“Not Sick Enough”

Despite an increasing recognition of the diversity of those who struggle with eating disorders (EDs), marginalized individuals are critically underrepresented and their voices often silenced within research and clinical encounters in this area. This chapter illuminates this experience of exclusion by examining the epistemic injustices faced by street-involved and homeless youth (SIHY) seeking support for eating struggles and body image distress. To do so, I share a case example from my research and highlight other client stories from my years of clinical practice in Canada. First, this chapter examines how the dominant biomedical model reinforces testimonial and hermeneutical injustices , including willful hermeneutical ignorance ; the biomedical framework contributes to the denial of SIHY access to and erasure of their knowledge and lived experiences of health and social services around eating struggles. Second, it explores how, despite advances in anticolonial and trauma-informed care within ED-related services, punitive treatment models persist, particularly in public ED inpatient and outpatient settings, reproducing agential testimonial injustice within clinical encounters. Drawing on my direct clinical experience and research, I discuss treatment applications for social workers and healthcare providers, emphasizing epistemic honoring, trauma-informed curiosity, and customized care.