Welcome back to Rebuilding Trust With Your Body, it’s Katy here. As you can tell from the title of this episode is going to be about what happens when I’m working with a client and we discover that they’re actually struggling with an eating disorder, and that this is what’s driving their struggles in their relationship with food. 

I want to be clear that I’m not diagnosing anybody here, this is not medical advice, and if you are wondering about this for yourself you need to talk to a professional.

This might make you curious though – and that’s ok. It’s good to be curious. 

We’re going to talk about how it might become apparent that you’re struggling with an eating disorder, and what some of the most subtle and sneaky signs are that might make it be something that’s not even on your radar. Or it’s possible that some of you listening have a history of an eating disorder and truth be told you never fully recovered, or maybe you have had a suspicion that you have an eating disorder but nobody has ever told you that’s what it is. Perhaps you’re a clinician – a dietitian or therapist or other health and wellness professional – and you have wondered this about some of your clients, and you’re not sure if that’s really what’s going on, or what to say or do.

I’m going to share how I navigate these situations, what I’m looking for and what that conversation sounds like if I think a person has an eating disorder – and how it might change some aspects of the work we’re doing (and how other aspects of it will stay the same whether they have an ED or not).

Before we dive into our main topic for today, you know what time it is…We’ve got some Wellness Woo to talk about. 

Wellness Woo is the stuff that diet and wellness culture tells us we should do in the name of health, but it’s really based on pseudoscience, exaggerated claims, or just nonsense. 

Today’s Wellness Woo is: Mushroom coffee – s/o to Beth who sent this to me! 

Mushroom coffee is literally coffee that has mushrooms added to it, and it often has other things added to it which basically makes it a supplement. 

Claims:

better sleep, more energy, improved focus, immune-boosting benefits, and reduced inflammation.

And of course….weight loss, metabolism boosting, fat burning

Is there evidence for any of this?

While mushrooms themselves do have some wonderful nutrients and health benefits, there isn’t good scientific evidence for mushroom coffee specifically for these claims being made.

The idea that you’ll have better sleep and be less jittery is b/c it has less caffeine…but they’re talking out both sides of their mouth because they’ll simultaneously claim more mental clarity and energy which is probably coming from the caffeine that is in it.

I was on the website for Four Sigma mushroom coffee and one of their reviews said “This inadvertently cut my coffee cravings way back” – LOL

And a lot of times the way they’re getting away with making some of the other health claims is because they’re adding in things like B12, n-3’s or vit D.

If you have an example of Wellness Woo that you want to share, send it to me at rebuildingtrustwithyourbody@gmail.com. 

Ok, that’s enough of that. Moving on to today’s main topic…What I Say to a Client Who Discovers They Have an Eating Disorder While Trying to Heal Their Relationship With Food

A lot of times, if someone is dealing with an undiagnosed ED it will become apparent after we’ve been working together for a bit, and we start to see thought and behavior patterns that are indicative of EDs. 

• A lot of cognitive distortions
• Pretty intense shame around food and body
• An inability to make changes and apply the IE principles
• Over focus on weight
• Obsession with healthy eating
• Resistance towards gentle nutrition, feeling triggered by it

What Are Eating Disorders?

Let’s get on the same page here, because a lot of people (even clinicians) don’t fully understand what eating disorders actually are. I often think back to my health class in high school where they showed us pictures of emaciated young women with AN, and pictures of young women by the toilet in the bathroom representing how they were purging and had BN. (Explain why this isn’t helpful, or accurate)

According to NIMH: “Eating disorders are serious illnesses marked by severe disturbances in a person’s eating behaviors. Although many people may be concerned about their health, weight, or appearance on occasion, some become fixated or obsessed with weight loss, body weight or shape, and controlling their food intake.”

Research shows that EDs don’t discriminate between ages, genders, body size, SES, ethnicity or any other demographic. They can happen to anyone. And I cannot emphasize this enough: You cannot tell whether someone has an ED simply by looking at them. The vast majority of the clients with ED that I’ve treated over the years you’d never know by looking at them. They are average everyday people just like you and me. They are teachers, nurses, moms, sisters, doctors, lawyers, accountants, grocery store clerks, baristas – you name it. It could literally be anyone around you…or you. 

I want to give you a quick rundown on the different types of EDs:

• Anorexia
• Bulimia
• BED
  • Stats
  • Eating past comfort repeatedly
  • Feeling out of control
  • Eating quickly or secretly
  • Intense shame afterward

• ARFID
• Orthorexia
• Other (not going to get into these) Rumination disorder, pica
• Most people don’t fit squarely into one category

And as you can probably see, it’s also very tricky to diagnose because the line between what is an ED vs disordered eating is very blurry, and so many of these thoughts and behaviors are actually pretty normalized and even encouraged in our culture. Think how many people are praised for restrictive eating, extreme exercise, and weight loss. In fact, I think it was Ragen Chastain that once said that “The behaviors that we diagnose as eating disordered in thin people are prescribed to people in larger bodies.” 

How Do You Know If You Have An ED?

There are some online assessment tools and questionnaires that can be used for screening if you think you might have an ED. There are also some websites that have great information and resources that I’m more than happy to send you if you DM or email me. I’ll link to some of them in the shownotes for this episode to get you started.

