Eating disorders & body image
When thoughts about food, weight, shape or exercise have begun taking up more of your life than you want them to.
It doesn't always look the way people expect.
Eating disorders do not always look like the versions we are most often shown. Someone can be struggling significantly while continuing to work, study, care for other people, eat in restaurants, or appear physically well. Weight alone tells us very little about how much of someone’s life is being occupied by food, exercise, weight or body image.
Sometimes the difficulty is obvious. At other times it lives in hundreds of small negotiations: whether you have “earned” a meal, how much you are allowed to eat, what needs to be compensated for later, whether your body has changed, or whether you are really unwell enough to deserve help. A person may be eating regularly while relying on increasingly rigid rules, or may experience episodes of eating that feel out of control after periods of restriction.
For some people, the eating disorder has been present for so long that its rules no longer feel unusual. For others, life may look much freer than it once did while thoughts about food, shape or weight still quietly determine choices, relationships and how safe it feels to inhabit the body.
You do not need to fit a stereotype, reach a particular weight, or be certain that what you are experiencing “counts” before it is worth understanding. A useful question is not simply how you look or what you eat, but how much freedom you still have.
Looking for information about specific eating disorders?
Read more about different eating-disorder presentations, recovery and how I work with them.
Knowing what you “should” do isn't always enough.
One of the most frustrating things about an eating disorder is that insight does not necessarily make it easier to change. You may understand nutrition, recognise that a fear is disproportionate, know that your body needs more food, or be able to identify an eating-disorder thought as it happens — and still feel unable to act differently.
That is not simply a failure of logic or willpower. Eating disorders involve learning, habit, emotion and the brain’s systems for detecting threat and safety. Behaviours such as restricting, checking, compensating or following rigid food rules can reduce anxiety in the short term. Each time they do, the brain has another opportunity to learn: this behaviour helped me feel safer. What began as a coping strategy can gradually become an increasingly automatic response.
Undernutrition can make this harder still. When the brain is not receiving sufficient energy, thinking can become more rigid, attention can narrow around food and threat, and adapting flexibly to uncertainty can become more difficult. This means that some of the psychological processes maintaining an eating disorder can also be intensified by the effects of not eating enough.
And when change begins, anxiety may initially rise rather than fall. Eating more, resting instead of exercising, tolerating uncertainty about weight, or breaking a familiar rule can feel unsafe precisely because the brain has learned the old behaviour as protective. Recovery therefore involves more than knowing that something is safe. It involves repeatedly experiencing something different, so that new learning becomes possible.
We need to understand both the eating disorder and the person who developed it.
Eating disorders are complex, multifaceted mental illnesses. There is rarely a single explanation for why one develops. Biological and genetic vulnerability can interact with psychological characteristics, relationships, life experiences, culture and environment. Factors such as anxiety, perfectionism, sensitivity to threat, identity, attachment, trauma or neurodivergence may be relevant for some people — but no two formulations will be exactly the same.
That is why therapy needs to understand more than the symptoms. We are interested in what may have made someone vulnerable to an eating disorder, what was happening when difficulties emerged, what the eating disorder has come to mean or provide, and — crucially — what is keeping it going now.
Some maintaining processes are psychological or relational. Others are behavioural and biological. Restriction itself can intensify preoccupation with food, rigidity and anxiety; checking can strengthen uncertainty about the body; avoidance can preserve fear; and behaviours that bring immediate relief can become increasingly difficult to relinquish. Understanding these processes helps us identify where change is actually possible.
Therapy is therefore individual rather than formulaic. Depending on what is maintaining the difficulty, our work may involve eating and behavioural change, body image, anxiety and compulsive patterns, perfectionism, shame, emotional regulation, relationships, identity, attachment or trauma where it is relevant. Understanding why an eating disorder makes sense in the context of someone’s life is not the same as allowing it to remain in charge.
Recovery is about more than eating differently.
Food and behavioural change matter. An undernourished brain and body cannot simply be talked out of the effects of insufficient nutrition, and recovery often requires doing things that feel difficult before they begin to feel safe: eating adequately and consistently, reducing compensatory behaviours, resting when rest is needed, and gradually loosening the rules that have accumulated around food and the body.
But recovery is not measured only by what happens on a plate. An eating disorder can gradually organise a life around itself — influencing relationships, spontaneity, work, movement, sexuality, identity, self-worth and the amount of mental space available for everything else. Someone can be eating considerably better and still find that much of their inner world is governed by avoiding weight gain, controlling their body or remaining within carefully negotiated limits.
This is why recovery can also involve discovering what becomes possible as the eating disorder occupies less space. That might mean tolerating a changing body, responding more flexibly to hunger, eating without needing to compensate, reconnecting with other people, developing an identity that is not organised around weight or control, or making choices according to what matters rather than what feels safest to the eating disorder.
Recovery does not have to look identical for everyone, nor does progress need to be perfect to be meaningful. The direction is towards greater nourishment, flexibility, connection and freedom — and towards a life that is increasingly able to belong to you rather than to the eating disorder.
