Working with clients with eating disorders

Why Do I Work With Eating Disorders?

As a therapist, I am often asked why I choose to work with eating disorders. I have come to understand that this question is not always driven solely by curiosity. Sometimes what people are really asking is, “Don’t you know how difficult that work is?”

I do.

Eating disorders are among the most complex and misunderstood mental-health conditions. I have developed such a strong hatred for what eating disorders do to people—their health, relationships, freedom, self-worth, and sense of identity—that it continually drives me to learn more, understand more deeply, and work harder to support the people who trust me with their care.

My work is not simply about helping someone stop eating-disorder symptoms. It is about helping them reach a place where they no longer feel that they need their eating disorder.

As long as an eating disorder continues to feel necessary—as a way to cope, regulate emotions, feel safe, create control, communicate distress, protect against vulnerability, or simply make it through the day—symptoms of some kind are likely to remain. This is why treating symptoms without understanding the function of the eating disorder is often not enough.

Understanding the Eating-Disorder Voice

In plain language, I sometimes describe an eating disorder as a relentless bully living inside someone’s mind. It criticizes, judges, threatens, and reinforces deeply insecure beliefs.

Imagine trying to manage the ordinary challenges of life while a constant voice reminds you of your perceived flaws, weaknesses, inadequacies, and past failures. Imagine that voice taking every difficult experience and using it as evidence that its cruel messages are true.

Over time, when the criticism is persistent and experiences appear to confirm those beliefs, it can become incredibly difficult not to believe the eating-disorder voice. The eating disorder can begin to feel more trustworthy than the person’s own needs, emotions, body, or relationships.

At the same time, an eating disorder is more than a bully. It may also have developed as a protector. Although its strategies are harmful, it may initially have offered the person a sense of control, emotional relief, numbness, predictability, identity, safety, or care when other ways of coping did not feel available.

This creates a painful conflict: the eating disorder causes tremendous suffering, yet the person may also believe they cannot cope without it.

Learning From the People Who Trust Me

A client once asked how long it had taken me to recover from my own eating disorder. When I explained that I had not personally experienced one, she was surprised. She wondered how I could understand eating disorders so well without having lived through one myself.

This is where I feel deeply privileged.

Throughout my career, people have trusted me with their most vulnerable experiences. They have allowed me to understand the intensity of the eating-disorder voice, the beliefs it reinforces, the functions it serves, and the fears associated with letting it go. They have invited me to accompany them through the complicated and deeply personal process of recovery.

Every person has taught me that no two eating disorders are exactly the same. Symptoms may appear similar from the outside, but the meaning and function of an eating disorder are unique to the individual. To understand why it exists, we must understand the person—not simply the diagnosis.

Understanding Eating Disorders Through an Attachment Lens

Attachment-focused and trauma-informed therapy help us explore how a person learned to understand themselves, relationships, emotions, and safety.

Early relationships contribute to the development of an internal working model: the beliefs and expectations we carry about ourselves, other people, and what we can expect from relationships. These experiences can influence whether someone feels worthy of care, whether it feels safe to depend on others, how they respond to emotional distress, and how comfortable they are identifying and expressing their needs.

For some people, an eating disorder becomes connected to these attachment experiences. It may provide a way to manage feelings that seem overwhelming, create control when life or relationships feel unpredictable, avoid needs that feel unacceptable, or protect against shame, rejection, dependency, and vulnerability.

Understanding these connections does not mean blaming caregivers or reducing an eating disorder to one cause. Eating disorders are complex and influenced by many biological, psychological, relational, social, and cultural factors. An attachment lens helps us understand one essential part of the person’s experience: how their ways of coping developed and why those strategies may still feel necessary.

Through therapy, I help clients explore their attachment experiences, recognize the beliefs they have developed about themselves, and understand the origins of their emotional and relational patterns. Together, we work toward developing safer and more compassionate ways of coping, relating, and responding to their needs.

Recovery is not simply about taking away an eating disorder. It is about helping someone build enough internal and relational security that they no longer need to rely on it in the same way.

That is why I work with eating disorders.