Online Eating Disorder Therapy & Recovery
Online eating disorder therapy exploring the patterns that keep eating disorders going, and what recovery can involve.
An eating disorder can become very good at looking reasonable.
It might tell you that you're simply trying to eat healthily, be disciplined, get fitter or feel more comfortable in your body. It might convince you that you'll relax once you've reached a particular weight, found the right way of eating, exercised enough, or finally feel in control.
Sometimes it is much more obvious. Meals become frightening. Certain foods feel impossible. You restrict, binge, purge, compensate or find yourself caught between them. You may exercise because not exercising feels unbearable rather than because you want to. Hunger can feel threatening; fullness can feel worse.
But eating disorders can also become quieter and harder to recognise. You may be eating regularly and still negotiating every mouthful in your head. Choosing the lowest-calorie option without consciously deciding to. Comparing your plate with everyone else's. Checking your body in mirrors or avoiding mirrors altogether. Planning food hours in advance. Delaying meals. Researching nutrition. Mentally calculating what you've eaten or what you need to do to compensate for it.
Life can look remarkably normal from the outside while food, weight, movement and your body are occupying an enormous amount of space inside your mind.
You may also feel that you aren't really unwell. Perhaps your weight isn't low enough. You eat more than someone else. You don't behave the way you think a person with an eating disorder should. Other people seem worse. You may even wonder whether you're exaggerating the whole thing.
That feeling of not being “sick enough” is extraordinarily common in eating disorders. It isn't a reliable measure of whether you deserve help.
The aim isn't to care less. It's to have more choice.
One of the understandable fears about changing perfectionism is that something important might disappear with it. If you stop pushing yourself, will you become lazy? If you prepare less, will your work suffer? If you become more accepting of mistakes, will your standards slip?
Therapy doesn't require you to stop being ambitious, conscientious or invested in doing things well. Instead, we can begin to distinguish between standards you genuinely choose and rules that feel as though they have to be obeyed.
When perfectionism is in charge
I have to get this right.
I can't risk disappointing them.
I need to check once more.
I should be doing something useful.
I can't stop until I've done enough.
I need them to be okay with me.
If somebody is upset with me, I need to fix it.
When there is more choice
This matters to me, so I want to do it well.
I can prepare without preparing for everything.
I can decide when something is good enough.
Rest doesn't have to be earned.
I can make a mistake and still be okay.
Someone can be disappointed with me and I can still be okay.
I can care about someone without being responsible for how they feel.
Some of this work happens through understanding where the rules came from and what they have been protecting. Some happens through experience. We might experiment with checking once rather than five times, sending something without one final revision, allowing somebody to have a different opinion, not immediately trying to repair another person's disappointment, saying no without giving a lengthy explanation, resting before everything is finished, or doing something simply because you enjoy it rather than because it is productive.
These are not exercises in becoming careless. They give the brain opportunities to discover what actually happens when an old rule is not followed — and to learn that discomfort, uncertainty, imperfection or another person's disappointment can be experienced without automatically meaning that something has gone wrong.
Over time, the question becomes less “How do I make myself stop being a perfectionist?” and more “How do I want to respond here?” That shift matters. It moves the work away from creating another standard you have to meet perfectly, and towards greater flexibility, self-trust and choice.
You don't have to prove that you're struggling before you're allowed to want something different.
online eating disorder therapy isn't simply about food. But food still matters.
People are often told that eating disorders “aren't really about food”. There is some truth in that, but the reality is more complex.
Eating disorders do not have a single cause. They develop through a complex interaction of biological, psychological, developmental, social and environmental factors, with the particular combination differing from person to person. Genetics and neurobiology can contribute to vulnerability, as can temperament, perfectionism, anxiety, sensory differences, experiences around food and the body, dieting or energy deficit, relationships, cultural pressures, significant life experiences and, for some people, trauma. There does not have to be one identifiable event or explanation that accounts for why an eating disorder developed.
Once established, an eating disorder can also come to serve important psychological functions. It may create a sense of control when life feels unpredictable, numb feelings that seem impossible to manage, provide rules when uncertainty feels frightening, communicate distress that has been difficult to put into words, or become intertwined with identity, safety and self-worth.
But that is only part of the picture.
Once eating becomes restricted, irregular or chaotic, biology enters the conversation too . The brain becomes increasingly interested in food. Thinking can become more rigid. Anxiety may increase. Decisions become harder. Rituals and rules can strengthen. Hunger and fullness cues can become confusing, and thoughts about food can begin to occupy extraordinary amounts of mental space.
Whatever contributed to its development, over time an eating disorder can become a self-maintaining system: psychological processes and biological responses begin to reinforce one another.
