practice: Dietitians 6

Parent/Caretaker Involvement Support 12

Tips on Dealing with Parenting Challenges 13

Education for Parents & Supports 13

Determining Appropriate Level of Care (LOC) for RDs 14

Nutrition Therapy Across Levels of Care 17

Nutrition Assessment 18

Introductory Questions 19

History Taking 19

Current Behaviors and Attitudes 19

Eating Attitudes Test 20

Physical & Medical Assessment 20

Lab Work 22

Recommended Lab Assessments for Eating Disorders 22

Recommended Lab Assessments for Symptomatic and Malnourished Clients 23

Symptoms of Malnourishment 25

Physical symptoms 25

Psychological Symptoms 25

In-depth Analysis of Eating Disorder Behaviors 26

Anthropometrics: Weight History 27

Step-by-Step Guide: Nutrition Therapy 28

Initial Work 28

First sessions 29

Second Session 30

Functions of Macronutrients – Biochemistry 101 31

Carbohydrates 31

Fats 32

Protein 32

Vegetables 32

β-carotene 34

Folate 34

Vitamin C 34

Vitamin K 35

Potassium 35

Calcium 35

Magnesium 35

Iron 36

Socioeconomic Status (SES) 36

Third Session 36

Treatment Planning Goals 37

Myth Busting and Nutrition Education 38

Carbohydrate and Sugar Myths: 45

Cholesterol and Fat intake myths 45

Hypertension and Sodium Intake: 47

Restriction Myths 48

Inflammation and Intake 48

Serving Sizes 49

Exercise Myths 49

Addressing Family Attitudes Around Food and Body 50

Middle Work 52

Later Work 54

Medical Considerations in Nutrition Therapy 55

Harm Reduction in Nutrition Therapy 60

Specific Skills: Harm Reduction for RDs 61

Weight Restoration 70

Weight Cycling Impacts 71

HAES® & Nutrition Therapy (from https://asdah.org) 71

Dietetics School vs Weight Inclusivity 72

Activity 74

Meal planning 74

Teaching Exchanges to Clients: 78

When Meal Plans Are Appropriate 78

Special Diet Considerations: Vegan, Vegetarian, Religious Diets 79

Considerations for Medical Diets 79

Supplements & Other Recommended Medications 80

Integration of Intuitive Eating 81

Exercise 85

Medical Considerations 85

Quesnel, Cooper, Fernandez-Del-Valle, Reilly, & Calogero (2023) explore in-depth these consequences: 85

Dysfunctional Exercise in Eating Disorders 94

Bariatric Surgery 98

References and Resources 100

Introduction 2

Early Eating Experiences 2

Satter Model of Eating Competence 3

Normal Eating Readiness 4

How do you know when a client is ready for intuitive eating? 4

Intuitive Eating Principles & ED Diagnosis Specifics 5

Foundational Introduction to Normal Eating 8

Key features 8

Intuitive Eating Outcomes 9

Initial Sessions 9

First Session 10

Second Session 12

Common Diet Rules 13

Third Session 17

Fourth Session 18

Stocking: Tool for Intuitive Eating 18

Client Activities:  Intuitive Eating Skill Building 19

Principles of Intuitive Eating  (Tribole & Resch, 2020) 20

Initial Work in Nutrition Counseling for Intuitive Eating 20

1. Reject Diet Culture (Tribole & Resch, 2020) 20

Research Supporting Intuitive Eating 21

2. Make Peace with Food (Tribole & Resch, 2020) 28

3. Challenge the Food Police (Tribole & Resch, 2020) 29

4. Honor Your Hunger (Tribole & Resch, 2020) 31

Hunger/Fullness Scale 33

Research 33

Middle Work in NutritionTherapy for Intuitive Eating 34

5. Feel Your Fullness (Tribole & Resch, 2020) 34

6. Discover the Satisfaction Factor (Tribole & Resch, 2020) 35

7. Cope with Your Emotions with Kindness (Tribole & Resch, 2020) 36

8. Respect Your Body (Tribole & Resch, 2020) 42

Later Work in Nutrition Therapy for Intuitive Eating - If Appropriate 44

9. Movement - Feel the Difference (Tribole & Resch, 2020) 44

Adequate Activity Mindsets 45

10. Honor Your Health - Gentle Nutrition (Tribole & Resch, 2020) 47

What is Healthism? 47

Learn More 49

References 49

Introduction to Therapy Modalities for Eating Disorders (EDs) 4

Fundamentals in Eating Disorder Treatment 5

The Therapeutic Alliance in Eating Disorder Treatment 6

References 9

Identity & Eating Disorder Recovery: An Introductory Overview 10

Treatment Interventions for Identity Reclamation & Reconstruction 11

References 15

Ambivalence in Eating Disorders: Introduction, Overview, & Clinical Interventions 15

