The way I work with individuals experiencing distress around food and weight differs slightly from my usual practice. I felt this was worth going into in more depth here, so you can decide whether this is an approach which might fit well with your personality, and with what you want to get out of any contact with me.
When I talk about eating disorders and distress, I mean:
- Anorexia nervosa, a disorder in which people find it extremely difficult to eat enough to maintain a healthy weight. Some people with anorexia have obsessive thoughts about being overweight or needing to lose weight when others around them tell them they are already too thin. Others struggle with rules around eating, with the feeling of being full, or with distressing emotions that are alleviated by restrictive eating.
- Bulimia nervosa, which involves periods of bingeing – eating more than intended in an uncontrolled way in a short space of time – and purging, which can include self induced vomiting, laxative or diet pill use, and excessive levels of exercise.
- Binge eating disorder, in which people regularly binge eat without compensating by purging. However, it is quite common for people with binge eating disorder and bulimia to restrict what they eat in between binges.
- Avoidant Restrictive Food Intake Disorder (ARFID): In this condition, people restrict the types and/or amount of food they eat for reasons other than body dysmorphia, such as sensory sensitivities, phobias of choking or vomiting, or a lack of connection to hunger signals.
- Other Specified Feeding or Eating Disorder (OSFED, previously known as EDNOS): this involves eating difficulties which are severe enough to have a negative impact on one or more of your health, relationships, social life, education, work or other areas of your life, but which don’t fit the fairly rigid criteria for the eating disorders listed above.
- Disordered eating and eating distress: these terms basically mean patterns of eating and of thinking about food and weight which cause you distress, and may affect your ability to join in with social situations involving food. Sometimes the distinction between OSFED and disordered eating can be quite blurry, and it is very common for people to not believe they have enough of a problem to ‘deserve’ help. I include these terms because I believe everyone who experiences distress around food deserves help to create a healthy and happy relationship with food, regardless of whether they have ever received a diagnosis of an eating disorder.
Other problems which blur the line between eating disorders and other conditions include obsessive thoughts and rules about healthy or clean eating (sometimes known as orthorexia), fears of contamination relating to obsessive compulsive disorder.
Eating disorders and distress are often very much simplified by the media. Causes suggested by magazines and newspapers include the desire to look like underweight models and celebrities, lack of willpower or weakness. Eating disorders are far more complex than this: there is no single, easy to explain ’cause’ which can be generalised to every person experiencing these problems. The model I work from suggests that people may have vulnerabilities which predispose them to particular kinds of eating distress, triggers which set the problem off for the first time, and maintaining factors which keep the problem going. For example, traits such as perfectionism, sensitivity to criticism, and difficulties coping with change and spontaneity, may make a person more vulnerable to anorexia as opposed to binge eating. If that person then begins to eat restrictively or erratically at some point in their life – due to physical illness, stress or trauma, deliberate dieting, or any other reason – they may go on to develop anorexia. Once they develop anorexia, positive attention from others due to the weight loss, the calming effect of restriction on anxiety or post-traumatic symptoms, or low mood exacerbated by malnutrition may make recovery seem less appealing or achievable.
The way I work with people experiencing eating disorders and distress is informed by my professional and personal experience. Because no two people are the same, I will not try to fit you into my preconceived ideas about what works; however, there are a range of techniques which my clients and I have found very useful, which you may be interested in. These might include:
- Alternative psychoeducation. You probably already know how restrictive or chaotic eating affects your body, and I don’t know that scare stories about dire physical consequences are particularly helpful. However, lots of people with eating disorders find it interesting to learn how malnutrition and chaotic eating can affect their brain, locking them into a cycle of obsessive thoughts and behaviours, rigidity, and fear of change. Knowledge can be powerful, and sometimes learning about the processes behind this can help people find hope that they can change.
