Eating Disorders 

Maybe food is taking up more space in your life than you want it to. You think about what you ate yesterday. You plan what you'll eat later. You check the menu before agreeing to go to dinner. You tell yourself you'll be “good” today because you ate more than you wanted last night.

Maybe you aren't sure whether any of this “counts” as an eating disorder… You eat. You go to work. You see your friends. You might exercise regularly and cook nutritious meals. From the outside, you may even look like someone who has an incredibly healthy relationship with food. But inside, it doesn't feel very peaceful.

You might feel guilty when you eat something you weren't planning to eat. Maybe there are foods you simply aren't allowed to have. Maybe missing a workout makes you anxious. Maybe one part of you wants to order the burger and another part immediately starts calculating how you'll compensate for it later. Or maybe you sometimes feel completely out of control around food. You restrict all day, eventually eat far more than you intended, feel awful about it, and promise yourself that tomorrow you'll have more discipline. Then tomorrow comes, and the cycle starts again.

Eating disorders don't always look dramatic from the outside. They don't belong to one body type, gender, age, or kind of person. And you don't have to meet every criterion of a diagnosis before your relationship with food deserves your attention.

At Health in Tandem, we work with people whose relationships with food, exercise, weight, and their bodies have become more complicated than they want them to be. Sometimes that means treating an eating disorder. Sometimes it means addressing disordered eating that doesn't fit neatly into a diagnosis. And sometimes it simply begins with:

“I don't know if I have an eating disorder. I just know I don't want to think about food like this anymore.”

That is enough of a place to start.

When Trying to Feel in Control Starts to Feel Out of Control

For many people, eating disorder behaviors begin with something that makes sense.

You want to feel healthier.

You want to lose weight.

You want to improve your athletic performance.

You want something in your life to feel manageable.

You want to feel more comfortable in your body.

So you start paying closer attention to food. You make a few rules. You start exercising more consistently. Tracking your food feels helpful because suddenly there is something concrete you can measure.

For someone who is perfectionistic, driven, achievement-oriented, or comforted by structure, this can feel especially appealing. There is a right answer, there is a plan, there are numbers you can follow. And for a while, that structure can create a genuine sense of control.

But then the rules start multiplying. You don't just prefer to exercise in the morning; you have to exercise in the morning. You don't just usually eat dinner before 7:00; eating after 7:00 suddenly feels wrong. You don't just choose a salad because it sounds good; you choose the salad because ordering anything else would leave you feeling guilty. You don't just notice calories—you know exactly how many are in nearly everything you eat.

Little by little, the structure that once made you feel in control starts controlling you. Now you're not deciding what you want to eat, the rules are. You're not deciding whether your body needs rest, the rules are. You're not deciding whether you'd like to go out with your friends, you first need to know where they're eating, what will be on the menu, and whether there will be something there that feels safe.

That's one of the painful contradictions of an eating disorder: something that may begin as an attempt to gain control can eventually leave you feeling like you don't have much choice at all.

What Does Disordered Eating Actually Look Like?

There is a spectrum in the way people experience difficulties with food. On one end, someone may have several food rules or feel uncomfortable about their body without those thoughts significantly interfering with their life. On another part of the spectrum, thoughts about food, weight, exercise, or body image may be influencing someone's mood, relationships, social life, physical well-being, and day-to-day decisions.

Diagnosable eating disorders—including anorexia nervosa, bulimia nervosa, binge-eating disorder, ARFID, and other specified feeding or eating disorders—have specific clinical criteria. But you don't need to know your diagnosis before you ask for help. Eating disorder symptoms can include:

• restriction

• bingeing

• compensatory behaviors

• excessive exercise

• food rituals

• strong preoccupation with weight or food

• avoidance of situations involving eating

Often, the more useful question isn't, “Do I technically have an eating disorder?” It's, “How much is this affecting my life?”

You might recognize yourself in some of these experiences:

• You meticulously track calories, macros, weight, steps, exercise, or other numbers.