Treatment Interventions for Ambivalence 16

References 17

Dissociation In Eating Disorders 18

References 20

Developing Emotional Competency in Eating Disorder Recovery 20

References 29

Autonomy 29

References 32

Dialectical Behavior Therapy (DBT) 33

Core Principles of DBT 34

Techniques & Skills 35

DBT for Eating Disorders 38

Examples of how the approach may be integrated into clinical practice: 40

Case Study: Using DBT to Treat Bulimia Nervosa 41

Contraindications & Limitations of DBT for Eating Disorders 42

Learn More 43

References 44

Radically Open Dialectical Behavior Therapy (RO-DBT) 45

Basic Concepts and Assumptions of RO-DBT 45

RO-DBT versus DBT 47

RO-DBT & Eating Disorders 47

Theory of Change 48

The Primary Mechanism of Change: Social Signaling 49

Application in Therapy 50

Treatment Protocols and Delivery 51

Treatment Strategies 52

Specific Skills & Concepts in RO-DBT 53

Mindfulness 53

Radical Openness 54

Behavioral Activation 56

Cognitive Flexibility & Dialectical Thinking 57

Skills Training 58

Applying RO-DBT to the Treatment of EDs 59

Last Notes on Providing RO-DBT with Clients 60

Learn More 60

References 61

Acceptance and Commitment Therapy (ACT) 61

Foundational Premises: ACT 61

Treatment Strategies - Techniques, Principles, Style 63

Six Core Strategies of ACT 64

How to integrate into clinical practice (Harris, 2009): 69

ACT and Eating Disorders 69

Case Study 71

Contraindications & Limitations for ACT 72

Learn More 72

References 72

Emotion Focused Therapy (EFT) 74

Overview of the EFT Philosophy & Model 75

Emphasis on Emotional Awareness 76

EFT & Eating Disorder Treatment 76

Primary Emotions 77

Secondary Emotions 78

Transformation of Emotions & Clinical Interventions 79

EFT and Attachment in Eating Disorder Recovery 81

Attachment Styles and Their Impact 81

More Therapeutic Interventions Involving Attachment in EFT 85

Contraindications and Limitations of EFT 88

Learn More 88

References 88

Exposure and Response Prevention (ERP) in the Treatment of Eating Disorders 91

Obsessive Compulsive Disorder and Eating Disorders 92

Overview of Exposure and Response Prevention (ERP) Therapy 93

Components of ERP (Foa et al., 2012; Becker et al., 2020) 94

The Function of Exposure Therapy in ED treatment 95

ERP in Clinical Practice 95

Step 1: Assessment 95

Step 2: Hierarchy 97

Step 3: First Exposure (critical step) 98

Step 4: Repeated, gradual progression through hierarchy 99

Food and Eating Exposures 100

Body Image Exposures 100

Mirror Exposures 101

Cue Exposure for Binge Eating 102

Exposure Work with Avoidant/Restrictive Food Intake Disorder 103

Limitations of Applying CBT and Exposure work to ARFID 104

Contraindications and Limitations of Exposure Therapy for EDs 105

References 106

Motivational Interviewing 107

Overview of Philosophy and Theory of Change 108

Integration and Treatment Strategies 109

Techniques: Motivational Interviewing 110

Contraindications & Limitations 112

Where To Learn More 113

References 113

Harm Reduction 114

Key Aspects of Harm Reduction in Eating Disorder Treatment 115

Six Key Principles of Harm Reduction In Healthcare Settings 117

1. Humanism 118

2. Pragmatism 118

3. Individualism 118

4. Autonomy 119

5. Incrementalism 120

6. Accountability without Termination 120

Treatment Strategies 121

Tips: How to Integrate Harm Reduction into Clinical Practice 121

Readiness for Change 122

Client Autonomy & Clinician Bias 124

Eating Disorder Behavior Monitoring 124

Case Study 126

Where to Learn More 127

Contraindications & Limitations 127

References 127

Cognitive Behavioral Therapy (CBT) 128

CBT Treatment 129

Phase One 129

Phase Two 129

Phase Three 129

Dysfunctional Thinking Patterns: Examples 130

ABC Monitoring 130

Phase Four 131

Case Study 132

Contraindications and Limitations 132

Where to Learn More 132

References 133

Family Based Treatment (FBT) 133

Five tenets of FBT 134

FBT Treatment Involves Three Phases 134

