Table 1 The difference between a harm-reductionist approach and a traditional treatment approach

Goal of Treatment

Reduction, cessation, and/or abstinence of ED behavior.

Decrease likelihood of mortality. Behaviors can be maintained. The goal is to increase the safety of ED behavior.

Goal of Treatment outcome

Find a life worth living outside an ED.

Restore a ‘normal’ eating pattern, where a normative pattern upholds colonial and capitalist structures of oppression.

Find a life worth living while living with an ED.

Identify that normative eating is not necessary or possible, and that the person can find their own normal, and that their normal can shift over time.

Perspective of ED

Pathological: ED is seen as extrinsic to the person, and is often compared to cancer or an abusive partner.

Treatment team identifies that behaviors are harmful and must be ceased to increase health and well-being.

Strengths-based: ED is viewed as a coping mechanism which naturally developed given their biological susceptibility and the environment they live in.

Allows persons with ED to set boundaries about what behaviors they are not willing to give up at that time. The person has access to education on the harms of behaviors and on how to reduce the harms of these behaviors if they are maintained.

Power

Top-down approach to treatment where the clinician is the expert of the clients health.

Nutrition and weight goals are prescribed to person living with an ED, tracked by the clinician who has access to restricted client information. Person living with an ED may limit the information they share in fear of judgment and suggestions of change.

Person-centered and strengths-based approach where the person with the ED is the true expert of their health.

Goals and information are decided and tracked by the person living with an ED. They can share this information with a clinician or similar, if they have access, when they trust that there will be no judgment or directions to change the behavior.

Family approaches

Family is recruited as an extension of a treatment team. They may monitor behavior, make rules around food and exercise, and communicate with a treatment team about progress or symptoms of the person with an ED.

Any communication with family by a treatment team is focused on conflict prevention and resolution. Family is taught to set boundaries, about non-judgmental approaches, and encouraged to focus on their own well-being.

Research

Group-based research is seen as the gold standard for identifying evidence-based approaches.

Evidence is based on the individual. A person is their own case study, setting their own baseline, finding techniques that maintain their health and well-being based on success and usefulness in the past.