Harm Reduction and Eating Disorders

Treatment for eating disorders can vary widely and is typically informed by the severity of the illness and accompanying behaviours. This can include, but is not limited to, counselling, groups (including peer support), residential support, outpatient support through specialized hospital programs, and intensive inpatient treatment (National Eating Disorder Information Centre [NEDIC], n.d.). Harm reduction can be integrated at all stages of treatment, and those who have attempted multiple intensive treatments with little success may benefit from a harm reduction approach, which promotes quality of life and client choice (Westmoreland & Mehler, 2016). However, there can be significant risk involved with this approach, and it should be addressed with care, expertise, and if needed, bioethics consultation (Bianchi et al., 2021; Westmoreland & Mehler, 2016).

There is very little empirical evidence available studying harm reduction approaches to eating disorders. Because of the potential lethality of eating disorders, there are complex ethical considerations to conducting research, including assessing consent and the potential impact of eating disorders on cognition (Bianchi et al., 2021). Anorexia specifically has the highest mortality rates of all psychiatric diagnoses (Auger et al., 2021). Eating disorders should therefore be approached with the support of qualified and specialized mental health professionals, potentially including regular medical monitoring or the involvement of an interdisciplinary health team (Bianchi et al., 2021). Harm reduction practices within the context of eating disorders, is therefore, not the end goal, but may be part of the recovery process depending on severity and capacity.

Harm Reduction for Eating Disorders webinar hosted by The Victorian Centre of Excellence in Eating Disorders discusses when and where harm reduction approaches are applied within the context of treating people with eating disorders.

Just about any strategy for self-compassion can help reduce the harm of disordered eating (CMHA, 2022). These can include:

• For Anorexia — use nutritional supplements (Boost, Ensure) to meet basic nutritional needs; aim for longer stretches between periods of fasting
• For Bulimia – aim for longer stretches between periods of binging or purging; get regular dental check ups
• For Binge Eating Disorder – keep high risk binge foods out of the house; consume sweets/treats only after a healthy meal

• For any eating disorder or disordered eating
  • Explore non-abstinence recovery goals
  • Focus on quality of life and not on the eating disorder
  • Avoid or limit use of social media
  • Distraction; engage in fun activities/ hobbies to keep distracted from thinking about food or body
  • Allow eating disorders behaviours at specified times
  • Explore options for things that can be within reasonable control
  • Remove scales from the home or limit weighing opportunities
  • Build a healthy network of friends, colleagues, neighbours
  • Seek out counselling or supports to deal with stress or life experiences (e.g., trauma, abuse, relationships, etc)
  • Avoid emotionally intense discussions during meals
  • Get creative about activities at mealtime (e.g., theme nights, games) and avoid conflict or watching the news
  • Take a cooking class or learn to cook for the joy in the activity and not for the eating
  • Go for regular medical check ups