EMDR and Eating Disorder Treatment

Let me start with the thing you are least likely to be told by a clinic advertising EMDR for eating disorders.

EMDR is not a NICE-recommended treatment for any eating disorder. Not for anorexia, not for bulimia, not for binge eating disorder. The NICE guideline on eating disorders (NG69) recommends eating-disorder-focused CBT, family-based treatment for children and young people, MANTRA and specialist supportive clinical management for adults with anorexia, and guided self-help for binge eating disorder. EMDR is not in the list.

That is the honest starting position, and if you are reading this because someone has offered you EMDR for an eating disorder, you deserve to know it before we go any further.

Now the more interesting question. Why is EMDR being offered anyway, and is there anything in it?

The case for looking at it at all

Eating disorders are among the most treatment-resistant conditions in mental health. CBT-E is the best we have, and it is not close to being good enough. A large number of people go through a full course of first-line treatment and remain unwell.

At the same time, the association between trauma, adverse childhood experience and eating disorders is well established in the literature. That association does not mean every eating disorder is caused by trauma. It does mean that for a substantial subgroup, there is trauma sitting underneath the eating.

If you accept EMDR's own model, the Adaptive Information Processing model, the logic follows. Distressing experience gets stored badly. It goes on generating the beliefs, the affect and the body sensations that were present at the time. If the belief that got laid down was "I am disgusting", or "my body is the problem", or "I am not safe unless I have control of something", then the eating behaviour is downstream of the memory, not the thing itself.

Tal Croitoru gives two short case examples that show what this looks like in the room. A young man of 24, very thin, who had lost a great deal of weight but still saw himself as fat. What they processed were not his eating habits. They processed the memories that had, in Croitoru's phrase, burned him with the sense of being physically flawed: being laughed at in school, sweating in class, eating in secret, eating two falafels while other boys ate half of one.

Another man, still heavy, eating emotionally and punitively. What they found was a single early memory: overhearing his mother telling his older sister the story of him as a small child standing on a table and breaking it. Fat, therefore flawed. He had been carrying it for decades. They processed that memory, and a good deal of the obsessive relationship with food went with it, because the eating had been comfort for the self-loathing.

Croitoru also makes a physiological point that is easy to miss. Stress pulls blood away from the digestive system. It produces stomach ache, nausea, a hollow feeling in the stomach. That hollow feeling can be mistaken for hunger when it is actually fear or grief. Eat to fill it and you have a loop.

What the evidence actually says

This is where I have to be careful, because the temptation with EMDR is always to run ahead of the data.

Hatoum and Burton published a systematic review in 2024 in Mental Health Science looking at the evidence for EMDR in eating disorders and body image. A systematic review of a small literature does not become a large literature.

The first pilot randomised controlled trial of EMDR for binge eating disorder was published by Hatoum and colleagues in the International Journal of Eating Disorders. Thirty-eight Australian adults meeting criteria for BED were randomised to either a ten-session EMDR protocol, adapted from an existing bulimia protocol, or a waitlist control.

Completion was 68.8 percent. Intention-to-treat analysis found significantly greater reductions in binge eating symptoms, days and frequency, in metacognitive beliefs about eating, in eating and shape concerns, in anxiety and in sleep disturbance. It found no significant benefit over control for dietary restraint, weight concerns, self-esteem or sexual problems.

Read that carefully, because it is doing two things at once. The binge eating went down. The weight concern and the restraint did not.

The authors themselves frame it as preliminary, and call for larger, well-powered trials to establish whether this is an effective treatment option.</cite> That is the correct reading of a pilot with 38 participants and a waitlist comparator. A waitlist is not a hard test. It tells you a treatment beats nothing. It does not tell you it beats CBT-E.

There is more coming. <cite index="22-1">A randomised controlled trial is running in Italy comparing a four-week EMDR intervention against a parallel CBT intervention in inpatients with obesity and binge eating disorder who have experienced a traumatic event.</cite> That is an active comparator, which is the design that will actually tell us something.

Beyond binge eating, the picture thins out fast. There are disorder-specific EMDR protocols for anorexia, for bulimia, for body dysmorphia and poor body image. Protocols are not evidence. A protocol is somebody's clinical hypothesis written down neatly.

Anorexia in particular has almost nothing. Given that anorexia has the highest mortality of any psychiatric disorder, "almost nothing" is not a gap to be filled with enthusiasm.

