Commonly Asked Questions and Concerns for Eating Disorder Counseling

September 14, 2017

Alexandra, Eating Disorders, Krystal

Here we hope we can answer some of your questions about what you may expect from counseling for an eating disorder:

What is an eating disorder? What’s body dysmorphia or body image?

An eating disorder is a mental health disorder in which an individual engages in “behaviors” surrounding food. This may involve restricting food intake, eliminating certain groups of food entirely such as carbohydrates or proteins. Or, it could involve an individual eating large amounts of food (bingeing) and then purging (making oneself vomit, take a laxative or exercise excessively) after bingeing. Eating disorders are an addiction and cause physical, emotional, or mental harm to the individuals they impact.

Poor body image or body dysmorphia is a word to describe how we see our bodies or our “body self-confidence”. If we have poor body image that means we have poor self-confidence in how our body looks or how we imagine others may perceive it.  Body dysmorphia is a word used to describe the feeling of seeing our body inaccurately; we may perceive ourselves to be “gross” or “disgusting” when these are not accurate words to describe ourselves.

Eating disorders and their effects can be wide ranging but recovery is possible!

What causes eating disorders or poor body image?

Poor body image (Body Dysmorphia) and/or eating disorders are not thought to be caused by a single issue but rather a combination of individual, family, and cultural factors. Cultural factors include cultural emphasis on thinness/appearance and weight loss, family factors can include family emphasis on weight, dieting or attractiveness and major life changes such as a divorce, graduating from school, a breakup or move. There is also some research that suggests some individuals may have a genetic component that makes them more susceptible to eating disorders or poor body image. Within the eating disorder community, it is thought that a combination of factors (family, cultural and individual) combined with life stresses or change contribute to a person developing an eating disorder.


What types of Eating Disorders do you work with?


Body Dysmorphic Disorder an individual perceives their body to be flawed, too small, too big or not muscular enough. Often when struggling with body dysmorphic disorder we obsess about a certain area of our boy or are preoccupied with not feeling good enough, attractive enough or not having the type of body that we desire.


Binge Eating Disorder This is an eating disorder in which an individual each large quantities of food (binges) in a short period of time. Binges are not based on hunger (for example, if I went hiking for 5 hours then ate a large pizza I could be eating from hunger whereas when bingeing I might eat because I am anxious or upset but not physically hungry.) Binges typically involve eating a large amount of food (often carbohydrates or dessert type foods and may be followed by extreme feelings of guilt.


Anorexia Individual with anorexia severely limit their caloric intake. This could mean not eating certain food groups such as protein (meats, tofu, beans etc.) or carbohydrates. It could also mean an individual is limiting their caloric intake to an extremely low number of calories per day or refraining from eating at all. Individual struggling with anorexia typically perceive their body as larger than it is and may develop an obsession with obtaining a lower body weight and/or thinner body.


Bulimia This is an eating disorder in which a person eats many calories in a short amount of time (bingeing) then engages in a purging behavior (forcing themselves to throw up, taking a laxative or excessive exercise) to try and compensate for the calories they have just eaten.


Eating Disorder Not Otherwise Specified (EDNOS) sometimes a person struggles with disordered eating/and or poor body image but does not fit into one of the categories listed above. For example, someone may meet some but not all the criteria for Anorexia but still struggle with restricting their caloric intake and have strong feelings of dissatisfaction with their body. The diagnosis of EDNOS was created to address these individuals


How do I know if I have an eating disorder?


If you believe you may be struggling with your body image or relationship with food you can click here to take an eating disorder screening too, provided by the  national eating disorders association.


How do you treat an eating disorder?


Of course, every person and their story are unique, however when treating eating disorders or poor body image I utilize interventions that are evidence based. This means that the therapeutic techniques I use have scientific research that demonstrates they are safe and effective. Eating disorder treatment will typically include;

-Understanding what function or purpose your disordered eating is serving in your life. This may sound odd, but your eating disorder is serving some purpose. Is bingeing a distraction or way of coping with a stressful relationship or pressure at work? Does restricting help you cope with anxiety or give you a sense of control? Understanding the purpose your eating disorder is serving is an important first step in recovery and will help us understand what  who can provide education on gentle nutrition. This means no shame and no diets! A specialized dietitian can help you work through fears around specific foods, or phobias and begin to eat in a more balanced and nourishing way.

