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Box 3 Trauma-informed care

From: Management of eating disorders for people with higher weight: clinical practice guideline

A relationship between trauma and eating disorders is well established. Adverse experiences (e.g., emotional/physical/sexual abuse, crime victimisation, bullying) across the lifespan, but particularly in childhood are risk factors for the development of eating disorders [89,90,91,92]. Moreover, people who are at a higher weight are at greater risk of adverse experiences such as bullying and weight-related victimisation from peers, friends, parents and teachers than their peers without higher weight [93, 94].

Eating disorder treatment, in and of itself, may be traumatising for the person experiencing an eating disorder, especially when there is a lack of collaborative care and the misuse of power relations [95]. Components of eating disorder management such as weighing in a professional’s office may provoke intense anxiety, distress, and erode feelings of safety and trust. Thus, a crucial consideration for health professionals working with people with eating disorders who are of higher weight is to practice trauma-informed care through understanding the effects of actions that may be perceived as abusive, traumatic and/or triggering of previous trauma and moderating these actions as appropriate [88]. This is vital across all aspects of management of people with eating disorders who are of higher weight. For a detailed discussion of treatment principles for trauma informed care for eating disorders see Brewerton [88, 96, 97] and Trim et al. [98].

In addition to trauma-informed care, due to the high prevalence of co-occurring trauma and eating disorders, mental health professionals working with people with eating disorders who are of higher weight should also assess the need to incorporate specific trauma specific interventions (such as trauma-focused cognitive behaviour therapy or prolonged exposure) with eating disorder treatment.