Harm Reduction for Eating Disorders: What it is and Why it’s Not ‘Giving Up’
Written by: Allyson Inez Ford, MA, LPCC
Eating Disorder Harm Reduction
Eating Disorder Harm Reduction (EDHR) hasn’t always had the best reputation in the eating disorder field, or in mental health more broadly. That’s not because it’s ineffective or “giving up” but because its core principles challenge long-standing beliefs about what healing is supposed to look like. Much like early substance use treatment models, EDHR bumps up against a cultural legacy that equates recovery with purity, abstinence and rigid compliance to generalized goals.
For decades, dominant approaches to addiction and mental health were shaped by abstinence-only frameworks rooted in moralism: if someone couldn’t stop a behavior entirely, it was viewed as a personal failure rather than a symptom of suffering. These beliefs were influenced by the sociopolitical and religious values of the time, which equated ‘self-control’ and restraint with virtue and being a “good” person. But how backwards is that? A person is only good enough if they have enough willpower to fully stop all behaviors that are part of a mental health condition, that they didn’t choose?! Doesn't that just sound like a recipe for shame, and if so, how is that healing for anyone?
Now don’t get me wrong. If someone feels capable and willing to let go of all eating disorder behaviors, GREAT. I agree that life is better without an eating disorder and that challenging the behaviors that fuel it is a key part of the healing process. The issue is, I have never met someone (myself included) who was ready to end all behaviors at once. Effective treatment is often gradual and behavior change comes with the development of a secure relationship between client and therapist, when outside life is safe enough for the client to let go of their life raft (what I consider an eating disorder) and when they have enough insight, motivation, coping skills and support (peers, medical care, nutrition therapy and mental health therapy) to help them manage the mental and psychological distress that will absolutely emerge when they start eating more, purging less or reducing compulsive exercise.
Further, the idea that a person must immediately stop all behaviors to be considered “committed” or “serious about recovery” is a remnant of those older, punitive models of care. However, true, lasting recovery is rocky and full of setbacks. Demanding perfection from someone whose eating disorder thrives on perfectionism is also…ironic.
“are you ready to go all in on recovery?”
Most people with an eating disorder will say hell no to this question. It’s one reason why so many don’t seek the support of higher levels of care (among a myriad of other barriers, like cost, insurance, childcare, lack of accessibility). Most people suffering from an eating disorder need someone to meet them where they are at. Many of us don’t even fully know if we want to recover, at least not right away. That’s because the eating disorder serve a protective function, otherwise we wouldn’t develop them. Eating disorders blunt emotions, regulate traumatic experiences, give us a sense of purpose, worth and identity. They help us mask parts of ourselves the world has deemed “too much” or “not enough.” So giving them up feels terrifying. It’s a way many of us have created safety when nothing or no one else was available. This doesn’t mean the person is manipulative, weak or not worth investing support into. This just means you need to go slow, and meet them where they are at. Harm reduction can help keep people safe before they are ready or wanting to cease harmful behaviors. Harm reduction is life saving, it’s not giving up. Giving up would be offering zero strategies to help a person stay safe and alive, which is the exact opposite of harm reduction
What Eating Disorder Harm Reduction Actually Is
Eating Disorder Harm Reduction (EDHR) is a compassionate, client-centered framework grounded in the belief that people deserve care before they’re ready or able to stop eating disorder behaviors. Rather than demanding sudden abstinence or perfection, harm reduction focuses on safety, stabilization, trust-building, and supporting people in making changes that are realistic and meaningful for them.
At the heart of EDHR are values that challenge the rigidity, shame, and moralism that have historically shaped eating disorder treatment. These values include:
Humanism: people engage in eating disorder behaviors for reasons. EDHR starts with curiosity and respect rather than assumption. Instead of asking, “Why are you doing this?” with judgment, humanism says: There is a reason, let’s understand it together and explore options to keep you safe that are aligned with your values and needs right now”
Individualized Care: no one fits into a tidy “recovery checklist.” When the field pushes universal standards or assumes one path works for everyone, it often deepens shame for those that don’t fit within the margins. Harm reduction honors cultural differences, neurodiversity, traumatic experiences and intersectionality; while building a safety plan around each person’s unique needs and goals.