-Once we have identified the function your eating disorder is serving in your life we can begin to develop healthy new coping skills to address your needs. I utilize a therapy called Dialectical Behavioral Therapy (DBT) which is a type of cognitive therapy that teaches us how to regulate overwhelming emotions and thoughts. DBT also focuses on helping us improve our relationships with ourselves and others by learning how to communicate assertively, set healthy boundaries and learn how to take time for ourselves. DBT can also help us learn how to be less self-critical and kinder to ourselves.
-We may also decide that working with your family members, a dietitian or your primary care doctor could be beneficial. Again, everyone is unique but often working with family members can help to reduce stressful family or relationship dynamics and help your family to better understand eating disorders and the recovery process. I also often recommend that clients struggling with food or body image work with a dietitian that specializes in eating disorders


-Once we have built healthy new coping skills to address overwhelming emotions or life situations we can begin addressing underlying trauma, past experiences of not feeling good enough and/or low self- esteem. I don’t think anyone gets through life without experiencing some type of trauma. Especially when we consider that trauma is merely an overwhelming event in which we feel we have no control. Family or childhood experiences or feedback about our body, major life transitions such as graduating high school or feeling misunderstood or not loved by the family we grew up with can leave us with feelings of sadness, guilt or feeling not loveable or good enough. These feelings can often contribute to us feeling bad about ourselves and our bodies. To address these beliefs and experiences I often use a therapy called Eye Movement Desensitization and Reprocessing (EMDR) you can click here to learn more EMDR, EMDR allows us to address these memories and experiences which many clients find are the “root” of feelings of low self -esteem, poor body image and/or eating disorder concerns. Many clients report feeling significant reduction of symptoms and increased feelings of confidence and self-esteem following EMDR work.


Do you work with other issues?


Eating disorders often present with other mental health issues such as anxiety or depression. I am a Licensed Professional Counselor and I have experience treating general mental health concerns (anxiety, depression, trauma etc.) as well as specialized training to diagnose and treat eating disorders. If you have other general mental health concerns or concerns that you are struggling with in addition to your eating disorder we can address these concerns in our work together as well.


How do you work with Adolescents?


Just as adults are unique, each adolescent has their own unique story and challenges related to their eating disorder and just as I do with my adult clients I work with adolescents to understand what function their eating disorder is serving, develop new healthy coping skills and address underlying issues. However, because for adolescent’s peer group and family extremely. For this reason, I typically recommend that adolescent’s families are involved in the treatment process. This may involve attending family counseling, family members receiving education about eating disorders or eating together as a family to model a healthy relationship with food.


I’ve been in recovery for a while. Do I still need to see a therapist?


Unfortunately eating disorders and poor body image can often be life-long challenges. Transitions or life challenges such as a breakup or divorce, move or starting a new job can trigger thoughts of poor body image or desire to engage in eating disorder behaviors. If you find yourself struggling with thoughts of wanting to engage in behaviors or poor body image working with a therapist can be helpful to identify the stresses in your life, review or develop new healthy coping skills or work through any other challenges that may be triggering your desire to engage in eating disorder/poor body image behaviors.


What results do you see?


My goal as a psychotherapist is to work with you to understand your recovery goals and provide you with the tools to empower yourself and your recovery. Because you are a unique individual your own level of engagement in psychotherapy (practicing the tools we discuss, willingness to identify underlying issues) will directly impact any changes in your life. For many people change is a long-term process, remember to be patient with yourself and your recovery, it takes time to start practicing new thoughts and behaviors, your recovery is not a race.


I’m not ready to start therapy but I want to learn more about my eating disorder/body image. What resources are available?




  • Life without ED
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  • Health at Every Size


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by Alex House