If you suspect or wonder about yourself, the best thing you can do is make an appointment with a therapist who specializes in EDs who can do an assessment and make a proper diagnosis.

Sometimes the symptoms are really subtle and sneaky, and aren’t as obvious as things like bingeing or purging or hardly eating anything. EDs act like goggles:

• Distorting hunger
• Distorting fullness
• Distorting thoughts, judgements and rules about food
• Distorting body signals
• Distorting self-trust

Some symptoms that can fly under the radar are – I’m going to give you a bunch of examples because this can be so widely varied, and it’s ok if you feel a little called out here or seen (it doesn’t necessarily mean you have an ED, but if you’re identifying with a lot of these then it may be worth talking to someone):

• “Healthy” restriction (clean eating, low-carb, intermittent fasting, food rules disguised as wellness)
• Eating the same foods on repeat because they feel “safe”
• Difficulty eating without planning far in advance
• Avoiding foods based on fear… of fullness, fear of loss of control
• Eating enough calories but with very limited variety; or very slightly under eating calories to control weight
• Delaying eating until food is “worth it”
• Needing distraction to eat or needing silence/control to eat
• Consistently stopping at “not quite enough” instead of satisfied
• Eating more freely only after “earning it” through exercise or productivity
• Feeling out of control even when the amount eaten doesn’t look “large”
• Eating past comfort repeatedly but telling yourself it “doesn’t count”
• Eating faster than intended, then feeling shame or regret
• Grazing all evening with a sense of urgency or restlessness
• Mental preoccupation with food before and after eating
• Planning restriction “tomorrow” to compensate for today
• Binge urges triggered by emotional relief, not just stress
• Shame around eating even when no one else would notice
• Frequent body checking (mirrors, clothes fit, photos)
• Avoiding certain clothes “until my body changes”
• Increased distress around normal body fluctuations
• Avoidance of medical appointments or hyper-focus on labs
• Feeling calmer when weight is trending down, regardless of health
• Believing body acceptance is only possible after weight loss
• Needing reassurance about body size to feel okay eating

If you’re listening to this and thinking, “Omg this sounds like me…” Take a deep breath. It’s ok. This is actually a gift that you’re having this increased awareness. And there’s no shame in having an ED – it can literally happen to anybody. A lot of really smart, successful people have struggled and recovered. 

What I Say to a Client if I Suspect an ED

Now if I am working with a client and I suspect they have an ED, here’s what that conversation is going to sound like…

• I wonder if what’s actually going on here might be an eating disorder – and I’ll explain why I’m wondering about this
• Then I’ll do some education about eating disorders, and why this is really important that we don’t minimize it or ignore it:
• All eating disorders carry:
  • Increased mortality risk
  • Medical complications
  • Psychological harm
    

• Emphasize:
  • Severity is not determined by weight
  • “Not sick enough” is an ED thought
• I then want them to get evaluated by a therapist specialized in ED, and have a medical workup.
  

Recovering from an Eating Disorder

• Let me be clear:
  • Dieting worsens eating disorders
  • Explain why:
    • Increases rigidity
    • Fuels binge–restrict cycles
    • Strengthens the ED voice
    • Brain chemistry
      
• Name the paradox: The thing you were told would help is often what keeps you stuck.
• TCT
• Recovery Model
  • Normalize structure:

• Many clients need more structure with food first
• This is not a failure of intuitive eating and it doesn’t mean you can’t do IE or that you have to stop doing IE – it means we need to adjust how we’re applying it

Clarify the misunderstanding: Hunger/fullness cues may not be reliable yet, and the ED thoughts and rules may be distorting what your body actually needs

Reframe structure:

• As support, not control
• As temporary scaffolding
• Emphasize:
• The philosophy of intuitive eating still applies:
  • Rejecting diet mentality
  • Food neutrality
  • Body respect
  • Compassion
    

Externalizing the Eating Disorder: One of the Most Important Shifts

• Externalizing the ED: The ED as a part, not the whole self
  
• Name its intention:
  
  • Protection
  • Control
  • Safety (even when misguided)
    
• Separate voices:
  
  • ED voice vs. True Self
    
• Explain the goal:
  
  • Stop following ED’s orders
  • Strengthen trust in the True Self

Next Steps

If you are listening to this and are wondering if you have an ED, send me a DM or email and I’ll share with you some resources to help you get it figured out. 

If you are a dietitian, therapist or health and wellness professional, I have put together a brand new free guide for you called “10 Well Intended Comments That Miss the Mark With Struggling Clients” – and it’s all about the things that we’re tempted to say in those moments where it’s clear that our clients are struggling with their relationship with food or body image, and how a lot of times these well-intended comments are more harmful than they are helpful…and don’t worry I’ve included scripts for what you can say instead. So if you want a copy of this free guide, just DM or email me and I’ll send it your way!! You are such a gift to your client, and it’s really important to know what to say (and what NOT to say) in moments like this – because I know you care deeply and want to help them, so I’m taking what I’ve learned and the mistakes I’ve made, and the times I have put my own foot in my mouth over the years, and I’ve condensed ht here into this guide that will help you avoid these mistakes that I used to make all the time.

Ok that’s a wrap for this episode…I know it might feel kind of heavy, so be gentle with yourself. 

In case nobody has told you today – you are worthy just as you are. We’ll talk again soon.

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