• You feel anxious when you don't know exactly what is in your food.

• You regularly look at restaurant menus before going out so you can determine what you're “allowed” to order.

• Certain foods are completely off-limits.

• You divide foods into categories like good, bad, clean, unhealthy, safe, unsafe, earned, or indulgent.

• You have strict rules about when you're allowed to eat.

• You regularly skip breakfast or other meals even when you're hungry.

• You feel proud when you successfully ignore hunger.

• You choose what you eat based primarily on calories rather than what sounds satisfying.

• You compare what is on your plate with what everyone else is eating.

• You feel guilty, anxious, ashamed, or “gross” after eating.

• Eating something you consider unhealthy can make you feel as though you've done something morally wrong.

• You tell yourself you'll compensate tomorrow for what you ate today.

• You exercise because you feel like you have to rather than because you want to.

• Missing a workout makes you disproportionately anxious or irritable.

• You exercise while injured, sick, exhausted, or in need of rest.

• You use exercise to “earn” food or “burn off” something you've already eaten.

• Once you start eating certain foods, you sometimes feel as though you cannot stop.

• You eat rapidly or continue eating beyond comfortable fullness and afterward wonder, “What did I just do?”

• You hide what or how much you've eaten.

• You purge after meals or binges.

• You use laxatives, diuretics, medications, fasting, or exercise in an attempt to compensate for eating.

• Food can feel almost dangerous or toxic once it's inside your body, leaving you desperate to get rid of it.

• You frequently check your weight.

• You examine your stomach, legs, arms, face, or other parts of your body throughout the day looking for changes.

• You repeatedly check how your clothes fit.

• You compare your body with strangers, friends, coworkers, influencers, or family members.

• Or you avoid your body entirely—mirrors, photographs, fitted clothing, swimsuits, intimacy, or other situations where your body feels visible.

• You avoid plans because food will be involved.

• You feel relieved when plans are canceled because now you don't have to figure out what you'll eat.

• You eat differently in front of other people than you do alone.

• You prepare nearly all of your own meals because not knowing exactly what's in food feels too uncomfortable.

• Food, exercise, or your body takes up an exhausting amount of mental space.

Not everyone experiences all of these things, and experiencing one occasionally doesn't automatically mean you have an eating disorder. What matters is the pattern, the rigidity, the distress, and how much freedom you are losing.

Sometimes the Eating Disorder Sounds Like Your Own Voice

One of the things that makes eating disorders so difficult to recognize is that they don't usually feel like an outside force. The thoughts sound like your thoughts:

“I have to work out today.”

“I can't eat that.”

“I already ate too much.”

“I'll start over tomorrow.”

“I shouldn't be hungry yet.”

“I have to stop eating after 7:00.”

“Everyone is going to notice if I gain weight.”

“I can't possibly order that.”

“I'll feel better once I lose five more pounds.”

Often, one of the clues that an eating-disorder part may be leading the conversation is urgency. It feels like something has to happen right now. You need to fix it, undo it, burn it off, skip the next meal, get back on track.

Another clue is the presence of absolutes: “Always. Never. Can't. Have to. Not allowed. Should.”

Healthy choices generally allow for flexibility. Eating disorder rules usually don't.

There is a big difference between:

“I usually like eating breakfast around 8:00.” and “I am not allowed to eat before 8:00.”

There's a big difference between:

“Movement helps me feel energized.” and “I have to exercise today even though I'm exhausted.”

There's a big difference between:

“A salad actually sounds good.” and “I want the sandwich, but I'm making myself order the salad.”

From the outside, the behaviors can look identical, but the relationship underneath them is completely different.

The Binge-Restrict Cycle

One of the most common—and frustrating—patterns we see with disordered eating is the binge-restrict cycle. If you've experienced it, it can feel like a problem with self-control: Why can I be so disciplined all day and then completely lose control at night? Why can't I just stop once I start eating?

