Eating Disorder Counseling

Eating Disorders: Information on Eating Disorders, Anorexia Nervosa, Bulimia Nervosa, and Counseling Advice for Overcoming An Eating Disorder


Amanda had binged a few times upon first getting to college.  Afterward she would take laxatives and go the gym for hours to work off the calories.

Shannon and Cameron were best friends whose anorexia began early on in high school mostly due to their intense, unspoken competition with one another.  They secretly each obsessed over who ate less and exercised more.

Every time Allison broke up with a boyfriend or started dating someone new, she would binge and purge for a few weeks afterward.  After marrying her husband, her habits stopped for a while but it recently returned.  She is getting cavities from all of the vomiting and thinks it may be time to tell her husband about her problem.


Eating disorders are characterized by an overwhelming obsession with food- either eating too little or too much- and other compulsive behaviors related to eating.  Often such behaviors are the result of an individual’s efforts to gain control or cope with anxiety or stress.  Compulsive overeating and other milder forms of obsessions with food and weight may also be forms of eating disorders if they lead to unhealthy or obsessive behaviors, or an altered body image or thought process.

Two examples of eating disorders include Anorexia Nervosa and Bulimia Nervosa:

  1. Anorexia Nervosa.  Individuals suffering with this eating disorder starve themselves as a means of feeling thin. These individuals still believe that they are fat, even while weighing well below the lowest weight recommended for their age and height.  Individuals with Anorexia Nervosa have an extremely distorted body image.  They believe that hunger pains are good- being that they are evidence of success at weight loss, and commonly do not experience menstruation as a result of their malnutrition. Anorexics obsess over the amount that they consume and exercise.  The disorder is most common among teen girls that have controlling parents who hold them to very high standards.  When such standards become unclear, the individual feels out of control and as though the only thing that they hold power over is food- unfortunately, however, eventually even food begins to control them.  It is also common among individuals who experience conflict with their same sex parent. Anorexia Nervosa is an eating disorder that is ultimately fueled by fear- of being fat, failing, being less than perfect, rejection, or losing control.
  2. Bulimia Nervosa.  Individuals suffering with this eating disorder binge on fatty, high-calorie, or sweet foods and, afterward, self-induce vomiting, exercise excessively, or overdose on laxatives in order to counteract their eating.  Their binges take place in secret, during which hundreds or thousands of calories are consumed in a sitting.  Unlike Anorexics, individuals with Bulimia Nervosa are usually of normal weight, though they do have a similar obsession with fat and food.  Also unlike anorexics, Bulimics do not have troubles with distorted body image and they generally know that their behavior is not normal or right.  Bulimia Nervosa is most common in girls in their late adolescence, and can often result in destruction of tooth enamel and electrolyte imbalances.

There are often several barriers that prevent an individual from getting proper treatment for an eating disorder.  Among some of the most common are:

  1. Access.  Finding treatment from a specialist in eating disorders can be extremely difficult.
  2. Will.  There are many emotional and interpersonal complexities to take into account when healing of an eating disorder.  Individuals with eating disorders cannot just will themselves out of having one.
  3. Denial. Individuals with eating disorders can have very distorted body images and can deny that they are inflicting any harm on themselves.
  4. Fear.  Treatment of an eating disorder requires facing pain, hurt, and discomfort.  It can be a very frightful and difficult process.
  5. Financial barriers.  Many treatments for eating disorders are quite expensive.
  6. Idols. For individuals with eating disorders, food is an obsession and a preoccupation.  It is not at all about sustenance.
  7. Lack of faith.  An individual may believe that no treatment or person will be able to help them with their eating disorder.
  8. Minimization of the problem.  Many individuals put off treatment because they do not realize just how great a grasp their eating disorder has on their life.  Some also believe that their problem might just go away by itself.
  9. Pride. It is very difficult to admit to oneself and others that something is out of control.
  10. Shame and guilt. Shame and secrecy may obscure eating disorders for a long time and make it very difficult for an individual to admit that they have a problem.  For most it is embarrassing to admit to binging, vomiting, or not eating.

Some common warning signs that an individual may be suffering from an eating disorder include:  preoccupation with appearance and body weight, frequent and obvious weight fluctuations, restrictive dieting, social withdrawal, depression, heart palpitations, laxative or diuretic abuse, secret behaviors, and trips to the bathroom after eating.


When helping an individual to overcome an eating disorder, consider the following action steps:

  1. Identify a target weight.  Determine an ideal and safe weight for the individual by taking into account their height, age, and body type.  Using the body mass index, or consulting a doctor or dietician may also be of assistance when calculating this.
  2. Focus on relationships.  Individuals with eating disorders have a difficult time opening up and accepting help.  Build a positive relationship with the individual, do not criticize or condemn them, be patient, speak the truth, and make sure that they are ready to hear the truth.  Healing that individual’s relationship with others is essential to recovery- encourage others to show the individual unconditional love.
  3. Take the focus off of food.  Unless an individual’s health is in immediate danger, examine what weight loss means to the individual, what eating stands for to them, and what their greatest fears about eating are.  Help those close to the individual to take the focus off of food, as well.  Teach them that food is not the solution, but rather part of the individual’s problem.
  4. Look for triggers.  Help the individual to see what triggers their binging; identify the situations that precede it.  Help them to see what is driving their actions.
  5. Change thinking patterns.  Gently question the individual’s thinking and help them to see the untruth that lies behind their harmful behaviors.
  6. Examine perfectionism. Help the individual to recognize the high standards that they hold themselves to, but do not even hold their own loved ones to.
  7. Keep a journal.  Encourage the individual to record their feelings and each day’s events.  Help them to view their feelings as acceptable and normal.

Note:  Do no try to treat an individual whose health is at immediate risk; these individuals must be hospitalized or in an inpatient treatment program.  What you can do is focus on that individual’s family and help them to avoid placing blame on themselves or the individual for the problem.

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(Portions of the above material is reprinted with permission from Thrive Boston Counseling in Boston, MA.)

(Portions of the above material is reprinted with permission from Thrive Boston Counseling in Boston, MA.)

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