Eating Disorders & Body-Image
What Are Eating Disorders?
Eating disorders are serious psychological conditions that affect the way a person thinks about food, eating, weight and body image. They do not happen because someone lacks willpower or wants attention. They develop when patterns around eating and body image become rigid, distressing and difficult to control. These patterns influence emotions, health, relationships and daily functioning. Eating disorders often begin gradually and can become entrenched because the behaviours temporarily reduce anxiety or create a sense of control, even though they ultimately increase distress.
Types of Eating Disorders and How They Differ
Anorexia Nervosa
Anorexia involves an intense fear of gaining weight, a distorted experience of body shape or size, and a persistent restriction of food intake. Even when someone is underweight, they may still believe they are “too big” or feel unable to eat more. There are two subtypes.
The restricting type, where weight loss is achieved through dieting, fasting or excessive exercise.
The binge eating or purging type, where the person restricts food but also experiences binges or uses vomiting, laxatives or other methods to remove food from the body.
People with anorexia often struggle to recognise the seriousness of their low weight or the impact on their health.
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Bulimia Nervosa
Bulimia involves cycles of binge eating followed by behaviours intended to prevent weight gain, such as vomiting, fasting or excessive exercise. After a binge the person may feel guilt, shame or fear, which maintains the cycle. Weight is often within the normal range, but the emotional distress is significant.
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Binge Eating Disorder
Binge Eating Disorder involves repeated episodes of eating unusually large amounts of food accompanied by a sense of loss of control. There are no compensatory behaviours such as vomiting or fasting. People often eat rapidly, secretly or until physically uncomfortable, followed by feelings of guilt or sadness.
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Other Specified Feeding or Eating Disorder (OSFED)
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OSFED includes serious eating difficulties that do not fit neatly into the above categories but still cause significant distress and impairment. Examples include atypical anorexia, subthreshold bulimia or purging disorder.
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Orthorexia
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Orthorexia refers to an unhealthy fixation on eating only foods that are perceived as pure, clean or healthy. Although wanting to eat well is not a problem in itself, orthorexia becomes concerning when the pursuit of “healthy” eating becomes rigid, anxiety-driven or socially isolating.
What Keeps Eating Disorders Going
CBT-E explains eating disorders through a maintenance model, which describes how certain thoughts, emotions and behaviours reinforce one another over time. Most eating disorders are maintained by an intense focus on shape, weight or control of eating. This over-evaluation leads to restrictive dieting, which increases hunger, preoccupation with food and emotional tension. Restriction is often followed by binge eating, because the body and mind are overwhelmed. Binge eating may then lead to behaviours such as vomiting or excessive exercise, which reduce anxiety briefly but strengthen the cycle.
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Other maintaining factors include body checking or body avoidance, constant comparison with others, perfectionistic and rigid personal standards, and difficulty managing strong emotions. People may also use restriction or bingeing as ways to cope with stress, numb feelings or create a sense of control.
How I Support Clients With Eating-Related Difficulties
Therapy focuses on understanding the patterns that maintain the problem and gradually building a more balanced, flexible and compassionate relationship with food, the body and oneself. This work is highly effective for bulimia, binge eating and other eating difficulties that do not require urgent medical intervention.
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CBT-E is the main therapeutic framework. It provides a clear, transdiagnostic and structured approach that helps people stabilise their eating, reduce binge episodes, soften rigid food rules and change the underlying beliefs that maintain the cycle. We explore the thoughts, emotions and habits that keep the problem going and work toward regular eating routines, reduced body checking and more helpful coping skills.
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ACT principles are integrated to help clients respond differently to intrusive thoughts and difficult emotions. Instead of fighting or suppressing urges, ACT teaches a more flexible stance where thoughts are observed rather than obeyed. This supports a calmer relationship with eating and reduces the urge to act on impulses. Clients learn to identify their values and to take small, consistent steps toward a life that is not organised around food or weight concerns.
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DBT-informed skills are helpful when binge eating or purging is linked to emotion regulation difficulties. People learn to notice emotional triggers, soothe themselves in healthier ways and tolerate internal discomfort without turning to eating behaviours for relief. These skills strengthen stability and support lasting change.
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Important note
(I work only with clients who are medically stable. Individuals who have a significantly low BMI require a multidisciplinary team including medical professionals, dietitians and mental health specialists who can support weight restoration and ensure safety as psychological treatment begins.)
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Taking the First Step
Recognizing that you might be struggling with an eating disorder or persistent difficulties around food is an important first step. When concerns about eating, weight, body image or control begin to affect your relationships, your health or your daily life, reaching out for professional support can make a meaningful difference. You do not have to go through this alone, and you deserve care that helps you understand what is happening and guides you toward a healthier relationship with food and with yourself.
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Therapy offers a safe, confidential space to explore the thoughts, emotions and patterns that keep the cycle going. Together we work to stabilise eating, reduce distress, address the beliefs that maintain the problem and build skills for navigating urges and emotions. With the right support, many people find they can break out of restrictive or binge-purge cycles, feel more connected to their bodies and move toward a life that is no longer dominated by food and worry.