But often, what feels like a lack of discipline is actually a predictable response to restriction.

Maybe you wake up determined to be “good.” You skip breakfast or have only coffee. You eat a small lunch, even though you're still hungry afterward. You notice hunger in the afternoon but decide to push through it because dinner isn't that far away. By the time evening comes, you've spent much of the day asking your body to function without enough food.

Eventually, the drive to eat becomes much harder to ignore.

You may start with one food and then move quickly to another. You might want something sweet, then something salty, then something else entirely. Eating starts to feel urgent or automatic, and at some point you realize you've eaten far more than you intended. You may feel physically uncomfortable, emotionally overwhelmed, or almost disconnected from what was happening until the binge is over.

Then comes the guilt.

You wake up the next morning thinking, I need to make up for that. Maybe you skip breakfast again. Maybe lunch becomes a salad because you feel like you don't deserve anything more substantial. Maybe you decide you're going to spend two hours at the gym. Maybe you purge or use laxatives, diuretics, fasting, or other compensatory behaviors to try to undo what happened.

And just like that, you're restricting again.

That's what makes this cycle so persistent. The response to the binge often creates the conditions that make another binge more likely.

When our bodies aren't getting enough energy, hunger becomes stronger. We may think about food more often. Foods we've labeled as “off-limits” can become especially compelling. This isn't your body betraying you or evidence that you are incapable of self-control. Your body is trying to make sure you get what you need.

Breaking this cycle usually doesn't mean becoming more disciplined after a binge. In fact, it often means doing the exact thing the eating disorder doesn't want you to do: returning to regular eating rather than compensating.

That may mean eating breakfast even when part of you insists you shouldn't. It may mean taking a normal rest day instead of punishing yourself at the gym. It may mean allowing yesterday to be yesterday instead of structuring today's food around trying to erase it.

The goal gradually shifts from “How do I make up for what I ate?” to “What does my body need today?”

That shift can feel uncomfortable at first, but it is an important part of creating a relationship with food that is based less on punishment and more on trust.

When Food Starts Taking You Away From Your Life

Eating disorders don't only affect what happens at mealtimes. Over time, they can shape where you go, what you do, who you spend time with, and how present you are when you're there.

Maybe your coworkers suggest going to happy hour after work. You want to go. You like them. You could use a night out. But before you can even think about whether the evening sounds fun, your mind is already somewhere else.

What restaurant are we going to? What am I going to order? Should I eat beforehand? What if everyone gets appetizers? What if someone comments on the fact that I'm not eating? What if I have a drink? How many calories will that be?

Eventually, staying home feels easier.

The same thing can happen with birthdays, dates, vacations, work dinners, family gatherings, weddings, or completely spontaneous plans. When food feels unpredictable, social situations can begin to feel unpredictable too.

And sometimes you go—but you aren't really there.

Maybe your mom makes one dessert every Christmas Eve that you've loved since childhood. Part of you wants to sit at the table, eat it, and enjoy being with your family. Another part of you is calculating what you already ate at dinner, deciding how much dessert is acceptable, wondering whether you'll gain weight, and planning tomorrow's workout before you've even finished tonight's meal.

The dessert itself may take five minutes to eat, but the conversation in your head can last for hours.

This is one of the ways eating disorders make life smaller. They can take away spontaneity, connection, travel, dating, intimacy, celebration, concentration, and rest—not always because you're physically unable to participate, but because so much of your attention is being pulled toward food and your body.

Therapy isn't just about changing what you eat. It's also about helping you reclaim the parts of your life that food anxiety has started taking over.

Why Holidays Can Feel So Complicated

Holidays can be particularly difficult because food is often woven into the center of the celebration. Meals may be larger or less predictable, schedules are different, alcohol may be involved, and foods that don't normally appear throughout the year suddenly show up everywhere.

Then there are the comments.

Maybe a relative talks about how “bad” they're being for eating dessert. Someone announces that they're going to have to work off dinner tomorrow. Someone comments on another person's weight. Someone compliments weight loss without knowing anything about what caused it.

