Occasionally, I will come across a comment online or in my real life where someone calls reading disorder harm reduction radical. And honestly, part of me is flattered that people think I’m doing something so revolutionary and the other part of me wants to explain it’s not that radical when you think about it. Harm reduction is a term you may have heard of in the context of substance use. Things like clean needle exchanges are a well known harm reduction strategy for folks injecting drugs. Harm reduction isn’t just for substance use disorders, I use it regularly when working with folks with eating disorders. Harm reduction is an approach I use in therapy but it’s part of a larger system of policies and practices, and supports designed to keep people safe. For some excellent reading on the origins of harm reduction and especially it’s application to eating disorders I strongly recommend the work of Gloria Lucas. She has been, and continues to be an amazing resource in my learning. 

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Harm reduction is a perfect compliment for eating disorders in my opinion. Many times those struggling with ED’s aren’t sure, aren’t ready, or just don’t want to stop their eating disorder behavior.  Harm reduction allows me to meet the person where they are without getting into a power struggle about why they have to stop all behaviors completely (right now or ever). My job is not to take on a paternalistic role and tell you “No more therapy sessions until you stop binging”. That tactic didn’t work on me when I was a teenager and it doesn’t work well for most of us as adults. 

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When I use a harm reduction approach, instead of trying to get someone to stop all eating disorder behaviors, I focus on minimizing some of the negative outcomes of a behavior to keep a person safe. Think of the needle exchange programs I mentioned above. The folks who work at needle exchanges aren’t trying to convince anyone to stop; they offer a safer way to inject drugs that will minimize the dangers of reusing or sharing needles with others. Many also offer other resources for those who want additional support but no one is required to utilize them in order to participate in the needle exchange. No coercion, no power struggle, just support, when and where it’s needed. 

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It makes sense that we’d apply this same concept to eating disorders. One barrier to treatment for eating disorders is the fear that the therapist is going to “make you” stop all your eating disorder behaviors. Like some sort of parental figure who is going to take your phone away if you don’t “straighten up”. And while some providers do emphasize that in their work, I haven’t found that particularly helpful for clients nor does it feel good as a clinician to feel that my way is the right way for someone else. Eating disorder behaviors are often a way of coping with being a human in this world. We have all earned the right to coping behaviors, and anybody trying to tell you otherwise could do well to develop some of their own.  My goal is to help you understand more about how you’ve learned to cope, help you learn more ways of coping, and to support you in reducing harm to your body and mind in the process. 

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I realize this all may seem radically different from what you’ve been told in treatment before. But if other approaches have felt too punitive or strict, or like they aren’t a fit for you, maybe harm reduction is a piece that’s been missing. Not everyone is ready for recovery. And not everyone wants recovery. You aren’t required to want to recover in order to get help. A little louder for those in the back: You aren’t required to want to recover in order to get help. If you feel like you haven't been getting what you need from treatment there are other options out there.

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I have included links for published research for my science nerds as well as articles if you’d like to read more about harm reduction. And again, this can sound like a radical idea. Like a lot of things that challenge the status quo, it sounds radical even when it really isn’t. Please reach out to me if you’d like to discuss more. 

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Further Reading/Resources

https://filtermag.org/eating-disorder-harm-reduction/

https://www.nalgonapositivitypride.com/

Treasure, J., & Schmidt, U. (2013). The Role of the Therapeutic Alliance in the Treatment of Eating Disorders. Clinical Psychology Review.

Sweeney, L. C., & O’Connor, D. B. (2020). Harm Reduction and Eating Disorders: Implications for Treatment. Eating Disorders Review.

Murray, S. B., & Touyz, S. (2011). Eating Disorders: The Importance of a Harm Reduction Approach. International Journal of Eating Disorders.

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