- Working out what your eating behaviours do for you, and take from you. The ‘cons’ are easier to spot, but again, knowing that eating disorders can have a profoundly negative impact on your health/relationships/career/etc doesn’t always make change easy. If that were the case, all you would need to do to, for example, stop people smoking, would be to tell them about lung cancer and heart disease. However, sometimes there are more ‘hidden’ negatives that people have not considered, which can help them to realise that the eating disorder is not compatible with their values and future plans. Equally, exploring the function of your behaviours – how they help you to cope and survive – is important. An example of this might be someone who finds counting calories and obsessing about food a more calming alternative to worrying about a hundred other things they have no control over. Understanding this is useful, because then we know they might benefit from trying out other anxiety management strategies.
- Talking about your feelings about recovery. Is this something you want for yourself, something you’re scared of, something you’ve been told is not possible? As a therapist in private practice I can’t force you to change, but I can help you clarify your thought processes around change, and support you to plan and follow through with manageable steps forward.
- Writing down particular areas where you have trouble with food, ranking them from easiest to change to hardest, and creating small experiments to test them. For instance, if someone had decided they need to increase the amount they are eating, we might look at which times of day they find least stressful, and start there. If they found it easier to eat at home rather than at work, we could agree on increasing breakfast or dinner first, and slowly work up to eating a bigger lunch, or snacks at work. This is just one small example – there are all sorts of ways in which to apply this idea.
- Visualising your life with and without the eating disorder in the future. If you’ve been struggling with eating problems for a number of years, you might find it difficult to untangle what is part of you and what is the eating disorder. For example, do you really not enjoy going out for dinner (going out with friends, barbecues at the beach, visiting your relatives at Christmas – there are many possible examples), or is it the uncertainty around food that makes it too anxiety-provoking to enjoy? What might your life be like free from anxiety over food and weight? What could you do with all that extra space in your head?
- Questioning cultural narratives around food and weight. Poor body image is not common to everyone with an eating disorder, but often the messages we receive around gaining versus losing weight, healthy versus junk food, being ‘good’ versus being ‘bad’ and so on, can be quite difficult to deal with in recovery.
- Dealing with co-morbid issues. As I mentioned before, there is no single cause of eating disorders that are common to all, but when other problems do co-exist with eating disorders, they can complicate recovery. If your ideas about food and weight are bound up with obsessions and compulsions, phobias, post-traumatic stress, mood disorders, issues relating to sexuality and gender, or anything else, we can try to unpick and resolve both sets of concerns.
This is not an exhaustive list, and I don’t use all of these with all of my clients. I use my professional judgement to decide what might suit the personality and experience of the person sat in front of me, and everything I do is in collaboration with my clients. I encourage you to tell me if something doesn’t feel right, so we can work out another approach. On the other hand, recovery from eating disorders and distress is often very uncomfortable, particularly to begin with. You might be highly motivated to change, but still experience extreme anxiety when you try. While I wish I could make this process easier, the reality is that eating disordered behaviours often feel very safe and familiar, and changing them can be difficult. That’s not to say it’s impossible though, and it does get a lot easier with practise. Often, many small changes, which were really hard at the time, can add up to make future, bigger changes less anxiety provoking.
In addition to all of this, I sometimes use my personal experience to help illustrate a point to a client. Personal disclosure by therapists is a controversial issue, but it is more common in relation to those working with eating disorders, addictions, and with clients identifying as LGBT+. There are whole treatment programmes in existence which were founded on the idea that people who have been there and come out the other side can use their experience to help others. I have significant personal experience of eating disorders, from struggling with cycles of bingeing and restricting in my early teens, through to anorexia in my late teens and early 20s. During recovery, I realised there was very little out there to help adults like myself who had been living with these conditions for a long time. Often people describe being told – sometimes after a relatively short experience with eating disorders – that there is no hope that they will recover. This can feel like being written off, sometimes at a very young age. That seemed like such a travesty, because I know of many people, including myself, who have recovered from long standing serious eating problems. I wondered how many more might recover if someone believed in them and supported them to make small changes.
If it feels like any of this might be relevant to you, or something you could be interested in, please feel free to email me at firstname.lastname@example.org. I am happy to answer any questions you might have!