Even when those comments aren't directed at you, they can make an already complicated relationship with food feel louder.

Holiday foods can also carry emotional significance. Maybe your family makes a certain cookie once a year. Maybe there is a breakfast that only happens on Christmas morning or a dessert your grandmother has made for decades. You may genuinely want to participate in the tradition and still feel terrified of what eating that food means for your body.

Part of healing your relationship with food can involve making room for the reality that food isn't only nutrition. Food is also pleasure, culture, memory, tradition, and connection.

You don't have to choose between caring for yourself and participating in the parts of your life that matter to you.

Summer Can Bring a Different Kind of Pressure

During colder months—especially here in the Midwest—it can be easy to stay home and keep eating disorder behaviors private. But summer brings visibility.

There are patios, vacations, happy hours, barbecues, weddings, pool days, beach trips, and spontaneous plans. Food is often more social, and bodies tend to feel more visible too.

If your sense of safety depends on knowing exactly what you'll eat, when you'll exercise, or how your body will be perceived, that unpredictability can make summer surprisingly stressful.

You may want to go to dinner with friends and also wish no one would see what you order. You may want to spend the day at the pool and feel consumed by the thought of wearing a swimsuit. You may genuinely want to travel while worrying about how you'll maintain your food or exercise rules away from home.

The problem isn't that you don't want connection. Often, you want it very much. The eating disorder just keeps making participation feel more complicated than it should.

Eating Disorders Don't Have a Look

One of the most persistent stereotypes about eating disorders is that they affect thin teenage girls. While teenage girls absolutely can and do experience eating disorders, but they are far from the only people who struggle.

Eating disorders and disordered eating can affect people of all genders, ages, body sizes, identities, and backgrounds. And when someone doesn't match the stereotype of what an eating disorder is “supposed” to look like, their symptoms can be overlooked—for years, sometimes even by healthcare professionals.

You can have an eating disorder and live in a larger body. You can have an eating disorder and eat every day. You can have an eating disorder without ever purging. You can be athletic, muscular, successful, social, and outwardly high-functioning while privately spending an enormous amount of time thinking about food. Your body cannot tell us how peaceful or painful your relationship with food is.

People in Larger Bodies

At Health in Tandem, we work with people across body sizes, and we don't assume we can determine someone's health, habits, or well-being by looking at their body.

People in larger bodies often face relentless messages that thinness is inherently healthier, more attractive, more disciplined, or more desirable. Being in a larger body can be treated as evidence that someone is lazy, unhealthy, or lacking self-control—even though body size is influenced by genetics, medical conditions, medications, environment, stress, access to food and healthcare, and many other factors. That stigma can make disordered eating especially difficult to recognize.

A person in a smaller body who is restricting food dramatically may quickly raise concern. A person in a larger body doing the same thing may be praised for their “discipline” or congratulated for losing weight.

You may be eating less and less while people tell you how great you look. You may be struggling emotionally while others encourage you to “keep doing whatever you're doing.”

That can make it incredibly difficult to trust your own experience.

Our goal is not to help you pursue a smaller body as the solution to distress. Instead, we want to help you develop a relationship with food and your body that allows for flexibility, care, and a fuller life.

Athletes

Athletes can have an especially complicated relationship with food because food and body composition may be directly connected to performance.

At higher levels of competition, you may have meal plans, training schedules, weigh-ins, body-composition goals, or specific recommendations from coaches, trainers, and sports dietitians. In some sports, athletes have to meet weight requirements. In others, a certain body shape or appearance may be strongly emphasized.

None of that automatically means an athlete has an eating disorder. Structure can be an important part of training and performance. The difficulty comes when performance begins to matter so much that your own needs become secondary.

Food can stop being something you enjoy and become solely fuel. Movement can stop being something your body does and become something your body owes you. Rest can start feeling like laziness. Hunger can feel inconvenient or even threatening because it doesn't fit the plan.

