Eating Disorders: A Case Example & What to Expect from Counselling

Last reviewed by

Dr. Sheri Jacobson March 4, 2023

Eating Disorders - stepping onto scales The Conditions of Bulimia, Anoxeria and ‘Eating Disorder Not Otherwise Specified’

Bulimia Nervosa and Anorexia are now widely recognised in the public eye as well as amongst Mental Health professionals. The conditions came closer to the forefront of concern due to the suicide rate being the highest amongst eating disorders than any other area of mental health. Eating disorders are very complex conditions where most sufferers will not fall neatly into one category, and may only display traits from one or the other, or some of both. These sufferers will fall into ‘Eating Disorder Not Otherwise Specified’ which incorporates a myriad of symptoms including binging, purging and overeating. For people questioning whether they are suffering with an eating disorder, being diagnosed is only a peripheral part of their treatment. Facing up to the condition, and breaking a pattern of denial around their deteriorating health is the biggest challenge. Usually an eating disorder serves people well for a time as they go about their daily lives and activities, until their relationship with food begins to completely take them and their lives over, severely impeding their physical and mental health. Seeking help to talk about these feelings and exploring the reasons beneath them is paramount to recovery. Counselling Psychologists can help clients take real control of their lives by understanding the deeper reasons for their disorder and helping them gain a positive sense of identity.

The Misunderstood Benefits of Having an Eating Disorder

Many people suffering with eating disorders feel misunderstood and ashamed of their relationship with food, which makes it difficult for them to confide in others about their problems. But there will be very good reasons for someone developing an eating disorder, as the benefits make life easier to cope with. These benefits could include feeling more in control – especially when other things feel so out of control such as the stresses of school work, careers, friendships, bullying, traumas or romantic relationships. Another benefit is feeling in control of emotions, as an eating disorder plays a part in being a distraction to painful feelings. For others, an eating disorder feels like a safe haven – something they know well, a bit like a best friend. It can also serve as a self punishment tool for those that feel they hate themselves and do not deserve to be well nourished.

Symptoms – The Journey of an Eating Disorder

It is important to stress that everyone is individual, and one person’s eating disorder will be slightly unique and different to another’s. Some people only ever display mild symptoms – perhaps through rigid calorie control or the occasional binge – whilst some will present with a full-blown disorder such as Anorexia Nervosa where their Body Mass Index (BMI) will fall below 17.5 (healthy BMI is 20-25). Many people do not see the progression of their eating disorder, and whilst technically they are ‘sick’ for clinical reasons, such as an abnormally low weight or regular purging, there is a feeling of being in control. This means that whilst the sufferer can still go about daily life and activities, they will not seek help. However, an eating disorder usually has a shelf life. People’s physical and mental states deteriorate and their lives become completely dominated with thoughts of food and their bodies.

At this point, people can feel dreadfully scared, vulnerable and emotional. Clear reasoning and thought patterns can become skewed, as thoughts around food and weight become the only thing they can focus on. Perhaps weight plunges to dangerous levels, as close family and friends start to notice and worry for the individual. This level of severity can lead to necessary hospitalisation and a long road to recovery, as the sufferer battles with the mental and emotional torment of ridding themselves from powerful behavioural and cognitive patterns.

Case Example of Anoxeria: ‘Cathy’

‘Cathy’ is a teenager at school studying for her GCSEs. She has always been somewhat of a perfectionist and likes to do well, and studies hard to get good results. Cathy is quite shy and reserved in character, but is generally well-liked by people. She starts going out with a boy from her year and feels very happy. However, after a few weeks, her boyfriend dumps her and starts going out with her best friend. Cathy feels an overwhelming sense of betrayal and hurt, and tries to talk to her family about it, who tell her ‘there are plenty more fish in the sea’, and not to worry about it. Cathy feels ashamed and embarrassed of her feelings and very alone. Not only has she lost her boyfriend but also her best friend, and no one around her seems to understand the severity of what she is going through. To Cathy, whose life as a teenager revolves heavily around her friend and boyfriend, she feels she has lost everything.

In order to cope and distract herself, she plunges herself into her studies, working until late at night and ensuring her grades are high. She starts to eat less as she loses her appetite, and within a few weeks people are commenting on how fantastic she looks with her weight loss. She goes to a party one night in a tight fitted dress and receives a large amount of attention from the boys. In a very difficult and painful time, Cathy finally finds she has some praise for something, and begins to more consciously restrict her food intake to ensure that she continues to lose weight and feel good about herself.

However, after a few months, Cathy’s family begin to worry about her, as she stops eating evening meals with them and has lost a lot of weight. Cathy’s friends also comment on how thin she is. Cathy only sees this as a positive thing, believing it is praise and attention from others, but she has become completely obsessed with food. She goes to bed at night counting the calories she has had in the day, and rigidly planning what she will eat the next day. She has started looking at recipe books and watching cooking programmes, with no intention of eating what she is researching. She gradually stops eating evening meals with her family altogether, and wishes they would just understand that she doesn’t need to eat. She starts to look at herself critically in the mirror and homing in on imperfections, thinking that she is overweight and must lose more in order to be perfect. Meanwhile, friends and family have become increasingly worried about Cathy, as they see her wasting away and plunging to a dangerously low weight. To them, they don’t understand why this is happening to her – she is a lovely person who does well at school and is well-liked. They try to get her to eat more meals and understand the types of food she will eat, but to Cathy, they are being misunderstanding because she has a fixed belief she needs to lose weight. Cathy’s life has become restricted to going to school and counting calories, as she has very little physical or mental energy to do anything else.’

This is an example of the journey of Anorexia Nervosa. You can see the difference between Cathy’s internal world and belief system, and what others are experiencing of her. All the ‘pros’ of feeling in control and blocking out painful emotions are only an illusion to the real feelings underneath. Recognising this is the first and bravest step for someone suffering with an eating disorder. Whatever the severity of causes or symptoms, this denial is the hardest to break through. There is help at hand.*

What Can I Expect From Counselling?

Most of the time, an eating disorder has served the purpose of blocking out painful emotions. However, people suffering with severe eating disorders will often deny this, because they are afraid to open themselves up to the possibility that the eating disorder is dysfunctional, and having to feel the pain that lies underneath. The first step in this case is to build up trust in a counsellor to look at the internal world of the client and their thoughts about their weight, body image and eating patterns, compared to the reality of their current situation.

The next step is to deal with the emotional side. The problem with having had an eating disorder blocking out emotions, is that the feelings are still there, they are just buried. In counselling, the person can safely talk through these emotions as they surface – by talking about past and present experiences and feelings. As the emotions surface and are dealt with, a sense of calm is achieved and the rigid pattern of the eating disorder is no longer a necessary coping mechanism.

The counsellor can help the client to look at healthy eating and even seek consultation of a dietician, so that bringing food back into the person’s life is properly planned and supported. A counsellor can help the client deal with feelings of anger as they surface, especially around the fear of putting on weight and changes in perception to body image. Overall, a counsellor is a source of support that can help the client come to their own answers about how to deal with their very personal condition. It is not a ‘one size fits all’ approach, and unless the person’s life is in danger because of their eating disorder, a counsellor will not enforce an eating pattern on the client – it is down to the individual to change at their own pace. The key to recovery therefore, is to heighten and broaden awareness and insight, which leads to positive change and a rich, varied life.

Jasmine Childs-Fegredo

Please refer to the follow links for more information on the specific types of Eating Disorders, their symptoms, the treatment and support available.

https://www.b-eat.co.uk/