1. Phase 1: Psychoeducation and weight restoration 134

2. Phase 2: Returning control to the adolescent 134

3. Phase 3: Consolidation and relapse prevention 134

6 Stages of Growth of Family Members Regarding the Eating Disorder 135

The Debate About FBT 135

Pros: 136

Cons: 136

Learn More 137

References 137

Introduction 2

Acknowledgements 3

Internal Family Systems (IFS) 3

Key Principles 4

Implementing IFS 5

The 6 Fs of working with Protectors: 6

Unburdening: 7

IFS & Eating Disorders - Case Example 8

Considerations & Limitations 12

Learn more: 13

References 13

Eye Movement Desensitization & Reprocessing (EMDR) Therapy 13

Overview of EMDR 14

Research 15

Eight-Phase Protocol: An Overview 16

Three-Pronged Approach & Dual-Attention 16

Digging Deeper: Basic Protocol 16

Clinical Themes 19

EMDR-ED Protocol 19

Applying EMDR Basic protocol to Eating Disorders 20

Contraindications & Considerations for Treatment of EDs with EMDR 24

There is Always More To Learn 26

References 26

Psychodynamic Therapy 27

Basic Assumptions of Psychodynamic Theory 27

Psychodynamic Therapy & Eating Disorder Treatment 28

Developing Insight 28

Treatment strategies 32

Case study 34

Contraindications & Limitations 36

References 36

Somatic Experiencing (SE) 37

SE Theory of Change & Philosophy 39

Treatment Strategies 39

SE & Eating Disorders Overview 40

Integration into Clinical Practice for Eating Disorders 41

Clinical Assessment 42

Example Treatment Goals 42

Treating Trauma and Eating Disorders Through the Body 43

Case Study 45

Contraindications & Limitations 49

References 49

Introduction 2

Body Image Defined 2

Theoretical Perspectives 2

Body Image Distress or Body Shame 3

Individual and Developmental Factors 4

External and Societal Factors Contributing to Body Shame 4

White Supremacy Culture (WSC) 4

Thin-Privilege, Drive for Thinness, & Muscularity 5

Social Media/Media Literacy 5

Health-Care/Medical Community 6

Body Image in the LGBTQIA+ Community 6

Body Image in BIPOC community 7

Clinician Self-Work & Self-Reflection 7

Activity - The Clinician’s Own Body Image 7

Body Image & Eating Disorders 8

Body Image in Specific Diagnoses 9

Clinical Interventions: Body Image Spectrum, Healing Stages, & Techniques 10

Address the Functions of Body Image Distress 10

Body Image Healing Continuum 11

Body Dysmorphic Disorder 17

Body Dysmorphic Disorder (BDD) Assessment 17

Common Behaviors: 18

Related symptoms: 18

Key differences between BDD and Other diagnoses: 18

Risk Factors: 19

BDD Treatment 19

Best Practices for BDD 20

CBT-BDD: 20

CBT-BDD Treatment model with Techniques: Case Example 22

ERP for BDD: 23

ERP Case Examples: 23

Contraindications, Limitations, & Considerations 26

References 27

Overview: Compulsive Exercise 2

Compulsive Exercise Defined 2

Exercise Dependence Defined 3

Excessive Exercise Defined 3

The Invisible Behaviors in Compulsive Exercise 4

Causes: Compulsive Exercise 4

Prevalence: Compulsive Exercise (CE) 4

Functionality of Compulsive Exercise (CE) 5

Dissociative Processes 5

Emotion Avoidance 6

Avoidance of Physiological Sensations 6

Stored, Unprocessed Trauma 7

Response to Obsessive, Intrusive, or Distressing Thoughts 7

Body Image Distress 7

Exercise as Identity 7

Inability to be Still 8

Fitness Culture 9

Diagnostic Considerations 12

Body Dysmorphic Disorder (BDD) 12

OCD/OCPD in Compulsive Exercise 12

Risks: Compulsive Exercise 14

Symptoms: Compulsive Exercise 15

CE Triggers 16

Assessment: Compulsive Exercise 16

Assessment Questions and Themes 16

CE Assessment Tool Options 17

Exercise Dependence Scale (EDS) 17

Compulsive Exercise Test (CET) 18

Treatment: Compulsive Exercise 19

A Word of Caution in Incorporating Exercise into Eating Disorder Treatment 19

A Brief History of Incorporating Exercise in Eating Disorder Treatment 21

Overview: CE Treatment Modalities 22

Psychoeducation 22

Exposure and Response Prevention 22

Cognitive Behavioral Therapy 23

Dialectical Behavior Therapy (DBT) 25

Harm Reduction 26