And because athletes are often praised for discipline, behaviors that are actually rigid or harmful can be difficult to distinguish from dedication.

You may be excelling at your sport while also becoming increasingly disconnected from your body.

Both things can be true.

When You're Not an Athlete Anymore

Former athletes face another transition that doesn't get talked about nearly enough.

Maybe for years your schedule revolved around practices, lifting, conditioning, games, travel, and recovery. You didn't have to think very much about how to incorporate movement into your life because movement was your life.

Then your sport ends. You graduate. You get injured. Your season ends. You decide not to compete anymore.

Suddenly, you're trying to learn how to feed and move a body that no longer has the same demands placed on it. Your hunger may change. Your schedule changes. Your body may change.

And those changes can be emotionally difficult, especially if your identity has been closely connected to being an athlete.

You might find yourself trying to maintain the body you had when you were training 20, 30, or 40 hours a week, even though your life no longer looks anything like it did then.

Therapy can help you explore a different set of questions: What kind of movement do I actually enjoy now? What does my body need when performance isn't the goal? Who am I when my identity isn't organized around my sport?

Sometimes the work is about food. Sometimes it is also about grief, identity, and learning how to live in a body that is allowed to change.

Pregnancy and Postpartum

Pregnancy and postpartum bring enormous changes to the body, often in a very short period of time. And despite how normal those changes are, our culture places tremendous pressure on women and birthing people to minimize weight gain during pregnancy and lose it quickly afterward.

You may have just spent nine months growing another human being and already feel pressure to “bounce back.” Maybe you're seeing before-and-after photos on social media. Maybe someone asks how much baby weight you've lost. Maybe you're looking at clothing that no longer fits and wondering whether your body will ever feel familiar again.

Meanwhile, your body may still be healing. You may be breastfeeding or pumping. You may be sleep-deprived, overwhelmed, and trying to remember to feed yourself while caring for a newborn.

For someone who has previously struggled with an eating disorder, these changes can reactivate old behaviors. For someone who hasn't struggled before, postpartum can sometimes be the first time food and body image begin to feel consuming.

The phrase “get your body back” can be particularly painful because your body never went anywhere. It changed while doing something extraordinary.

Therapy can make room for the complexity of that experience. You don't have to love every change in your body to treat your body with care.

Adolescents and College Students

Adolescence is one of the first periods in life when the body can begin changing dramatically without our permission.

Weight changes. Height changes. Appetite changes. Fat distribution changes. Muscle changes. Puberty can reshape the body in ways that feel unfamiliar or uncomfortable, and at the same time, peers often become intensely aware of one another's appearance.

That can be difficult for teenagers of any gender.

Boys and young men may become preoccupied with being lean enough, muscular enough, or “big” enough. Girls and young women may feel tremendous pressure to become or remain thin. Transgender and nonbinary adolescents may experience body changes that intensify gender dysphoria.

College can add another layer.

For the first time, you may be managing your own meals, exercise, alcohol use, sleep schedule, stress, and social life without much structure from home. Dining halls offer constant choices. Schedules change day to day. Socializing often revolves around food or drinking.

And then there's the phrase “freshman 15,” which turns ordinary body change into something students are taught to fear before they've even arrived on campus.

For someone already inclined toward perfectionism or body dissatisfaction, college can be fertile ground for rigid food rules, bingeing, restriction, compensatory exercise, and shame.

LGBTQ+ Community Members

For some LGBTQ+ people, body image concerns also intersect with gender identity, safety, belonging, and how they are perceived by others.

This can be particularly complicated for transgender and nonbinary people who experience gender dysphoria.

If certain aspects of your body feel inconsistent with your gender identity, changing your weight or body shape through food and exercise can start to feel like a way of creating alignment.

Someone may pursue a thinner body because they associate thinness with femininity. Someone else may become intensely focused on muscle growth because muscularity feels more masculine. Others may restrict food because they hope changing their body will reduce curves or make certain gendered characteristics less visible.

