Eating disorders
What therapy can help with

What is an eating disorder? What are the signs? Why do they develop, and how can counselling help? 麻豆原创-accredited therapist and eating disorders specialist Harriet Frew shares her expertise.

An eating disorder is a mental health condition in which a person develops a distressing and disruptive relationship with food, eating, weight or body image. This may involve restricting food, binge eating, purging behaviours such as vomiting or using laxatives, or exercising excessively.

鈥淔rom a psychological perspective, an eating disorder is a coping strategy. Therapy can help with eating disorders in a multitude of ways,鈥� shares Harriet.

Eating disorders affect people of all ages, genders, races and body sizes. The charity BEAT estimates that around 1.25 million people in the UK are currently living with an eating disorder.

Why do eating disorders develop?

Eating disorders develop due to a combination of genetic, psychological, social and environmental factors.

For many, it may offer temporary feelings of control, comfort or self-soothing, or become a way of communicating distress. At the root of most eating disorders, Harriet says, is low self-worth and a sense of not being good enough.

They often begin during or after a significant life event, such as bereavement, relationship breakdown or major transition. Perpetuating psychological and physical factors then maintain the cycle. A strong desire to change weight or shape, where self-worth feels tied to appearance, is also common.

Eating disorders, autism and ADHD

Neurodivergent people can be particularly vulnerable.

鈥淪ensory sensitivities may limit food choices, and black-and-white thinking can make rigid food rules feel safer,鈥� says Harriet.

For some, food can become a way to manage overwhelm, trauma or emotional distress.

Signs you or someone you love may have an eating disorder.

Research suggests that 85% of people with eating disorders are not underweight, so eating disorders are often hidden. Shame and secrecy make detection harder, and weight loss is often praised socially, reinforcing harmful behaviours.

Changes in eating patterns are a key sign. Someone may become increasingly restrictive or chaotic around food, or their weight may fluctuate. Anxiety around eating - particularly in social situations - is also common. They may spend long periods in the bathroom after meals or avoid eating with others.

Behavioural changes can also occur. A person may withdraw from usual activities, become preoccupied with food or body image, or exercise excessively. Harriet notes that men are frequently underdiagnosed, as their behaviours may be misinterpreted or overlooked.

If you are worried about a loved one, Harriet advises approaching them gently:
鈥淭ry not to judge or be critical, even if you feel frightened or unsure.鈥�

Eating disorders and GLP-1 medication

Harriet also says that many people coming off GLP-1 medication (which helps control blood sugar and reduce appetite) are vulnerable to developing eating disorders.

She adds: 鈥淔ood noise is the distractions or external cues that can interfere with your body鈥檚 natural hunger and fullness signals, making mindful eating and a balanced relationship with food more difficult. In therapy, it is often observed that food noise can return strongly after stopping GLP-1 medications, making it challenging to maintain the level of restriction previously experienced. This may contribute to patterns such as binge eating, purging, or excessive exercise.鈥�

How counselling can help

Counselling offers a safe and confidential space to explore what is driving the eating disorder and to understand its role in someone鈥檚 life. Therapy can support people to build motivation for change, develop more regular patterns of eating and begin to form a healthier relationship with food and their body.

Counselling may also focus on strengthening self-esteem, managing difficult emotions, challenging unhelpful thinking patterns and developing strategies for relapse prevention. Over time, therapy helps individuals to replace harmful coping strategies with more compassionate and sustainable ways of managing distress.

To find an eating disorder specialist to support you or a loved one, please visit our Therapy Directory.

Anorexia nervosa

Anorexia involves an intense fear of weight gain, a strong desire to lose weight and significant restriction of food intake, sometimes accompanied by excessive exercise. Periods may stop in women and BMI may fall below 17.5, although psychological symptoms remain central to diagnosis. Because the condition can feel rewarding or purposeful to the person, they may find change extremely difficult. Beneath the behaviours, individuals often live with very low self-worth.

Atypical anorexia

A person meets the psychological and behavioural criteria for anorexia but remains within a 鈥渉ealthy鈥� BMI range. This is a valid diagnosis, particularly for people in larger boned, taller or more muscular bodies.

Bulimia nervosa

Bulimia is characterised by cycles of binge eating followed by attempts to compensate, such as vomiting, laxatives or excessive exercise. People often move between restrictive eating and episodes of eating large amounts of food in secret. Most individuals with bulimia are of average weight or above.

OSFED (Other Specific Feeding and Eating Disorder)

OSFED applies when someone has significant symptoms of an eating disorder but does not fit neatly into the criteria for anorexia, bulimia or binge eating disorder.

Binge Eating Disorder (BED)

BED involves episodes of eating large amounts of food quickly and in secret, accompanied by distress or a sense of losing control, but without purging afterwards.

ARFID (Avoidant/Restrictive Food Intake Disorder)

ARFID is an eating disorder where a person avoids or restricts certain foods or limits how much they eat, for reasons not related to body image or weight. Instead, ARFID is usually linked to sensory sensitivities to taste, texture or smell, a fear of choking or vomiting, or a general lack of interest in eating. ARFID can affect people of any age and is often associated with anxiety, neurodivergence or past traumatic experiences around food.

If you have any comments or would like to share your story, please get in touch with us.听

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