As our understanding of eating disorders evolves, harm reduction approaches are gaining recognition as valuable tools in our clinical toolkit. But what does this look like in practice?
According to Yager et al. (2021): "Harm reduction approaches do not do away with clinicians' interest in finding definitive cures... Nor does it involve simply going along with the patients' desires to continue unabated self-harm."
Key Implementation Principles:
- Building Trust and Collaboration
- Meeting clients where they are
- Creating realistic pathways to change
- Maintaining hope while being practical
- Practical Strategies
- Working with delayed response techniques
- Making incremental dietary changes
- Developing safer alternatives
- Separating risk behaviors
- Creating achievable safety plans
- Gloria Lucas's Six Priorities Framework (scroll down for an expanded version):
🔹 Survival First: Focus on keeping clients alive while respecting autonomy
🔹 Safety Planning: Develop realistic harm minimization strategies
🔹 Quality of Life: Build meaning beyond the ED
🔹 Past Treatment Learning: Understand what has and hasn't worked
🔹 Connection: Address isolation and build support
🔹 Education: Share knowledge that empowers better decisions
What makes this framework transformative is its recognition that eating disorder care isn't just about symptom management—it's about creating comprehensive, sustainable change that honours both safety and autonomy.
In our clinical experience, implementing these priorities has led to:
- Improved therapeutic alliance
- Better treatment engagement
- More sustainable outcomes
- Reduced treatment dropout
- Enhanced client empowerment
The framework particularly shines when working with complex presentations, marginalised populations, and clients who haven't responded to traditional approaches.
Check out our free resource:
Harm Reduction Approach for Mental Health Clinicians
Or for training around applying this approach with eating disorders:
Working With Highly Complex Eating Disorder Presentations
Sources:
- Yager J. Why Defend Harm Reduction for Severe and Enduring Eating Disorders? Who Wouldn't Want to Reduce Harms? Am J Bioeth. 2021 Jul;21(7):57-59
- Gloria Lucas from Nalgona Positivity Pride (NPP)
Gloria Lucas's Six Priorities Framework Expanded:
- 🌱 Survival First: "How do we keep this person alive?" This isn't just about crisis management—it's about creating sustainable safety:
- Developing non-coercive safety strategies
- Understanding medical complexities
- Balancing autonomy with protection
- Recognizing the impact of involuntary interventions
- Creating collaborative safety plans
- 🛡️ Safety Planning: "How can we maximize safety?" Moving beyond crisis protocols to create lasting stability:
- Preparing realistically for relapses
- Developing achievable harm reduction strategies
- Building confidence in safety tools
- Creating graduated response plans
- Establishing sustainable safety networks
- 🌟 Quality of Life: "How do we create a life worth living?" Essential yet often overlooked in traditional treatment:
- Supporting meaningful activity engagement
- Fostering relationship development
- Exploring interests beyond ED
- Creating daily purpose
- Building sustainable satisfaction
- 📚 Learning from Past Treatment: "What can experience teach us?" Critical insights that shape better care:
- Addressing treatment trauma
- Understanding institutional impacts
- Learning from unsuccessful approaches
- Identifying effective strategies
- Centering lived experience wisdom
- 🤝 Building Connection: "How do we reduce isolation?" Creating sustainable support systems:
- Breaking down connection barriers
- Developing support networks
- Encouraging community engagement
- Creating safe social spaces
- Maintaining therapeutic relationships
- 💡 Empowering Education: "What knowledge empowers change?" Moving beyond basic psychoeducation:
- Sharing information collaboratively
- Providing practical safety education
- Explaining medical considerations
- Discussing available resources
- Supporting informed decision-making