This doesn't mean that gender dysphoria automatically leads to an eating disorder, or that every transgender or nonbinary person experiences these concerns.

It means that sometimes food isn't just about food, and body image isn't just about conventional beauty standards.

The question may also be: Does my body look like me? Does it communicate who I am? Do I feel safe being perceived in it?

Chronic Dieting and Exercise Can Be Hard to Recognize as Disordered

Some of the people who struggle most with food are also the least likely to think they “qualify” for help.

Maybe you've been dieting for years. You're always trying something new: tracking macros, eliminating sugar, intermittent fasting, cutting carbohydrates, avoiding processed foods, hitting a certain step count, or following a strict workout schedule.

From the outside, people may describe you as healthy. And that's part of what makes it confusing.

There is nothing inherently wrong with eating a salad, tracking a workout, or choosing not to eat a particular food. The question is what happens underneath the behavior.

Are you eating the salad because that's what you genuinely want? Or because you believe you're not allowed to order anything else? Are you exercising because movement helps you feel good? Or because you feel anxious, ashamed, or guilty when you don't? Could you change your plan without significant distress?

Health isn't just about the foods on your plate. Your relationship with those foods matters too.

When dietary choices become hard-and-fast rules that override hunger, satisfaction, flexibility, connection, or common sense, something that looks “healthy” from the outside can feel anything but healthy internally.

Medical Conditions Can Make Your Relationship With Food More Complicated

Some medical conditions require real dietary changes.

You may need to monitor blood sugar, avoid foods that worsen gastrointestinal symptoms, alter certain nutrients, time meals around medication, or follow recommendations from your physician or dietitian.

Those recommendations may be medically appropriate. And they can still be psychologically difficult.

For someone who is predisposed to disordered eating, medically necessary food restrictions can provide fertile ground for eating-disorder rules to grow.

A guideline like “This food tends to make my symptoms worse” can gradually become “This food is bad, and I shouldn't ever eat it.”

You may begin to feel like you have no choice around food because every meal is connected to managing your health.

It can also be difficult when a medical condition or medication changes your body in ways you can't control. You may know intellectually that taking your medication is an important part of caring for yourself while simultaneously struggling with the fact that your body no longer looks the way it used to.

Therapy doesn't replace your physician or dietitian, and we aren't interested in asking you to ignore medical advice. The work is instead about helping you navigate the emotional impact of those recommendations without allowing medical management to become an increasingly rigid or fearful relationship with food.

Recovery From Substance Use Can Change Your Relationship With Food

People recovering from substance use may be surprised by how much their relationship with food changes once substances are removed.

For some people recovering from alcohol use, sweets or other highly rewarding foods become much more appealing. Eating patterns can change. Appetite may change. Weight may change.

That does not necessarily mean you have simply “replaced one addiction with another.” Early recovery involves significant biological, emotional, and behavioral adjustment, and food can become one of the ways the body and nervous system seek comfort and regulation.

Other people experience the opposite situation.

Maybe you stop drinking and lose weight because you're no longer consuming the same amount of alcohol. Suddenly, people start complimenting you.

You look amazing. You've lost so much weight. What are you doing?

Meanwhile, the reason your body changed is that you've been navigating one of the most difficult transitions of your life.

Receiving praise for weight loss in the middle of substance-use recovery can complicate your relationship with both food and your body. You may begin to feel pressure to maintain the weight loss, even when doing so requires behaviors that aren't healthy or sustainable.

Either way, changing your relationship with substances can mean changing your relationship with your body. That experience deserves care too.

GLP-1 Medications and Eating Disorders

GLP-1 medications have become an increasingly visible part of our cultural conversation about weight.

At Health in Tandem, we don't approach GLP-1 medications from a blanket position of being either completely for or completely against them. These medications can be medically appropriate and helpful for some people, and decisions about their use belong between the client and their healthcare providers.

