Amy Pershing – Binge Eating Disorder: Clinical Interventions to Treat Underlying Trauma, Body Shame, and the Diet/Binge Cycle

Outline

Get to Know Binge Eating Disorder (BED)

• 5 damaging myths about BED and the recovery process
• What makes treatment of BED unique from other eating disorders
• Why treatment often fails
• Current research: Gains, limitations, risks
• Why weight has nothing to do with it
• Is BED an addiction?
• Key tenets of weight-neutral recovery

Complex Trauma and Binge Eating

• The neurobiological legacy of trauma in binge eating
• Fragmentation of the self: the role of dissociation in BED
• How trauma activates the binge/diet cycle
• Saving “Self”: the role of binge eating in managing danger
• Attachment ruptures, social anxiety and the binge cycle
• A body-shaming culture’s impact on trauma narratives

Assessment & Treatment Planning

• 5 must-ask intake questions
• What to look/listen for to identify BED
• DSM-5® criteria
• How to gather food history information
• Ruling out co-occurring medical issues
• Common co-morbidities: depression, anxiety, personality disorders
• Screening for trauma 100% of the time
• Why the initial goal is not to stop bingeing

Clinical Strategies for Processing Trauma and Stopping the Binge Cycle

• Why a “do-no-harm, strengths-based” approach is critical with BED clients
• Psychoeducation – initially and throughout treatment
• P.O.W.R. process for trauma activation, finding the “window of tolerance”
• The nuanced parallel process of each treatment piece

IFS-Informed Recovery Strategies

• Stepping into Self
• Identify fragmented “parts”
• Develop compassionate curiosity toward the “parts”
• Build affect tolerance

Attuned Eating and Movement: Stepping into the Body

• What the data tells us about behavioral weight loss/dieting
• 5 steps of attuned eating to teach your clients
• The body as a wise ally, not broken or wrong
• Using the body as the best source of information
• Teaching clients to know when the trauma narrative has been triggered
• Attuned movement v. “exercise”

Reinventing Body Image: Help Clients Feel at Home in their Bodies

• The truth about weight and health
• Cultural narrative about weight and worthiness
• The healing power of Health at Every Size (HAES)
• Help clients shift from “body as billboard” to “body as home”
• How the clinician’s body image impacts treatment

Building Resiliency to Relapse

• 4 A’s: Awareness, analysis, action, accountability
• Finding community that aligns with your recovery
• Resources for weight-neutral medical/nutritional care
• Collaborative care with prescribers

Clinical Considerations

• Doing your own work: Modeling body acceptance
• Navigating countertransference/bias
• Multicultural considerations – Gender, race/ethnicity, sexual orientation