Eating disorders are among the most misunderstood mental health conditions. From the outside, they can look like extreme dieting or lack of self-control. From the inside, they're intricate survival systems—ways of managing unbearable feelings, asserting control, or expressing pain that has no other outlet.

If you're struggling with your relationship with food, you're not alone. Eating disorders affect approximately 1.25 million people in the UK, spanning all ages, genders, backgrounds, and body types.

This guide explains what eating disorders are, how therapy helps, and what options exist for recovery.

Understanding Eating Disorders

What Eating Disorders Are

Eating disorders are serious mental health conditions involving disturbed eating behaviours and related thoughts and emotions. They're not lifestyle choices, phases, or attention-seeking. They're genuine illnesses with psychological, physical, and social impacts.

Key types include:

Anorexia Nervosa: Restriction of food intake leading to significantly low body weight, intense fear of weight gain, and disturbed perception of body weight or shape.

Bulimia Nervosa: Cycles of binge eating followed by compensatory behaviours (purging, excessive exercise, fasting) to prevent weight gain.

Binge Eating Disorder: Recurring episodes of eating large amounts of food rapidly, often in secret, accompanied by feelings of distress, shame, and loss of control.

Other Specified Feeding or Eating Disorder (OSFED): Significant eating disturbance that doesn't meet full criteria for the above but causes real suffering.

Avoidant/Restrictive Food Intake Disorder (ARFID): Limited eating based on sensory characteristics of food, fear of consequences of eating, or lack of interest in food—not related to body image concerns.

What Eating Disorders Are Not

Not vanity: They're not about wanting to look good. They're about managing emotional pain, asserting control, or responding to trauma.

Not willpower failures: People with binge eating disorder aren't just greedy. People with anorexia don't just need to "eat more."

Not attention-seeking: Most people with eating disorders hide their behaviours and feel profound shame.

Not only affecting young, thin, white women: Eating disorders affect people of all ages, genders, ethnicities, and body sizes.

What Lies Beneath

Eating disorders are rarely about food itself. Common underlying factors include:

Control: When life feels chaotic, controlling food provides a sense of mastery.
Emotional regulation: Restriction or bingeing can numb painful emotions.
Self-worth: When self-esteem is low, appearance and eating become metrics of value.
Trauma: Eating disorders frequently relate to past trauma, particularly experiences of abuse or neglect.
Perfectionism: Impossibly high standards applied to body and eating.
Communication: Sometimes the eating disorder expresses what can't be said in words.
Identity: The eating disorder can become central to sense of self.

Understanding these functions doesn't excuse the behaviours but helps explain why they're so persistent and why simple advice to "just eat normally" doesn't work.

How Therapy Helps

Effective eating disorder treatment typically addresses multiple levels:

Stabilising Eating Behaviours

First, practical work on normalising eating:

Reducing restriction or binge-purge cycles
Establishing regular eating patterns
Addressing immediate physical risks
Managing triggers and high-risk situations

This isn't about willpower—it's about developing practical strategies and support structures that make change possible.

Understanding the Function

Therapy explores what the eating disorder does for you:

What needs does it meet?
What would be unbearable without it?
What triggered its development?
What maintains it now?

Understanding the eating disorder's function is crucial. Without addressing underlying needs, new coping mechanisms emerge or relapse occurs.

Addressing Underlying Issues

Deeper work might include:

Processing trauma
Developing emotional regulation skills
Challenging distorted thinking about food, weight, and body
Building self-worth independent of appearance
Improving relationships and communication
Addressing perfectionism
Developing identity beyond the eating disorder

Building a Life Worth Living

Recovery isn't just about stopping disordered behaviours. It's about building a life where you don't need them:

Meaningful activities and relationships
Healthy coping strategies
A relationship with your body that isn't adversarial
Ability to experience pleasure, including food pleasure
Resilience to face life's difficulties without the eating disorder

Types of Therapy for Eating Disorders

Cognitive Behavioural Therapy for Eating Disorders (CBT-E)

The most researched approach, CBT-E focuses on:

Identifying thoughts and beliefs that maintain disordered eating
Developing regular eating patterns
Addressing concerns about weight and shape
Building skills to prevent relapse

It's structured, practical, and typically delivered over 20-40 sessions depending on severity.

Family-Based Treatment (FBT/Maudsley Approach)

Primarily for adolescents with anorexia, FBT involves parents taking temporary control of their child's eating to restore weight, then gradually returning control. It has strong evidence for adolescent anorexia.

Interpersonal Psychotherapy (IPT)

Focuses on relationships and how interpersonal difficulties relate to eating behaviours. Particularly useful for bulimia and binge eating disorder.

Psychodynamic Therapy

Explores unconscious patterns, early experiences, and the deeper psychological functions of the eating disorder. May suit those for whom cognitive approaches haven't fully addressed underlying issues.

Dialectical Behaviour Therapy (DBT)

Originally developed for borderline personality disorder, DBT's emotion regulation and distress tolerance skills help many with eating disorders, particularly those with binge-purge patterns.

Specialist Supportive Clinical Management (SSCM)

Combines clinical management (focus on eating, weight, symptoms) with supportive psychotherapy. Sometimes used for anorexia when other approaches haven't worked.

