Disordered eating is characterised by extreme attitudes, behaviours and emotions about eating, body image and weight. Behaviours can include extreme restriction in food intake, overeating, compulsive exercise, and various methods of purging. Disordered eating is something I see quite a lot of in my practice in Waterloo and Covent Garden, an area where there many individuals working in very stressful and competitive environments. Please note, if you do not purge by any method, you will probably not be classified as a 'disordered eater' within my practice: Therefore anyone who is an ill-disciplined eater, comfort eater or emotional eater and experiencing weight gain should see my Weight Loss page for its own dedicated treatment programme. If you are purging, please read on.
Case Study: X came to me with difficulties around eating and food, and one of the first things she said to me was "I hate my body". She was struggling with severe body image distress and would get up at 5:30AM on weekday mornings in order to obsessively exercise before work. A very capable individual, she had risen to a high position within her professional field at a relatively young age. However, she felt very bad about herself when she compared herself to other young women in her work environment. She also experienced strong feelings of insecurity in intimate relationships with men. When these feelings heightened she went into a destructive, secret and nocturnal binge eating behaviour, working her way like a locust through her kitchen store cupboards and consuming anything edible rapidly and without conscious awareness until her body could take no more: Cereal would be wolfed down in dry form straight from the packet, lacerating the roof of her mouth; biscuit tins emptied; the entire contents of the fridge demolished. The binge would normally continue for a couple of hours, before it was time to purge. In the morning she would awaken to find the house in a total mess, food packaging strewn on the floors and vomit at various places in the property. Appalled and revolted at herself, her confusion was compounded as she could barely remember it all happening. Luckily she was successful enough to be able to employ a very discreet and highly efficient crew of East European cleaning ladies. They would arrive in a minivan whilst she was at the office to sweep away any evidence of her destructive behaviour, so nobody within X's social or family network visiting her the following evening would ever see or discover any evidence of her secret despair. We worked together for 24 sessions in order to:
- Correct body dysmorphia and engender attitude of love, compassion and nurture towards her body
- Learn and practice Mindfulness skills to keep things in balance when under stress
- Become aware of and indentify previously unconscious external stressors and triggers for the binge-purge response
- Define and install a new set of constructive behaviours to deploy instead of binge-purge response if under perceived threat
- Deal with low self-esteem in relation to other women and build confidence in relation to prospective male partners
- Streamline and optimise emotion regulation skills
- Establish a relapse prevention strategy
The most common four types of disordered eater I enounter in my therapy practices at Waterloo and Covent Garden fall into the following categories:
- Binge Eating Disorder (BED): A condition in which individuals engage in frequent binge eating that causes significant guilt and distress but do not engage in compensatory behaviors such as self-induced vomiting or exercise. Individuals with BED are often overweight or obese and experience feelings of guilt and shame about the binge eating, which often leads to more binge eating. It is also common for individuals to struggle with loneliness, anxiety and depression.
- Bulimia Nervosa (BN): A condition characterised by a cycle of binge eating and compensatory behaviour. Binge eating is defined as eating a large amount of food in a limited period of time while feeling unable to stop eating. Compensatory behaviours are undertaken to rid the body of calories (i.e., to “undo binge eating) and include both purging (e.g., self-induced vomiting, laxatives, diuretics) and non-purging (e.g., fasting, excessive exercise) forms. Unlike individuals with anorexia nervosa, individuals with bulimia nervosa are normal weight or overweight.
- Eating Disorders Not Otherwise Specified (EDNOS): Many individuals experience several symptoms of eating disorders without meeting the full criteria for anorexia or bulimia, (or even its own subset BED). Treatment is frequently warranted because the symptoms cause significant psychological and emotional distress. EDNOS is the most common eating disorder, effecting 1 in 20 people, and can take many forms. Worryingly, 40% of these go on to develp BN or AN within two years of the onset of EDNOS symptoms.
- Anorexia Nervosa (AN): I only accept GP referrals for individuals with AN. Likewise, if you have not been formally diagnosed with AN and believe you are noticing its early signs in yourself or a family member your first port of call is not me, it is your GP. No exceptions. I do not accept self-referrals for AN. Thank you.
The first three types of disordered eater listed above are all welcome to self-refer for help and support through psychotherapy.
Length of therapy for Disordered Eating: 24-36 appointments of fifty minutes each.
Fee: £75 per fifty minute appointment. Reduced fee slots are £45 but limited and based on demonstrated financial need.
Location: Southwark (Waterloo) and Covent Garden