How Therapy Helps With Eating Disorders

Updated 3/7/2022

In middle school, one of my best friends stopped eating. Though she was a notoriously picky eater, suddenly her penchant for munching on trail mix for every meal became less quirky and more concerning as the ziplock baggies of nuts grew smaller and smaller.

Exacerbating the issue, she competed in an image-based performance sport, in which size and appearance were paramount. One day, we were sitting in my living watching the movie Center Stage for the millionth time, when we reached a scene in which an aspiring ballerina battling bulimia throws up a meal in a bathroom stall. I tensed up, wanting to pause the movie and say something, anything, but I didn’t know how.

Therapy as Preventative Measure for Eating Disorders

With time, I found a way to help her (more on that below), but to this day I still wish I had acted sooner. My 13-year-old self hadn’t been equipped with the knowledge I now have about the many benefits of therapy.

I have been fortunate to have never struggled with an eating disorder, but like many other women I’m not impervious to difficulties involving body image. At times, this has manifested itself into unhealthy or disordered eating patterns. From dabbling in the occasional fad diet and extreme calorie counting, to bouts of restrictive eating, my relationship with food has been fraught.

When I first started going to therapy for depression and anxiety, I discovered it helped alleviate long-held negative thought patterns connected to my body and self esteem. Therapy has helped me confront issues that, left unchecked, could have the potential to materialize into more serious conditions.

It also helped me feel less alone. Eating disorders, as with many other mental illnesses, can be incredibly isolating. According to Talkspace therapist Jill Daino, LCSW-R and director at The Center For The Study of Anorexia and Bulimia, it is this sense of isolation that often prevents people from getting help in the first place.

“Many patients feel like they’re odd and the only one struggling in their particular way,” Daino said. “This sense of isolation increases their shame around their disorder and makes it even harder to initially seek help. It takes great strength to ask for help and is an amazing first step in healing.”

Therapy’s Role in Eating Disorder Recovery

In the United States, 30 million people suffer from an eating disorder, a condition that has the highest mortality rate of any mental illness. Eating disorders take many forms — including anorexia, bulimia, binge eating, and restrictive food intake disorder — and span across gender, age, race, and body size.

According to Daino, while treatment is typically a multi-step process, talk therapy is an instrumental first step to seeking help for an eating disorder.

“Oftentimes patients enter talk therapy not ready to address their eating disorder. Being able to safely explore and discuss concerns with a knowledgeable therapist, who also keeps their medical safety at the forefront, is crucial at all stages of treatment,” she said.

A good therapist can also assist a patient in finding additional resources they may need — including medical doctors, nutritionists, treatment centers, and psychiatrists in cases where medication for binge eating may be beneficial. 

“A common example of how talk therapy integrates with the treatment team is when the patient is working with a nutritionist on a meal plan and the patient is really struggling with the food choices,” Daino said. “The nutritionist can focus on the food and the patient can have the time and safe space with the therapist to explore all the concerns that are coming up around the meal plan and expectations.”

Helping a Loved One Seek Therapy for an ED

When it comes to helping a friend or loved one seek therapy for an eating disorder, Daino said the key is to be sensitive and compassionate, but also not to delay.

“It is important to remember that eating disorders can have very serious — and at times life threatening — medical consequences, so you should not hesitate to speak up if you are worried,” she said. “Keep it simple and express that you are concerned about a possible eating disorder and have noticed changes or that she seems more stressed, worried, and/or depressed.”

In the case of my friend, a few weeks after I almost confronted her while watching Center Stage, I finally gathered the courage to sit her down to express my concern and encourage her to get help. It was an incredibly challenging conversation, filled with tears and heartache, but it served as the catalyst to helping her get the treatment she needed.

Daino said not to get discouraged if the person becomes visibly frustrated of they refuse to admit there’s a problem. She added that it’s important to recognize you don’t have all the answers, and to explain the importance of working with a therapist trained in treating eating disorders and body image.

“An example of what to say could be ‘I want you to know how much I care about you and our friendship, and you can talk to me about anything. I also think it would be important to talk with a therapist who knows about these complicated topics,’” Daino said.

How Therapy Helps Long Term Recovery

Daino emphasized the importance of ongoing talk therapy appointments to stave off negative thought patterns, and avoid returning to old behaviors.

“Just as talk therapy is vital at the outset and throughout eating disorder treatment it certainly has a crucial role in maintaining recovery,” she said. “It continues to provide a safe space for the patient to explore and consolidate her new skills and get support around challenges as they arise. Many patients describe that the eating disorder symptoms go away long before the eating disorder mindset does, so to have talk therapy over time strengthens long term recovery.”

Similar to most mental illness, there’s no magic cure for an eating disorder. Even after a patient has made visible strides toward recovery, there is still a long road ahead to maintain the progress made during treatment and prevent relapse.