As a therapist who specializes in eating disorders and body image issues, I have worked with clients who begin therapy and — as they make progress — show signs of having an eating disorder. This doesn’t happen in an obvious way, though. To make the diagnosis, I analyze what they’re saying and look for subtle signs.
To illustrate this point, I am going to share two different client scenarios below. Each of them may seem like a typical case of anxiety, mild depression and struggles with self-confidence and lack of happiness. With a closer look through the lens of an eating disorder therapist, these two stories take on different meanings.
Client Scenario 1: Depression and Anxiety with Subtle Signs of an Eating Disorder
A client and therapist have been meeting for several sessions. The client’s initial reason for therapy was to deal with anxiety and depression that seem to come and go.
In the sessions, the client talks about how anxious she becomes when people invite her to a social event. In these discussions she also mentions the idea of eating in front of others is difficult. Her anxiety increases and she cannot focus on what is happening.
She loses her train of thought when talking or finds it difficult to engage in any meaningful conversation with others. After she departs from the social event, she is left feeling disconnected and depressed.
Client Scenario 2: Confusing a ‘Lifestyle Change’ with Something Else
Another client comes into therapy because she is struggling with feeling confident in herself. She says she needs to make a few changes that will help her feel more positive.
From the start she is talking about how she has tried many diets, but they don’t seem to work long-term. She feels good when she is working the diet. At some point, however, she blows the diet and is back to feeling like she will never be able to lose the weight and feel good.
She is currently trying a “lifestyle” change and is working with an online healthy living coach. She has lost some weight and is feeling good about this. During her sessions she reports to you how well she is doing with following her diet and how good this makes her feel.
She also shares that she has been to several social events. Each time she has brought her own food because the thought of not knowing what foods will be there makes her really anxious. If there are any “bad” foods being served, she couldn’t take the chance of ruining her day by eating these foods.
Looking Past the Surface
If you are not looking for eating disorder red flags, you would likely see the first client only as someone who is struggling with anxiety that can lead to feelings of depression. The second client could be seen as a woman who has been struggling with having confidence and simply did not find a diet that “worked.”
If you are looking through the lens of an eating disorder therapist, however, this anxiety/depression and struggle to find confidence and happiness looks much different.
The unspoken signs with the first client could sound like this:
- “My days are spent thinking about food, what foods I can eat, which foods are off limits.”
- “If I eat that food I am going to feel like such a bad person.”
- “I don’t deserve to eat anything.”
- “When I am in a social event that involves food, I feel so overwhelmed, anxious and scared I can’t concentrate on anything except all the food thoughts and food rules that are going through my head.”
With the second client the thoughts might be:
- “I hate my body”
- “I will never be thin enough or pretty enough for anyone or good enough for anyone or anything.”
- “I can’t eat any foods that are not on my food ‘rules’ list.
- “If I do eat any bad foods, I am such a failure.”
When you look at each client through the lens of an eating disorder therapist, the stories become different. Eating disorders are deceptive. It is easy to miss their unspoken signs.
Remember, these signs don’t guarantee the client has an eating disorder. They are, however, always worth discussing.
Going Beyond the Stereotypes of an Eating Disorder
Both of these clients could be of average, above average or somewhat below average weight for a person their size. Unless a client is severely under or overweight, a therapist cannot look at a client and determine from their size if they do or do not have an eating disorder. With the exception of the client deciding on their own that they need help with their eating disorder, it is going to take the skills of the therapist to discover and bring into discussion the unspoken signs.
We often think of people with eating disorders as having some sort of extreme weight or symptom such as binging or purging. People with eating disorders can look or act much different than that, though.
An eating disorder can be anything that includes “extreme emotions, attitudes and behaviors surrounding weight and food issues,” according to the National Eating Disorders Association [NEDA]. If anything related to food, weight or body image prevents you from living a full and happy life, it is a mental health issue — maybe something a therapist can help you with.
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