Eating Disorders
Eating disorders can be draining, isolating, and exhausting to deal with. You may feel that thoughts about food or your body have taken over much of your mental space, or feel that your eating habits really limit your ability to participate in life. Eating disorders don’t just affect eating, but impact our relationships, reflect or numb our emotions, occupy our thoughts, and can interfere with our ability to do the things we would like to do. Often, disordered eating is a way we learned to cope with distress, but unfortunately and unintentionally, it can lead to more distress over time. What initially gave us some sense of control can spiral and lead us to feel more like the eating disorder is controlling us.
Eating disorders do not discriminate, and can and do affect people of all genders, ages, ethnicities and backgrounds.
However, there is hope for change! We know through research and experience that it is possible to recover from eating disorders. Even if that feels very hard to imagine at this point.
Read below to find out more about the different kinds of eating disorder. Every person is different, and not all of the descriptions below will match your experience.
At the bottom of this page, there is information about the kinds of therapy I offer that can help support you through your journey with disordered eating.
Bulimia Nervosa
Bulimia is characterised by feeling like you have lost control over how much you are eating over a short period of time (bingeing), and then using some method to try to prevent weight gain (purging), such as making yourself sick, using laxatives, or exercising hard. People experiencing bulimia often have a negative view of their body, may also experience difficulties managing emotions, and can have poor self-esteem.
People dealing with bulimia often find themselves stuck in cycles of 'dieting' or trying to restrict how much they are eating, which leads to bingeing and purging, and then trying to diet or restrict how much they eat again to 'make up for' the bingeing.
Anorexia Nervosa
Anorexia is characterised by restricting how much you eat, which leads to low weight. Thoughts about food and eating may occupy much of someone's mental space, as do fears of gaining weight. People dealing with anorexia can be self-critical, might describe themselves as a perfectionist, often have negative thoughts about their body, and view themselves as bigger than they actually are.
Binge Eating Disorder
Binge Eating Disorder typically involves feeling like you have lost control over what you are eating in a short period of time (bingeing). This often leads to distress and feelings of guilt and shame. Similar to people experiencing bulimia, people dealing with binge eating disorder often find themselves stuck in cycles of trying to restrict how much they eat or 'dieting', which leads to binge eating, and then further attempts to diet or restrict to 'make up for' the bingeing.
Other Specified Feeding or Eating Disorder (OFSED)
Bulimia, anorexia, and binge eating disorder are all diagnosed based on certain expected symptoms. However, most people dealing with an eating disorder don't experience all of the symptoms for one condition, and might be diagnosed with OSFED. OSFED makes up the largest number of eating disorder diagnoses, and is just as serious and deserving of help and support as other more well known eating disorder diagnoses.
Avoidant/Restrictive Food Intake Disorder (ARFID)
Avoidant/restrictive food intake disorder (ARFID) is characterised by avoiding eating certain foods or types of foods, and/or limiting the amount eaten. In ARFID, beliefs about weight and shape don't affect the avoidance of foods (ie. people with ARFID are not motivated by trying to lose weight).
Avoidance of certain types of food, or limiting the amount of food eaten, is typically due to a mixture of:
- Sensory sensitivities (being very sensitive to taste, texture or smell)
- Fear of negative consequences when eating (such as choking, or unintentionally being sick)
- Little interest in eating and food
ARFID can occur at the same time as other conditions, commonly anxiety, autism or ADHD, but this is not always the case.
Cognitive Behavioural Therapy For Eating Disorders
Cognitive Behavioural Therapy for Eating Disorders (CBT-ED), also called Enhanced Cognitive Behavioural Therapy (CBT-E), is a structured, evidence-based psychological treatment specifically designed for eating disorders. CBT-ED is a transdiagnostic therapy, meaning it can be tailored to help people with anorexia nervosa, bulimia nervosa, binge-eating disorder and OFSED. CBT-ED targets the underlying thoughts, behaviours and beliefs that maintain the eating disorder, and helps us to develop new skills, behaviours, and ways of thinking that help to break us out of the vicious eating disorder cycles.
Core parts of CBT-ED include:
• Personalised formulation: We create a personalised map of your eating difficulties, that shows us why the eating disorder developed, and what is keeping it going. This helps us to plan treatment to best meet your needs and individual situation.
• Regular eating patterns: Supporting structured meals and snacks to break cycles of restriction, bingeing or purging. This is done gradually, in a way that balances your comfort, but also gently challenges you to support growth.
• Working with thoughts: Identifying unhelpful thoughts about food, weight, shape and self-worth, and learning skills to shift and change these thoughts.
• Addressing other factors: Such as perfectionism, low self-esteem or developing ways of coping with emotions.
• Relapse prevention: Making an action plan for maintain progress and managing setbacks into the future.
CBT-ED is typically delivered in a series of weekly sessions, with tasks set between sessions to help embed new skills into your everyday life.
Evidence supporting CBT-ED:
Research shows CBT-ED is effective in reducing disordered eating across a range of eating disorders, with many studies reporting meaningful improvements that are maintained over time. CBT-ED is recommended as a first-line treatment in the NHS’s NICE guidelines (England and Wales) and the Matrix (Scotland).
Cognitive Behavioural Therapy for Avoidant/Restrictive Food Intake Disorder (CBT-AR)
Cognitive Behavioural Therapy for Avoidant/Restrictive Food Intake Disorder (CBT-AR) is a structured psychological treatment specifically adapted to help people with ARFID.
CBT-AR is collaborative and tailored to your specific eating pattern and concerns. Therapy typically includes:
• Personalised formulation: Learning how ARFID works and identifying what keeps the difficulties going in your particular situation.
• Building regular eating habits: Establishing a structured pattern of meals and snacks.
• Gradual food exposure: Step-by-step support to increase the range and/or amount of foods you can eat, at a pace that feels manageable but gently challenging.
• Reducing fear and anxiety around food: Using practical CBT strategies to work with worries about choking, vomiting, or other feared outcomes, if relevant to you.
• Relapse prevention: Developing strategies to maintain progress and handle setbacks in the future.
CBT-AR is usually offered in weekly sessions.
Evidence supporting CBT-AR
ARFID was only formally recognised in recent years, and therefore there is less research looking into successful treatments for ARFID compared with other eating disorders. The NHS treatment guidelines (NICE guidelines in England and Wales, and the Matrix in Scotland), do not currently have a section focusing on ARFID, which will hopefully change in the future. However, research into CBT-AR is growing and early studies into the positive effects on ARFID difficulties are promising. Additionally, broad techniques used in CBT-AR, such as gradually facing feared situations, have been shown to be effective for other mental health difficulties like anxiety. Eating Disorder services in the NHS also tend to use CBT-AR when working with people with ARFID.
Compassion Focused Therapy
Compassion focused therapy (CFT) focuses on developing compassion towards yourself and others, to reduce self-critical thoughts and beliefs, and improve mood. CFT can be used alongside CBT-ED or CBT-AR, to complement treatment. Adding compassion focused techniques can be particularly helpful when someone struggles with self-criticism, low self-esteem, perfectionism, shame, or embarrassment.