Safe Exercise at Every Stage (SEES) 26

Treatment Considerations for Compulsive Exercise in EDs 27

Athletes and Compulsive Exercise 30

Treatment Strategies for Athletes & CE 33

Recovery from Compulsive Exercise 36

Intuitive Movement or Intuitive Exercise 36

CE Treatment Team Roles 38

Learn More from Ragen Chastain: 39

References 39

Objectives for Each Section 8

Racism 15

Social Impact 19

Emotional Impact 19

Political Impact 19

Historical Context 20

Foundations of the Medical and Healthcare Systems 22

Shifts Towards Recognition and Inclusivity 22

Ongoing Challenges and the Path Forward 23

Systems of Oppression 23

Colonization 24

Racism 24

Sexism 25

Classism 25

Ableism 25

Heterosexism/Homophobia 25

Ageism 25

Nativism 26

Patriarchy 26

Interaction and Compounding of Inequities: The Matrix of Domination 27

The Medical-Industrial Complex as a System of Oppression 30

An Historical Perspective 30

Modern Medical Landscape 31

Racism in Public Health 32

Pathologization of Race 33

Pathologization of Gender 34

Continued Experimentation and Mistreatment 34

The Modern Eugenics Movement 35

Impact of BMI 37

White Supremacy Culture 38

Centralization of White Norms 39

Institutional Power 39

Implicit Bias and Racial Stereotypes 39

Economic and Social Disparities 40

Resistance to Change 40

Whiteness and Body Hierarchies 41

The Valuation of Bodies Based on Looks 42

Impact of Body Hierarchies 43

Gender Non-Conforming Individuals 44

Persons with Disabilities 45

Conforming to Body Standards as a Coping Mechanism 45

Ancestral Patterns and Bodily Dissociation 47

White Supremacy as the Core Issue 49

Implications for ED Treatment 49

White Supremacy Culture By Trait 50

Perfectionism in White Supremacy Culture 52

Sense of Urgency in White Supremacy Culture 53

Defensiveness in White Supremacy Culture 55

Quantity Over Quality in White Supremacy Culture 56

Worship of the Written Word in White Supremacy Culture 58

Only One Right Way in White Supremacy Culture 59

Paternalism in White Supremacy Culture 61

Either/Or Thinking in White Supremacy Culture 62

Power Hoarding in White Supremacy Culture 64

Fear of Open Conflict in White Supremacy Culture 66

Individualism and Separateness in White Supremacy Culture 68

"I'm the Only One" in White Supremacy Culture 70

Silence in White Supremacy Culture 71

Objectivity in White Supremacy Culture 73

Right to Comfort in White Supremacy Culture 75

Progress is Bigger/More in White Supremacy Culture 77

Bias 80

Affinity Bias 82

Confirmation Bias 83

Groupthink or Conformity Bias 83

Perception Bias 84

Conscious Bias 84

Recognizing Bias in Ourselves and Our Practices 86

Shame and Stigma Sensitive Language 87

Perpetuating Shame 87

Creating Power Imbalances 87

Indicating Criminality 88

Principles for shame‐sensitive practice 89

Communal and Culturally Relevant Approaches 90

Terminology and Mind-Body-Spirit Unity 91

Actions for Inclusive Professionals 91

Intersectionality 93

Intersectionality as a Tool for Validating Experience 95

Enhances Understanding of Diverse Experiences 95

Promotes Culturally Competent Care 96

Challenges Stereotypes and Assumptions 96

Facilitates Equitable Access to Treatment 96

Supports Holistic Recovery 97

Exploring the Intersections of Identity and Bias 97

Anti-Blackness in the Context of Eating Disorders 98

Anti-blackness and the Role of Internalization and Colorism 99

Nativism and Immigration 101

Economic Changes and Disordered Eating 102

Cultural Food Whitewashing: 102

Acculturation and Eating Disorders 103

Conclusion and Charge to ED Professionals 104

Intersectionality of LGBTQIA+ and Gender Non-conforming Issues in Eating Disorders 104

Sexism and Misogyny: Impacts on Eating Disorders Recognition and Treatment 106

Sexism and Men with Eating Disorders 110

Anti-fat Bias and Size Privilege: Impacts on Eating Disorder Treatment and Prevention 111

Disabilities and Chronic Health Conditions: Navigating Barriers to Care and Support 113