Pragmatism: perfection is not only impossible, it mirrors the eating disorder itself. EDHR embraces what is possible today. Maybe a behavior can’t stop yet, but can it be reduced, spaced out, or made safer? This is realistic, compassionate progress deserving of celebration.
Autonomy: people have the right to make their own choices about their bodies, behaviors, and healing. Harm reduction rejects coercion and instead builds a collaborative relationship where the client leads and the clinician supports. Autonomy is not a barrier to recovery, it is the foundation of sustainable recovery and building self trust.
Incrementalism: recovery is nonlinear and slow. There may be no “end” point, depending on how you define your recovery. Harm reduction recognizes that small shifts matter, sometimes they matter more than big ones. There is nothing a person suffering needs to do to ‘earn’ care.
Hope: one of the most radical truths of harm reduction is that there is always a way forward, even when someone’s path doesn’t look like the mainstream version of recovery. Hope is not contingent on perfection. It rests on the belief that people can build lives worth living, even in the presence of ongoing struggles.
Together, these values form the backbone of EDHR (shoutout to Amanda Pecoraro’s webinar on this topic). EDHR values create a framework that is non-judgmental, realistic, and deeply aligned with anti-oppression care. Most clinicians in outpatient already practice harm reduction with eating disorders, they just might not use this language in fear that it will be seen as “giving up” or enabling.
Harm Reduction Isn’t “Giving Up”
One of the most persistent misunderstandings about Eating Disorder Harm Reduction is the idea that it’s a form of “giving up” on recovery. But this misconception comes from a narrow, often perfectionistic view of what recovery is “supposed” to look like. When we expect people to eliminate all behaviors immediately or follow a rigid path toward an idealized end state, we unintentionally replicate the very dynamics that fuel eating disorders: all-or-nothing thinking, control, rigidity, and shame.
Harm reduction offers an alternative rooted in compassion and reality. Here’s why it’s not “giving up” at all:
1. Harm reduction increases safety, rather than gambling on perfection.
Expecting someone to abruptly stop all eating disorder behaviors, especially without adequate support, readiness, or resources, can increase medical risk, emotional dysregulation and full blown trauma symptoms. EDHR lowers these risks by helping people make incremental, sustainable changes instead of pushing them into crisis.
2. Harm reduction strengthens engagement and trust.
People stay in treatment longer when they don’t feel judged or pressured to meet unrealistic expectations. EDHR creates space for honesty. When clients know they won’t be punished for “slipping,” they can talk openly about their struggles, which allows for earlier intervention and more accurate assessment of risk.
3. Harm reduction empowers clients, which is essential for long-term healing.
Autonomy is necessary for eating disorder healing. When people have agency, they’re more likely to build internal motivation and less likely to engage in secretive or compensatory behaviors. EDHR treats clients as the experts they are on their own lives.
4. Harm reduction reduces shame.
Rigid, compliance-focused models can send the message that if someone can’t stop behaviors immediately, they’re failing. Shame then becomes its own trigger for further disordered behaviors. EDHR actively interrupts that cycle by validating where the person is and supporting them without moral judgment.
5. Harm reduction is realistic about the role of trauma and oppression.
Many eating disorder behaviors are trauma responses or survival strategies. They are also shaped by systemic forces: anti-fatness, food insecurity, racism, heteronormativity, ableism. A person cannot simply “opt out” of these harmful systems. Harm reduction recognizes this complexity and avoids pathologizing people for adapting to environments that have harmed them.
6. Most importantly: harm reduction saves lives.
For clients with long-standing or severe eating disorders, especially those who’ve been harmed by traditional treatment models, harm reduction may be the most ethical and effective approach. It keeps people alive and engaged long enough for deeper healing to be possible.
