Individuals seek out therapists to support them with navigating emotions, life stressors, general mental health, and much more. Therapists are often the first health care professionals to recognize eating disorder signs and symptoms. But, it’s important for therapists to ask the right questions to know how to recognize an eating disorder.
Eating disorders are both medical and mental health conditions. They are characterized by severe disturbances in eating behaviors and related thoughts and emotions. Those who have an eating disorder struggle to live life close to their values and may notice that food, body image, and exercise take up more brain space and energy than they would like. Early detection is vital for effective intervention, yet the secretive nature of eating disorders can make them difficult to spot. This blog outlines key strategies therapists can use to recognize the signs and symptoms of eating disorders in their clients.
Understanding Eating Disorders
Before therapists can identify an eating disorder, It’s important for therapists to understand the connection between eating disorders and mental health. Over 50% of people with an eating disorder have another “diagnosable” mental health condition. Many of these individuals might seek support for their “other” mental health concerns and not their eating disorders. Clients may not even bring up any concerns about food or body image until asked. Because of this, it’s important for therapists to have a basic understanding of what classifies an eating disorder (or “disordered eating”) as well and signs and symptoms.
Eating Disorder Diagnoses Criteria in DSM-5
Let’s review the eating disorder diagnoses in the DSM 5:
- Anorexia nervosa: AN is typically classified by food restriction, fear of gaining weight, and body image disturbance.
- Bulimia nervosa: BN is typically classified by engaging in binging and compensatory behaviors. Compensatory behaviors include, but are not limited to using diet pills, diuretics or laxatives, exercising, vomiting or misuse of medications. We see body image disturbance in bulimia as well.
- Binge Eating Disorder: BED is typically classified as engaging in binging behaviors. A binge happens when an individual eats more food and more rapidly than “normal.” What the DSM 5 leaves out of the BED diagnosis is that binging occurs as a result of restriction – both food, mental and emotional restriction. Negative body image is also seen in BED.
- Avoidant Restrictive Food Intake Disorder: ARFID is classified by a “feeding disturbance” that shows up as a lack of interest in food, concern about aversive consequences with food or avoidance due to sensory components of food.
- Other Specified Feeding and Eating Disorders: OSFED is used to diagnose a person who may not “fit” all the criteria of AN, BN, or BED. We see “atypical anorexia” fall under the OSFED category.
I want to note that while the DSM can be a helpful guide to diagnosing eating disorders, there are definitely flaws to the DSM. Ultimately, if a client’s relationship with food, body or movement is negatively impacting their lives in any form, they deserve support and care!
Signs and Symptoms of Eating Disorders
In order for therapists to identify an eating disorder in their clients, it’s important to look for signs and symptoms of disordered eating. These signs and symptoms include:
- Cutting out food groups (ie cutting out all forms of carbohydrates)
- Deliberately cutting out meals or snacks
- Going on and off various diets
- Reports of body image disturbance of distress
- Reports of fear of gaining weight
- Reports of medical symptoms (ie dizziness, feeling cold, lack of concentration, difficulty sleeping, GI upset). Medical side effects for eating disorders can happen at any body size so it’s important to screen everyone.
- Reports of excessive exercise and/or purging behaviors
While some of these behaviors may be considered “common” in our culture (i.e. dieting and body image distress), they are far from “normal” or helpful in living a full life
Screening Questions to Ask to Help Identify an Eating Disorder
Here are some questions a therapist can ask to ascertain a potential eating disorder diagnosis:
- Tell me more about your eating and your relationship with food.
- Tell me more about how your body image impacts your life and your self-esteem.
- Ask about friendships, what they do during lunch at school or work, to get a sense of whether or not clients are socially withdrawing from loved ones (especially during meal times)
- Ask about physical symptoms – feeling cold, energy levels, apathy…etc
- Ask yourself: do our therapy sessions revolve around food, body, or movement?
If you’d like to learn more about questions to ask your clients read our blog: 8 Ways Therapists Can Screen For an Eating Disorder.
Final Thoughts on How to RecognizeSpot an Eating Disorder as a Therapist
Thank you for reading our blog, “How to Recognize Spot an Eating Disorder as a Therapist.” Ultimately, it’s important for therapists to ask screening questions for eating disorders. Just as they do for depression, anxiety, and other mental health conditions. If you’re noticing that food and body image-related topics are coming up frequently during sessions it’s crucial to refer to an eating disorder-specialized dietitian. Our clients deserve to live a life close to their values, and oftentimes a negative relationship with food can disconnect clients from those values.
The role of therapists in spotting and addressing eating disorders is crucial. By staying informed about the signs and symptoms, employing effective therapeutic strategies, and fostering an environment of openness and trust, therapists can play a key role in the early detection and treatment of these challenging disorders. Collaboration with dietitians, physicians, and other healthcare providers is also critical in providing comprehensive care for individuals with eating disorders.
Additional Resources
We at Courage to Nourish are passionate about helping our clients as well as other providers find appropriate and HAES-aligned resources to aid in recovery. On our website, we have put together some specific resources that would be great for professionals, including our monthly provider newsletter.
Contact Us
Courage to Nourish is a group of eating disorder specialized dietitians. We have in person locations in Alexandria, Virginia, Columbia, Maryland. and College Park, Maryland. We offer virtual services across the state of Virginia, Washington DC, Pennsylvania, and Colorado. We offer individual nutrition therapy. As well as support groups. We would love to guide you in building a better relationship with food.
Contact us for more information. And to schedule a discovery call. Also, sign up for our client or clinician newsletter!
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Alex is the founder and owner of Courage to Nourish. She opened Courage to Nourish to create a practice that aligns with her values in eating disorder recovery. She is a Certified Eating Disorder Dietitian and Approved Supervisor through iaedp. Alex loves working with children, high school and college students as well as athletes. Additionally, Alex is a proud anti-diet dietitian and works with her clients through a Health At Every Size © and intuitive eating framework. Read more about Alex here.