At the same time, we think it's important to pay close attention to how these medications interact with someone's relationship with food and body image—particularly if that person has a history of disordered eating or an eating disorder.

For someone already prone to restriction, appetite suppression can make it easier to ignore hunger or eat less than their body needs. Weight loss may increase body checking or create fear about ever regaining weight. Compliments from other people can reinforce the idea that becoming smaller has made you more successful, attractive, or worthy.

For someone else, a GLP-1 medication may be part of appropriately treating a medical condition and may not create those same concerns at all.

This is why context matters. Rather than asking only, “Is this medication good or bad?” we want to ask questions like:

How is this affecting your relationship with food? What happens emotionally when your appetite changes? How are you responding to changes in your body? Are old eating-disorder behaviors becoming louder? Are you receiving coordinated guidance from the people involved in your care?

When possible, we want decisions around these medications to happen collaboratively with your prescribing provider, therapist, dietitian, and other members of your healthcare team. The goal isn't to moralize medication use, it's to make sure that taking care of one part of your health isn't making another part harder.

What Are We Actually Trying to Change?

When we treat eating disorders or disordered eating, the goal isn't to teach you how to eat perfectly. There is no perfect way to eat.

We're also not trying to convince you that you have to love every part of your body every day.

Instead, we're trying to reduce how much fear, shame, rigidity, and mental energy food and your body are demanding from you.

Maybe progress looks like going out to dinner without studying the menu for an hour beforehand. Maybe you miss a workout because you're exhausted and are able to recognize that rest is actually what your body needs. Maybe you eat the dessert your mom makes once a year and then go back to talking with your family instead of spending the rest of the evening thinking about how to compensate for it. Maybe you eat more than you intended and can respond with, That didn't feel great, but I don't need to punish myself tomorrow. Maybe someone takes a photo of you and you don't immediately zoom in to examine your body. Maybe you choose an outfit based on whether you like it rather than whether it makes you look smaller. Maybe food becomes one part of your day instead of the organizing principle of your day.

The problem we're trying to solve isn't your body. It's the amount of distress surrounding your body. It isn't food. It's the fear, rigidity, and shame surrounding food.

And it isn't that you haven't been disciplined enough. For many people we work with, the problem is exactly the opposite: you've become so disciplined that there is very little room left for flexibility, enjoyment, or choice.

How Therapy Can Help Your Relationship with Food

Most people who struggle with an eating disorder do not need another person to explain basic nutrition to them. In fact, you may know an enormous amount about food already. You may know calories, macros, ingredients, serving sizes, nutrition labels, workout plans, restaurant menus, and the latest health recommendations better than most people around you.

The problem usually isn't a lack of information. It's that knowing something logically and feeling safe enough to act on it emotionally are two very different things. You may know that eating one dessert will not dramatically change your body and still feel panicked while eating it. You may know your body needs rest and still experience intense guilt when you skip the gym.

That's where therapy can help.

Internal Family Systems (IFS)

One of the primary approaches we use at Health in Tandem when working with eating disorders is Internal Family Systems, or IFS.

If you've seen Inside Out, you already have a loose framework for thinking about it. IFS starts with the idea that we all have different parts of ourselves that carry different feelings, beliefs, fears, and responsibilities. One part of you may desperately want more freedom around food. Another part may say, Absolutely not. If we stop paying attention, we're going to gain weight, lose control, and everything will fall apart.

Rather than treating that eating-disorder part as something bad that needs to be defeated, we become curious about why it exists. What does that part believe it is protecting you from? What has controlling food helped you manage? What does being thin, fit, disciplined, or in control represent to you?

Maybe it represents acceptance. Maybe achievement. Maybe safety. Maybe invisibility. Maybe belonging. Maybe it has helped you cope with emotions that otherwise felt overwhelming. If a part of you genuinely believes that restricting food or controlling your body is what keeps you safe, simply telling yourself to stop isn't likely to work.