Examples of EDHR in Practice:
Finally, the part many of you are probably waiting for. Below are some ways Eating Disorder Harm Reduction (EDHR) can be applied. These won’t fit for everyone, but are intended to be examples that illustrate how harm reduction can meet people where they are and support meaningful recovery from an eating disorder.
Harm Reduction in Action
*This is compiled from various sources including Flter Mag, Nalgona Positivity Pride, and Joy Project. This is NOT specific medical advice, this is for educational purposes only, please consult with your doctor or dietitian if possible first.
Reducing frequency or intensity of behaviors
If purging or other compensatory behaviors occur multiple times per day: aim to reduce to once a day, or fewer, as a first step.
Instead of sudden abstinence, scale back behaviors gradually, giving the body and nervous system time to adjust.
Delaying or interrupting urges
Use tools such as a timer or an “opposite-action” skill: when an urge arises (e.g. to restrict, purge, or over-exercise), pause and wait 5, 10, 20 minutes to allow the urge to pass or change.
Build in small, doable substitutions when abstinence feels impossible (e.g., choosing a small snack or snack-sized meal instead of none)
Prioritizing physiological and medical safety
For those who purge: hydration, dental care (e.g. using enamel-building toothpastes, gentle brushing, waiting to brush for 30 minutes after purging), get regular labs and EKG’s, and electrolyte replenishment if recommended.
For people restricting or under-eating: supplement with nutritional shakes, get regular labs and vitals checked, drink 8oz of full sugar juice or gatorade right before bed and right upon waking to reduce dangerous blood sugar drops (a common way people die from anorexia is in their sleep related to these blood sugar drops).
Hydration:
if you struggle to take in fluids, try getting them in other forms to replenish electrolytes.
Example: popsicles, watery fruits and vegetables, ice cube
Incorporate Gatorade, Pedialyte, chocolate milk, ramen, pho in your day.
Stomach and Digestive Issues:
Ginger is an incredibly useful agent for calming stomach issues and aiding in digestion. You can have it whole, candied, take supplements, drink tea, etc.
Herbal tea: mint and ginger are helpful for nausea and can relieve discomfort.
Triphala supplements: are affordable and can be helpful to alleviate stomach issues and pain from cavities
Utilize heating pads and hot compresses to reduce inflammation and discomfort.
Miralax can be helpful for constipation.
Gas-Ex is helpful for stomach pain and bloating.
Ibuprofen is anti-inflammatory as well.
Antacids are fairly cheap and extremely useful for acid issues.
Hydration is also very helpful to aid digestion.
A Resource for MORE Harm-Reduction Tools: Flter Magazine’s PDF
If you’re looking for a ready-made resource to reference or share with clients/colleagues: Flter Magazine has compiled a practical “Eating Disorder Harm Reduction” PDF resource. It includes harm-reduction tips developed with input from ED-specialists (nutritionists, dietitians, dental health professionals), framed as safety-oriented recommendations, not prescriptive treatment advice. I love being able to provide this resource to clients and families knowing they can take measures to stay safe while engaging in behaviors that could otherwise harm their physical and mental health.
And in case I haven’t made this clear- it’s not that I want anyone to engage in harmful eating disorder behaviors, but I know that it’s not up to me when and if they stop. I can (and will) provide encouragement, tools and foster motivation, but at the end of the day, people will do what they are ready to do and it’s my job to offer as much safety as I can and tons of compassion for how hard this is.
Wrapping Up: Why Practical Examples Matter
Using concrete examples in writing about EDHR makes it real and accessible, less of a vague concept. For someone reading who’s terrified of “failing recovery,” or for a clinician hesitating to introduce harm reduction, these examples demonstrate that EDHR is not vague or passive, it’s active, intentional, collaborative, and most of all, life-affirming—because we want you all eating disorder sufferers to live a long, meaningful life instead of ending up as another statistic- one that dies every 52 minutes from an eating disorder related complication.
If you’re looking for support that aligns with this approach:
Our practice offers:
Virtual therapy in California, Washington State, Utah, Maryland and Florida
In-person therapy in San Diego, CA (spots limited)
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