And this is why understanding why an eating disorder developed is important — but understanding alone may not make it possible to recover while the brain and body remain undernourished.
Food is not the whole treatment. But adequate, consistent nutrition creates conditions in which the rest of the therapeutic work becomes more possible.
For some people this means nutritional rehabilitation or weight restoration. For others it means establishing regular eating, responding more consistently to hunger, reducing binge–restrict cycles, challenging food rules, decreasing compensatory behaviours or allowing a greater range and flexibility of foods.
The exact work will look different for different people. The principle underneath it is the same: we don't ask a brain that is being repeatedly driven into threat by deprivation, unpredictability or compensation simply to think its way into feeling safe around food.
Anorexia nervosa is not simply about eating very little, and it does not always look the way people expect. It can involve restricting the amount or range of food you eat, rigid rules around eating, intense anxiety about weight or shape, compulsive or compensatory movement, and a powerful need to feel in control of food or your body.
As the brain and body become undernourished, thinking about food often increases rather than disappears. You may feel hungry and still find eating frightening, become increasingly preoccupied with food, develop more rigid routines, or find concentration, flexibility and emotional regulation becoming harder.
People can be seriously unwell without believing they are “thin enough” or “ill enough” to deserve help. You do not need to wait until things become worse before seeking support.
Bulimia nervosa involves cycles of eating in a way that feels out of control, followed by attempts to compensate — for example through vomiting, restriction, fasting or excessive movement. But the experience is often much more complex than a simple cycle of “bingeing and purging”.
Restriction and attempts to tightly control food can themselves increase biological and psychological pressure to eat. Over time, the brain can become increasingly preoccupied with food, while shame, anxiety and all-or-nothing thinking help keep the cycle going. What can feel like a failure of willpower is often a predictable response to deprivation, distress and learned patterns of coping.
You do not have to binge or compensate every day, be a particular weight, or “look unwell” to need support. Recovery involves helping the brain and body relearn that food is reliable, while gradually reducing the behaviours and emotional patterns that keep the cycle going.
Binge eating disorder involves repeated episodes of eating that feel difficult or impossible to control, often accompanied by distress, shame or secrecy. Unlike bulimia nervosa, these episodes are not regularly followed by compensatory behaviours such as vomiting or fasting.
Binge eating does not happen because someone lacks willpower. For many people, restriction, dieting or periods of not eating enough have taught the brain that food is uncertain, increasing both biological drive and mental preoccupation with eating. Emotions, stress, trauma, habit and the use of food for regulation can also become part of the cycle.
Treatment is not about imposing another restrictive diet. Recovery involves understanding what is driving the binge eating, establishing more reliable and adequate nourishment, reducing shame and gradually developing other ways of responding to difficult thoughts, feelings and urges.
ARFID (Avoidant/Restrictive Food Intake Disorder) is an eating disorder in which eating becomes restricted or limited for reasons that are not primarily driven by concerns about weight or body shape. It is much more than simply being a “picky eater”, and people with ARFID can experience significant nutritional, physical, psychological and social consequences.
There are different ways ARFID can develop. Food may feel overwhelming because of sensory characteristics such as texture, taste, smell or appearance. There may be fear of something bad happening when eating, such as choking, vomiting, pain or an allergic reaction. For others, hunger signals may be weak, eating may feel like a chore, or there may simply be very little interest in food. Many people experience a combination of these.
ARFID commonly overlaps with autism, ADHD, anxiety and gastrointestinal or other medical difficulties, but it can affect anyone. Treatment is individual rather than about simply making someone “eat normally”. We work gradually and collaboratively to understand what is making eating difficult, improve nutritional adequacy and safety, reduce fear and avoidance where appropriate, and help the nervous system and brain build new experiences of food.
OSFED (Other Specified Feeding or Eating Disorder) describes eating disorders that cause significant distress or impairment but do not fit neatly within the diagnostic criteria for another eating disorder. It is not a less serious or “milder” diagnosis. Someone can be medically and psychologically very unwell with OSFED.
Atypical anorexia is one example. A person can experience the restriction, fear, rigidity, preoccupation with food and weight, and other psychological and physical effects associated with anorexia nervosa without being at a low weight. Significant weight loss and nutritional deprivation can affect the brain and body at any body size.
This matters because people with atypical anorexia often believe they are “not thin enough” or “not sick enough” to deserve treatment — and may even have had this message reinforced by others. You do not need to reach a particular weight, BMI or level of illness before your eating disorder deserves to be taken seriously.
Recovery focuses on the whole picture: nourishment, eating-disorder behaviours, thoughts and rules around food, body image, emotional wellbeing and the factors that have helped the eating disorder take hold and continue.
Your struggle does not become more " valid " by becoming more severe.
