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Working with eating disorders

Updated: Aug 2, 2022

I was sad to learn of the death of Big Brother star Nikki Grahame yesterday. Maybe you'll think less of me for being a Big Brother fan, but I make no apology! The show has followed me through my early (and later) adulthood. Nikki was perhaps my favourite contestant - her wild tantrums gave me many smiles over the years.

It is even more sad that her death, at just 38 years old, was as a result of her long battle with Anorexia.

UK Addiction Treatment Centres, report that around 1.6m people in the UK suffer from Eating Disorders. 10% of those, like Nikki, suffer with Anorexia Nervosa, 40% with Bulima Nervosa and 50% with Binge Eating Disorder.

Anorexia Nervosa can be described as "a serious, potentially life-threatening eating disorder characterised by self-starvation and excessive weight loss. Individuals with anorexia are unable or unwilling to maintain body weight that is expected for their age and height."

It is important to note that Anorexia Nervosa has the highest mortality rate of any psychiatric illness. 5-10% of anorexics die within 10 years of onset (typically the average age of onset is 16-17). Even more sadly, 18-20% of anorexics die within 20 years of onset. Only 50% of anorexics report being cured.

Click the graphic for more information.

Commonly, people think that eating disorders are conditions suffered primarily by women and teenage girls. Men are affected too - although only 1 in 10 men with an eating disorder receive treatment.

As the infographic shows, the incidence of men and women suffering binge eating disorder is the same (50%). Anorexia and Bulimia are, however, less common in men than in women.

Eating disorders may present differently in men than in women. Some studies have suggested that they are more prevalent in gay men than straight men. Other studies show the contrary.

Experience shows that psychotherapy is very helpful in the treatment of eating disorders.

My own thoughts are that an eating disorder is very often a strategy someone has built to cope with something that has happened to them in their life. People don't have eating disorders because of food. They are using food to self-medicate or self-sooth. They are a method of fighting off despair. The eating disorder is a symptom rather than a cause.

Often, therapists will notice a lack of trust in clients - some clients know they don't trust and some think they do. So, one of the biggest challenges is to ensure that a strong and trusting therapeutic relationship is built. This doesn't happen overnight, so I would always say that a course of therapy for people with eating disorders is unlikely to be achieved in a small number of sessions.

Trust is particularly challenging because typically patients had often put their trust in someone a long time ago and they were let down by them in some way. These people could well have been the people offering them care. As psychotherapists, we too are seen as care givers, so building a genuine and trusting relationship may well be a huge challenge for the patient. I would rather bring this into the therapy room and be honest - after all, why would anyone trust me after just meeting me? It takes time to build trust. Just saying that gives the client the freedom not to trust me straight away and can remove the pressure from the initial relationship.

As the relationship builds, I am looking for the person to share what is going on within them - very often things they may not have shared with others, or even realised themselves. This is an exercise in building self-awareness and in building resilience. Again, this is a slow, step by step process where the client can feel safe in the therapeutic relationship. The safer they feel, the more they will reveal about the despair they may be experiencing beneath the eating disorder.

Very often the next stage after building trust in the therapist and the therapeutic relationship is for the client to build trust in themselves - building confidence in them, and in their awareness about the world and the types of people in it. This will allow them to develop and use tools for functioning well in that world. This can allow the patient to begin to stop using food as a crucial defence in their lives. They will then start to trust themselves and their own feelings - they can start, tentatively, to trust themselves to make decisions in the best interest of their health and welfare.

Hopefully the client can then begin to learn that trusting their own caring, trustworthy and responsible self is a far better protector than using food in such a manner. Clients learn that their eating disorder is far too destructive, time consuming and inefficient compared to relying on their own confident self.

If you see a person struggling with an eating disorder and you feel ill-equipped to properly assist them, I strongly suggest recommending them to a counselling or psychotherapy service such as Talking Works.

I would also recommend the BEAT Eating Disorders helplines :

Studentline: 0808 801 0811

Youthline: 0808 801 0711

In Hull and East Yorkshire, I would also point you to the SEED service

I have been asked to add this link to this blog article by Bicycle Health - it talks about the link between eating disorders and substance misuse.

Talking Works is a private counselling, psychotherapy and coaching service that I run. You can request a free consultation with me by using the contact details below, or by using the button above. More details about me, and the services I offer can be found on the website

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