We want to understand what that part is trying to do for you and help it discover that there are other ways to feel safe and cared for.

Acceptance and Commitment Therapy (ACT)

We also use Acceptance and Commitment Therapy, or ACT, to help you look beyond the immediate rules of the eating disorder and reconnect with what actually matters to you.

Maybe you deeply value friendship, family, adventure, career, creativity, travel, parenting, or connection. Then we ask: Is the eating disorder helping you move toward those things or away from them?

If your friendships matter to you but you're regularly declining dinner invitations because you're afraid of restaurant food, the eating disorder may be reducing anxiety in the short term while also pulling you farther away from something you value.

ACT isn't about waiting until you're no longer anxious before you participate in your life. It can look more like: I'm anxious about this dinner, and I'm going because these people matter to me.

That is a different kind of control. It's not control over food. It's agency over your life.

Recovery Doesn't Always Feel Better Right Away

This is an important part of eating-disorder recovery that can be surprising: the healthier choice may initially feel like the scarier choice.

Eating breakfast the morning after a binge may feel wrong. Taking a rest day may make you anxious. Ordering the food you actually want at a restaurant may feel irresponsible. Stopping calorie tracking may make you feel less safe before it starts to feel more freeing. Eating a food you've avoided for years may temporarily increase anxiety rather than immediately reducing it.

None of that means you're doing recovery incorrectly.

If your eating disorder has spent years connecting certain behaviors with safety, changing those behaviors will naturally feel unfamiliar. Part of the work is learning that discomfort and danger are not the same thing. Sometimes discomfort simply means, I'm doing something differently than I've done before.

It's Okay If Part of You Isn't Sure You Want to Get Better

Eating-disorder recovery can bring up a lot of ambivalence.

You may hate how much time you spend thinking about food and still be terrified of what would happen if you stopped paying attention. You may know restriction is hurting you and also feel proud when you successfully ignore hunger. You may desperately want to stop bingeing while being afraid that eating more consistently will cause weight gain. You may hate compulsive exercise and still feel panicked at the thought of missing a workout.

Those contradictions are common.

An eating disorder often serves a purpose, even when it is also causing significant pain. It may create a sense of control. It may help you avoid uncomfortable emotions. It may make you feel accomplished. It may give you rules to follow when the rest of life feels uncertain.

So, of course, giving it up can feel complicated.

You don't need to walk into therapy completely ready to abandon every eating-disorder behavior. You can show up conflicted. That's something we can work with too.

How Do I Get Started?

You don't need to diagnose yourself before reaching out. You don't need to know whether your experience technically qualifies as anorexia, bulimia, binge-eating disorder, ARFID, OSFED, or disordered eating. And you don't need to determine whether you're “sick enough.”

You may simply know that you're tired of thinking about food.

Maybe you don't know how to eat without rules anymore. Maybe you keep bingeing and don't understand why. Maybe gaining weight feels terrifying. Maybe missing a workout makes you feel awful. Maybe you're an athlete and aren't sure whether what you're doing is discipline or something more concerning. Maybe you've spent decades dieting and are beginning to wonder whether there is another way to live.

Or maybe all you know is:

“I don't think I have an eating disorder. I just know something about my relationship with food doesn't feel right.”

That's enough.

Depending on what you're experiencing, eating-disorder treatment may involve more than therapy. We may recommend working alongside an eating-disorder-informed dietitian, physician, psychiatrist, or another member of your healthcare team so that both your physical and emotional health are being supported.

At Health in Tandem, we can start by understanding what your relationship with food, exercise, weight, and your body look like in your life right now. There isn't an expectation that you'll walk in ready to give up every behavior that has helped you feel safe. We start with curiosity.

What is happening? What is it costing you? What do you wish felt different? And what might your life have room for if food and your body didn't have to occupy quite so much of it?

You don't have to know exactly what recovery should look like before you begin. Sometimes the first step is simply wondering whether life could feel a little better than it does right now.

Frequently Asked Questions