I’m worried about disordered eating: How will therapy help?

As published on Psychology Today.

Disordered eating and eating disorders are prevalent concerns, particularly in our society that seems to value shape, weight, health, and fitness above all else. Given the ways in which certain behaviours are normalized, it can be tricky to figure out whether what you are struggling with is actually problematic or warrants addressing.

Possible manifestations of disordered eating

Let’s explore some of the ways in which disordered eating may manifest itself and look at how therapy can help.

I’ve noticed a drastic shift in my eating behaviours and/or my weight.

Your behaviours themselves can be one of the key indicators that disordered eating may be something that you’re struggling with. You may find yourself actively restricting your calories or intake, or conversely, having a difficult time controlling how much you eat under different circumstances. Compensatory behaviours like purging, laxative use, or even exercise, can be an indication of disordered eating as well.

Drastic increases or decreases in weight over short periods of time, that aren’t a result of other medical concerns, may also be the outcome of disordered eating. However, there may be more insidious changes to be on the lookout for, like frequently weighing yourself, only trying to eat “healthy” or “low calorie” foods, or going on intensive diets and feeling guilty when you aren’t able to adhere to their “requirements."

Disordered eating is complex and the symptoms above aren’t exhaustive, but if you find yourself struggling with any of the above, therapy could be worth investigating. Gold standard treatment for disordered eating and eating disorders actively focuses on behaviour change, in other words, getting you to do different, in order to feel different. There will be a focus on changing habits and setting goals, such that you play an active role in developing a healthier relationship with food and eating.

I spend a lot of my day preoccupied with what I’m going to eat.

Given that we all need to eat more or less three meals a day to survive, it makes sense that food and eating are going to account for some proportion of your cognitive load. However, if you find yourself consistently coming back to questions like, “what am I going to eat?” “am I allowed to eat this?” or “how many calories does this have?” it may suggest that disordered eating thoughts are taking up a lot of space for you.

Therapy can help by teaching you techniques to reframe your thinking and place less emphasis on food. Some therapeutic orientations place more of an emphasis on changing how you relate to your thoughts, so rather than trying to change what you think, you may learn how to gain distance from difficult thoughts such that they hold less power over the choices you make. Chances are, you may also be preoccupied with food because you’re not allowing yourself to eat enough. In this case, therapy can also help you to establish a more regular eating schedule such that decisions are what to eat and how much become less charged. 

My thoughts often come back to my shape and weight.

We live in a society where emphasis is placed on the value of shape and weight, over and above other qualities and characteristics that make you the person you are. Therapy can help you to accept that your worth as a person is not contingent on what you look like, nor what size you are. It can also help you to change some of the behaviours that may keep you preoccupied with your weight and shape. For example, many individuals who struggle with disordered eating engage in shape-checking or avoidance behaviours, like critiquing themselves in the mirror, or checking how they fit in certain clothing. It follows that the more you do something, the more importance you give it, so therapy might focus on reducing some of these behaviours to help you feel more comfortable in your skin.

I think about how I need to compensate for eating by exercising, or feel like I need to “earn” my calories.

When it comes to disordered eating, food and exercise can become disentangled in a pretty toxic relationship. You may think that you need to exercise to compensate for something you ate, or pre-empt eating something high calorie with intensive exercise to tell yourself “you deserve the treat." Therapy can help you to clarify the value in both eating and exercising, in and of their own rights. All humans need to eat to keep our bodies and minds running. We also benefit from physical activity thanks to both the psychological and physiological gains it provides. Your therapist may help you to set a schedule for exercise, such that you do it as part of your routine, rather than compensation for an eating behaviour. For instance, you might set a time to go to the gym in the morning on Mondays, Wednesdays, and Fridays, while learning to refrain from acting on the urge of adding in another class or session if you feel you overate. In this way, you learn to break the cycle of compensating for unwanted eating behaviours through exercise. 

I’ve tried to make changes on my own before, but they’ve never really stuck.

Making change is hard. While many self-help books and other resources exist to help manage disordered eating and weight-related concerns, many people benefit from the accountability of having weekly sessions with someone who specializes in disordered eating and other mental health concerns. Therapy can also help to personalize treatment to your specific situation in a way that a book cannot. There is also a ton of misinformation out there about the “right” way to eat, and it can be difficult to debunk all of the myths that exist that are perpetuated by diet culture. Psychologists are trained in evidence-based practice, which means that you will learn skills that research has shown to work, rather than searching for a magic bullet solution that doesn’t exist.