Healthism: Consequences for Eating Disorder Perception and Treatment 114

Neurodivergence and Eating Disorders: Tailoring Diagnosis and Treatment 116

Ageism: Navigating Age Biases in Eating Disorder Care 118

Appearance Standards: The Role of Societal Beauty Ideals in Eating Disorders 120

WSC and Bias Compound Barriers 121

Addressing Intersectional Biases within WSC: 122

Application of Intersectionality: 124

Strategies for Incorporating Intersectionality into ED Treatment 125

Embrace Cultural Competence and Humility: 126

Develop Tailored Treatment Plans: 126

Foster Inclusive and Supportive Environments: 126

Engage in Advocacy and Community Collaboration: 126

Incorporate Intersectional Education and Training: 127

Utilize an Empowerment-Based Approach: 127

Intersectionality, White Supremacy Culture, and Their Influence on ED Research and Public Education 127

Understanding Systemic Disparities and Inequities 130

Health Disparity 131

Health Inequity 131

Eating Disorders as a Social Justice Issue 132

Impact of Inequities and Systems of Oppression 133

Prevalence and Diagnosis 134

Disproportionate Impact on LGBT Individuals 135

Transgender Individuals and Body Modification 136

Gay Males, Binging, and Purging 136

Lesbian, Bisexual, and Mostly Heterosexual Females 136

Disparities in Treatment and Recovery 137

Disparities along Socioeconomic Status 137

Systemic Inequity and Access to Care 138

Socioeconomic Status and Healthcare Outcomes 138

Social Determinants of Health 140

Partial List of Social Determinants of Health: 142

● Economic Stability: Employment, income, expenses, debt, medical bills, and support. 142

Social Determinants as Products of Structural Racism 142

Presenting Social Determinants as Conditions to Be Challenged 143

Structural Racism as a Social Determinant of Health 144

Implications for Health Professional Education 144

Implications for ED Treatment 145

SDOH of Particular Interest to the Eating Disorders Field 146

Trauma of Racism and Oppression 146

Psychological and Physiological Impact: 147

Internalization of Racial and Cultural Standards: 147

Impact on Eating Disorder Treatment Processes 150

The Diagnostic Process 151

● Reliance on BMI 151

● Bias Regarding Who Develops EDs 151

● Cultural Differences in Assessment Responses 152

Treatment Modalities: 153

Residential Treatment 154

Communal and Culturally Relevant Approaches 156

Tools that Promote Inclusion 160

Cultural Competency Continuum 161

Application in ED Treatment 162

Understanding Cultural Diversity in ED Presentation 164

● Recognize Variability in Symptoms and Ideals: EDs manifest differently across cultures due to varying beauty ideals, food practices, and body image perceptions. Healthcare providers should familiarize themselves with the diversity of ED presentations and be aware that the "thin ideal" is not universal (Pumariega, Gustavson, Gustavson, Stone Motes, & Ayers, 1994). 164

Training and Education 164

Culturally Sensitive Assessment and Treatment Planning 164

Incorporating Cultural Practices 165

Language and Communication 165

Building Trust and Rapport 165

Advocacy and Policy 165

Understanding Cultural Diversity in ED Presentation 166

Training and Education 166

Culturally Sensitive Assessment and Treatment Planning 166

Incorporating Cultural Practices 167

Language and Communication 167

Building Trust and Rapport 167

Advocacy and Policy 167

Intersectional Feminism in Eating Disorder Treatment 168

Dismantling White Beauty Standards 170

Systemic Change and Uplifting BIPOC Providers 170

Prioritizing Resources and Referrals 171

Anti-Oppressive Supervision and Support 171

Centering Marginalized Voices 171

Health at Every Size (HAES) as a Treatment Model in Eating Disorder Care 172

HAES Principles 173

Application in ED Treatment: 173

Structural Competency 174

How to Become More Structurally Competent 176

A Call to Action for Inclusive Eating Disorder Professionals 178

References 179

Person of the Therapist 2

Therapeutic Presence 2

Therapeutic presence defined 2

Weight Bias 4

Activity - Challenging Your Own Biases 5

Activity - Journal & Reflection Assignment: Your Body Story 5

Clinician’s Own Journey with Body and Eating Disorder Symptoms 6

Activity - Journal & Reflection Assignment 6

Research Article 7

Research Article 8

Research Article 9

Research Article 11

Research Article 12

Considerations in Eating Disorder Treatment - Levels of Care Defined and Explained 15

Research Article 15

Research Article 17

Review of Important Concepts 18

Activity - Complete the following 3 assignments 20

Activity - Contacting an Experience of Presence 21

The Eating Disorder Treatment Team 22

References 27