How it is actually used, and how it should be

In practice, most credible use of EMDR in eating disorders is adjunctive. It sits alongside first-line treatment, or it is brought in for people who did not respond adequately to first-line treatment, or where there is comorbid trauma or attachment difficulty that the standard protocol is not touching.

That is a defensible position. It is not "EMDR instead of CBT-E". It is "CBT-E is not shifting this, and there is a reason it is not shifting, and the reason is sitting in 1997".

The sequencing matters enormously, and this is where I would want you to be sceptical of anyone offering EMDR too readily.

An eating disorder is not just a set of beliefs. It is a set of behaviours that are actively harming the body, and in the severe stages it is a medical condition. A malnourished brain does not process. Whatever you think about the AIP model, nobody believes that a body in starvation, or in the chaos of daily purging, is in a state to do difficult emotional work and then regulate itself afterwards.

Shapiro's own guidance is relevant here even though she was not writing about eating disorders specifically. Before you process anything, phase 1 and phase 2 exist to take a history, assess stability, and build the person's capacity to regulate. She was clear that inadequate screening or preparation can be significantly destabilising, and that a client without decent affect tolerance, a stable living situation and adequate support is not ready.

Look at that list against an eating disorder and the problem is obvious. Restriction, bingeing and purging are affect regulation strategies. They are the ones the person actually has. If you process a memory that produces a wave of shame and grief, and the client leaves the room dysregulated, what do you think they are going to do with the evening?

Rotem Brayer's rule is the one to hold onto. You do not end a session with a client at a level of disturbance they cannot bring down. The consequence, he says plainly, can be deterioration into suicidal thinking, risky behaviour, hospital admission.

So the order of operations is not negotiable. Medical stability first. Nutritional restoration first. Regulation skills that are not the eating disorder, first. Then, if there is unprocessed trauma still driving the thing, EMDR.

What to ask, if you are considering it

If you have an eating disorder and someone is offering you EMDR, ask them these things.

Are you offering this alongside first-line treatment, or instead of it? Instead of is a red flag.

Who is managing my physical health while this is happening? If the answer is nobody, walk away.

What is your training in eating disorders specifically, not just EMDR? An EMDR qualification is not an eating disorder qualification.

What happens at the end of a session if I am distressed? What do I do that evening? If the honest answer to that question is "I would probably restrict" or "I would probably binge", then that is the thing that needs work before anything gets processed.

And ask what the evidence is. A good clinician will tell you it is promising and thin. If they tell you EMDR treats eating disorders, they are ahead of the data and you should assume they are ahead of it elsewhere too.

Where this leaves us

The plausible version of the claim is this. Some people's eating disorders are held in place by trauma that first-line treatment does not reach, and for those people, processing the trauma may unlock something that CBT-E on its own cannot.

That is a reasonable hypothesis. It is supported by one small pilot RCT in binge eating disorder, a scatter of case studies, several protocols and a great deal of clinical conviction. It is not supported by NICE, because NICE has not been given enough to work with.

Promising and unproven are both true at the same time. Anyone selling you only the first half of that sentence is selling you something.

If you are unwell, get the treatment that has the evidence. If it does not work, and there is trauma underneath, then EMDR is a reasonable next conversation to have, with someone who knows eating disorders, alongside proper medical care, in that order.

This is general information, not clinical advice. Eating disorders are serious medical as well as psychological conditions. If you are struggling with eating, speak to your GP. In the UK, Beat runs a helpline on 0808 801 0677. If you are in crisis, contact NHS 111 or Samaritans on 116 123.

References

Brayer, R. (2023). The Art and Science of EMDR: Helping Clinicians Bridge the Gap. PESI Publishing.

Croitoru, T. (2014). The EMDR Revolution: Change Your Life One Memory at a Time. Morgan James Publishing.

Hatoum, A. H., & Burton, A. L. (2024). Eye movement desensitization and reprocessing (EMDR) therapy for the treatment of eating disorders: A systematic review of the literature. Mental Health Science, 2(4).

Hatoum, A. H., et al. (2026). A pilot randomized controlled trial of eye movement desensitization and reprocessing therapy for adults with binge-eating disorder. International Journal of Eating Disorders.

National Institute for Health and Care Excellence. (2017, updated). Eating disorders: recognition and treatment (NG69). https://www.nice.org.uk/guidance/ng69

Shapiro, F. (2017). Eye Movement Desensitization and Reprocessing (EMDR) Therapy: Basic Principles, Protocols, and Procedures (3rd ed.). Guilford Press.