Levels of Care

Eating disorder treatment exists across a spectrum of intensity:

Outpatient Therapy

Regular sessions (typically weekly) while living at home. Suitable for:

Mild to moderate eating disorders
Those medically stable
People with good support systems
Maintenance after more intensive treatment

Day Treatment/Intensive Outpatient

Several hours of treatment multiple days per week while living at home. Bridges the gap between outpatient and inpatient care.

Residential Treatment

Living at a treatment facility while receiving intensive therapy, supervised meals, and 24-hour support. For those needing more structure than outpatient provides but not requiring hospital-level medical care.

Inpatient/Hospital Treatment

24-hour hospital care for those who are:

Medically unstable (severely underweight, electrolyte imbalances, heart complications)
At acute risk of self-harm
Unable to interrupt eating disorder behaviours at home

Stepped Care

Many people move between levels—stabilising in higher intensity, then transitioning to outpatient. Relapses may require stepping back up temporarily.

Finding Help

NHS Services

Community eating disorder services exist in most areas, typically accessed through GP referral. Specialist eating disorder services (SEEDS in many areas) provide assessment and treatment.

Waiting lists can be long, and services vary in quality. Don't wait for NHS assessment to seek private support if you can access it.

Private Therapy

Private eating disorder therapists offer:

Often shorter waiting times
More choice of therapist and approach
Potentially longer-term support

When seeking private therapy for an eating disorder, look for:

Specific training in eating disorders
Experience with your particular presentation
Willingness to work with your medical team
Appropriate approach to severity (some presentations need specialist services)

Specialist Organisations

Beat: The UK's eating disorder charity. Offers helplines, support groups, and information.

SEED: Support and self-help groups across the UK.

ABC (Anorexia and Bulimia Care): Christian-based but services available to all.

Medical Support

Eating disorders have physical consequences requiring medical monitoring:

Regular GP check-ups
Blood tests to monitor electrolytes
Heart monitoring in severe cases
Nutritional assessment
Possibly psychiatric input for medication

Therapy works best alongside appropriate medical care.

What to Expect in Therapy

Assessment

Initial sessions establish:

Current eating behaviours and thoughts
Physical health status
History of the eating disorder
Other mental health concerns
Readiness for change
Goals and priorities

Be honest. Therapists aren't there to judge but to understand and help.

Early Work

Early therapy typically focuses on:

Building a trusting relationship
Psychoeducation about eating disorders
Beginning to normalise eating
Addressing immediate risks
Understanding your specific patterns

Ongoing Treatment

As therapy progresses:

Deeper exploration of underlying issues
Challenging beliefs about food, weight, and body
Developing new coping strategies
Processing difficult experiences
Building a life beyond the eating disorder

Setbacks

Recovery isn't linear. Lapses happen. Good therapy anticipates this, helping you learn from setbacks rather than seeing them as total failures.

Endings

Therapy eventually ends, but recovery continues. Good endings prepare you for independent maintenance while knowing support is available if needed.

Supporting Someone with an Eating Disorder

If you're worried about someone:

Express concern gently: "I've noticed you seem stressed about food. I'm worried about you."

Avoid comments about food, weight, or appearance: These rarely help and often harm.

Listen without judgment: Let them share if they want to, without immediately offering solutions.

Encourage professional help: Offer to help find resources or accompany them to appointments.

Educate yourself: Understanding eating disorders helps you respond helpfully.

Look after yourself: Supporting someone with an eating disorder is draining. Get support too.

Frequently Asked Questions

Do I have to want recovery for therapy to work?

Ambivalence is normal. You don't need total commitment. But some willingness to try is necessary.

Will therapy make me gain weight?

If you're underweight, weight restoration is part of recovery—but it happens gradually with support. Therapy isn't about forcing weight gain; it's about developing a healthier relationship with food and body.

What if I'm not underweight?

Eating disorders occur at all weights. Bulimia, binge eating disorder, and OSFED often don't involve underweight. You deserve help regardless of your weight.

How long does recovery take?

Varies enormously. Full recovery (not just symptom improvement) typically takes years. But improvement begins much sooner.

Can you fully recover from an eating disorder?

Yes. Research shows full recovery is possible. Many people reach a point where food and body no longer cause distress.

What about medication?

Medication (usually antidepressants) can help some eating disorders, particularly bulimia and binge eating disorder. It's typically used alongside therapy, not instead of it.

Taking the First Step

Eating disorders thrive in secrecy and shame. Reaching out—whether to a friend, GP, or therapist—is the first step in breaking that isolation.

Recovery is possible. It's often longer and harder than anyone wants, but people do recover. They develop healthy relationships with food. They build lives not dominated by thoughts of eating and body. They become themselves.

While eating disorders benefit from specialist treatment, I work with people exploring their relationship with food, body image concerns, and related issues. For more severe eating disorders, I can help connect you with specialist services. If you're unsure what level of support you need, I offer a free phone consultation to discuss your situation.

You don't have to stay trapped in your relationship with food. Help exists.

Eating Disorders and Therapy: Understanding Your Options