Rumination disorder involves the repeated regurgitation of food after eating. Food may come back up into the mouth without nausea or the usual experience of vomiting, and it may then be rechewed, reswallowed or spat out. For some people this happens automatically and can feel largely outside their conscious control.
Rumination is not simply a “bad habit”, deliberate vomiting or something a person can necessarily stop through willpower. It can become an established brain–body pattern, often involving an automatic contraction of the abdominal muscles after eating. Stress, anxiety and anticipation can sometimes strengthen the cycle.
Treatment can involve helping the body learn a different response after eating — particularly through techniques such as diaphragmatic breathing — alongside establishing adequate, regular nutrition and addressing anxiety, avoidance or eating-disorder behaviours where these are also present.
Rumination disorder can occur on its own or alongside an eating disorder or gastrointestinal difficulties. Whatever the combination, the symptoms are real and treatable, and you deserve support rather than shame or blame.
Not everyone’s relationship with food, eating or their body fits neatly into a diagnostic category. You might recognise parts of yourself in several of the descriptions above, have behaviours that come and go, or simply know that food and body image are taking up far more space in your life than you want them to.
You may be eating regularly but living by increasingly rigid rules. You may compensate for food through movement, skip meals when you feel anxious, experience episodes of feeling out of control around food, or spend large amounts of time thinking about your weight, shape or what you have eaten. Perhaps nobody else would realise how difficult things have become.
Eating difficulties exist on a spectrum, and a diagnosis is not a threshold you have to cross before your distress matters. Early support can also prevent patterns becoming more entrenched.
Therapy can begin with understanding your particular pattern — what is happening with food and your body, what may be maintaining it, what function it has come to serve, and what you would like life to look like instead.
You do not need a diagnosis, a particular body size, or to be “sick enough” to ask for help.
What recovery can look like
Recovery is not about becoming perfect at eating, never having difficult thoughts again, or learning to love every part of your body.
It is about gradually creating more freedom.
That might mean eating without spending the rest of the day analysing it. Going out for a meal without needing to compensate before or afterwards. Feeling hunger without immediately becoming frightened by it. Having more flexibility around food, less time lost to checking or comparison, and more mental space for relationships, work, creativity and the things that matter to you.
For some people, recovery includes nutritional rehabilitation and weight restoration. For others, the work may focus on bingeing or purging, compulsive movement, rigid food rules, fear foods, body image, sensory difficulties, or restrictive patterns that may not be obvious to anyone else.
Recovery can also involve understanding why these patterns developed and what continues to keep them going. Anxiety, perfectionism, trauma, shame, neurodivergence, difficulties with emotions, identity and experiences within relationships can all become intertwined with food and the body.
You do not have to feel ready for every part of recovery before you begin. We can start with where you are now.
Therapy needs to fit the person, not just the diagnosis
Working therapeutically with eating disorders requires more than just focusing on symptoms. It involves looking at the whole person and your unique experience.
My approach is collaborative and integrative, combining an understanding of the psychological functions of the eating disorder with a recognition of the biological and neurological processes that made you vulnerable to the eating disorder and also keep it in place. We work together to create a space where it feels safe to explore your relationship with food and your body, moving at a pace that feels manageable for you.
Whether you have a specific diagnosis or simply feel that food and weight have begun to take up too much space in your life, therapy is about helping you find more freedom, flexibility and a different way of being in the world.
What we might work on together
The focus will be different for different people. Together, we can identify the patterns that are keeping the eating disorder going and decide what needs attention first.
Eating more regularly and adequately
Building greater consistency around food and helping the brain and body learn that nourishment is reliable and safe
Restriction, bingeing and compensatory behaviours
Understanding the cycles that maintain these behaviours and gradually creating different ways of responding.
Food rules, fear foods and flexibility
Working with rigid rules, avoidance and anxiety around particular foods, situations or changes in routine.
Body image, checking and comparison
Reducing the amount of attention, checking and judgement directed towards weight, shape and appearance, while developing a more workable relationship with the body. distress.
Movement and exercise
Exploring compulsive or compensatory movement and developing a relationship with activity that allows for rest, choice and flexibility.
Thoughts, emotions and the wider picture
Working with things such as anxiety, perfectionism, shame, emotional regulation, identity, relationships or trauma when they are relevant to the eating disorder and recovery.
Eating disorders can affect physical health as well as psychological wellbeing. Where medical monitoring, further nutritional support or other specialist care is needed, therapy can work alongside this rather than replacing it.
Not sure whether “eating disorder” quite describes your experience?
You can also explore the broader Eating & Body Image pathway, including difficulties with food, weight, shape, exercise or body image that may not fit neatly into a diagnosis.
If you'd like to explore whether working together might be right for you, you can send me a confidential enquiry.