What to Expect in Eating Disorder Counseling Part 1: How It Starts

If you think you might need help with your eating behaviors, you are probably wondering what that might be like. If you are struggling with anorexia (severely limiting your food intake below your body’s needs), binge eating (a sense of loss of control while eating large amounts of food in a short period of time), or bulimia (episodes of both binge eating and purging-- self-induced vomiting or use of laxatives, diuretics, fasting, or excessive exercise to control weight), or any combination of these behaviors, you might benefit from treatment to help you address this and regain a healthy relationship with food and your body.

You will likely feel nervous about opening up to a stranger about such sensitive personal issues. You might believe you can figure things out for yourself or that no one else can help you. That’s all understandable AND… not completely true. A therapist who understands eating disorders will help you feel comfortable talking about these vulnerable details, educate you about things you may not be aware of, and set you on a course of recovery -- all of which are difficult to do alone.

Here are some things that an eating disorder specialist will cover with you in counseling.

Assessment: Figuring out the problem

Your eating disorder therapist will ask questions to determine if you have an eating disorder. The American Psychiatric Association publishes criteria for mental health professionals to use in diagnosing individuals, and only those who have received specialized training and sufficient experience are qualified to diagnose and treat mental disorders. It’s important to keep in mind that even those who don’t meet full criteria for an eating disorder often experience significant distress in their life as a result of their dysfunctional relationship with food and can still benefit from therapy.

Education about eating disorders

Becoming knowledgeable about eating disorders is a necessary first step in the treatment process. Your eating disorder specialist will share with you what research says about what contributes to developing an eating disorder and the most effective ways to recover. With adolescents and young adult clients, this education process will ideally include the parents and other important support people in the client’s life. The therapist will dispel myths about eating disorders and educate and guide family members about things that can help or harm their loved one’s recovery.

Exploration of how the eating problem began  

Your eating disorder therapist will delve into details specific to you about what has led up to your unhealthy relationship with food and your body. This information may help you to understand how the problem developed, thereby reducing self-blame, and may also help tailor treatment to your needs. These details include those surrounding the development of the problem: information about its onset, likely triggers, and the sequence of events that followed; your weight history from before and since the eating problems started; and any treatment you have had to address the problem. The therapist will ask about your thoughts and feelings about treatment and how well you followed treatment recommendations.

Together you and your eating disorder therapist will also examine your personal and family history: history of family members’ psychological problems (depression, substance abuse, eating disorders), adverse events that occurred in childhood (bullying and teasing, death of friends and loved ones, witnessing traumatic events); and your history of anxiety, depression, perfectionism, low self-esteem, self-harm and substance use, particularly in relation to the timing of problems with food.

Your therapist will also assess the current state of the problem: typical eating habits, weight control behaviors, and how you think and feel about these. Your therapist will be curious about the rules you have about eating, your ability to eat in social situations, and how you manage your worries about your body. Perhaps most importantly, you will explore the impact of the eating problems on your psychological and social functioning, and how motivated you are to change this. Questions will also be asked about your physical health symptoms and mental health problems beyond disordered eating, and the therapist may refer you to additional professionals for lab work or medical testing, or for collaboration in treating the eating problem.

In Part 2 of this series, What to Expect in Eating Disorder Counseling, I will dive deeper into the issues covered in therapy for disordered eating.

If you are looking for a counselor in Plano TX or a counselor in Frisco TX give me a call at 469-850-2420 for a free 15 minute phone consultation. My name is Danesa, and I am happy to help connect you with a great therapist in the area, or we can determine if we would be a good fit. My specialties include body image, food and weight issues, eating disorders, and anxiety.