Eye-Movement Desensitization Reprocessing Therapy (EMDR) for Eating Disorders

EMDR (Eye-Movement Desensitization Reprocessing Therapy) is an evidence-based therapy for trauma and previous adverse life experiences. Originally created for post-traumatic stress disorder (PTSD), it has been increasingly applied to a range of psychiatric conditions, including complex PTSD, anxiety, phobic disorders, depression, bereavement, and eating disorders (EDs), if a traumatic etiology can be identified. EMDR is based on the Adaptive Information Processing (AIP) theory, postulating that previous difficult experiences (e.g., trauma, other adverse events, and emotional neglect), especially if happening during early development and with attachment figures, can remain unprocessed and influence negatively the perception of self in the present and in the future. Some parallels and contrapositions with the mentalizing model are highlighted. ED symptoms could develop, in this context, as maladaptive coping strategies, for instance, to regain a sense of control and agency, or to deal with difficult mental states. Although more observational studies and randomized controlled trials (RCTs)Randomized controlled trials (RCTs) are needed to establish efficacy of EMDR for EDs, the evidence is suggesting that EMDR could be used in case of comorbidity with PTSD, complex PTSD, or where past adverse experiences can be associated to the development of the ED as a coping mechanism. EMDR might be optimally employed in EDs after a foundational phase of physiological and psychological stabilization. In complex cases, I propose that an attachment-based framework like Mentalization-Based Treatment could precede EMDR, to foster therapeutic alliance, and improve interpersonal relationships and emotional regulation.