How Do I Know If I Need Therapy for My Eating or Body Image?
In my first blog post, I discussed eating disorders affect people of all body sizes, genders, ages, and backgrounds. Appearance is not a diagnosis.
So if we can't tell by looking at someone, the next natural question is: How do I know if I, or someone I care about, might need help?
As a therapist, sometimes eating disorders are relatively easy to recognize. Other times, it takes more nuance and asking the right questions to understand someone's relationship with food, exercise, and their body.
The good news is that you don't need to determine whether you have an eating disorder before reaching out for support. If your relationship with food, exercise, or your body is causing distress or taking up more space in your life than you'd like, it's worth talking with a mental health professional.
Food Takes Up More Space Than You'd Like
Most of us, especially in Western culture, have been influenced by diet culture (or what is often repackaged as "wellness" culture). Because of that, occasional thoughts about food or wanting to eat healthier are common.
One phrase I hear from clients all the time is:
"I think I took it too far."
Many people try counting calories or following a diet for a while and eventually return to eating more flexibly.
For my clients, though, it often doesn't stop there.
What begins as trying to eat healthier or lose a little weight gradually becomes more restrictive. More and more foods end up on the "off-limits" list, and the goal weight keeps getting lower because no amount of weight loss ever feels like enough.
Sometimes it starts with limiting one type of food. Maybe dessert becomes an occasional treat. Then it becomes no dessert at all. Eventually it's no birthday cake, not even on your own birthday.
The concern isn't simply having food preferences or making nutritious choices. It's when the rules become so rigid that breaking them feels impossible or incredibly distressing.
Eating Comes With Guilt
Most people occasionally eat more than they planned and move on, but someone struggling with their relationship with food often can't.
Instead, eating is followed by guilt, shame, replaying everything they ate, or being incredibly hard on themselves. They may spend hours thinking about how to "make up for it" or questioning their self-control.
It's not the food itself that's the problem. It's how much emotional weight the food carries.
Feeling Like You Have to Earn Food
One belief that often comes up in therapy is the idea that food has to be earned.
The truth is, you do not need to earn food. You deserve to eat because you are alive. Your body needs nourishment because you're human…not because you exercised enough, were productive enough, or ate "perfectly" that day.
If you feel like you have to burn a certain number of calories before you can eat, or that every meal needs to be "worked off," it may be worth exploring those beliefs with a therapist.
Another important warning sign is engaging in compensatory behaviors. These are actions intended to "undo" or make up for eating. These can include self-induced vomiting, excessive or compulsive exercise, misuse of laxatives, fasting after eating, or intentionally restricting food because you feel guilty about a previous meal.
Compensatory behaviors are different from making choices because they feel good or support your health. They are driven by guilt, fear, or anxiety around eating and often feel difficult to resist. The goal isn't to care for your body, it's to erase or cancel out what you ate.
When Exercise Stops Feeling Like a Choice
Movement can be wonderful for both our physical and mental health. It can be fun, challenging, stress-relieving, and even improve body image by helping us appreciate what our bodies can do rather than simply how they look.
The concern isn't exercise itself, it's your relationship with it.
If you feel like you have to exercise, struggle to take a rest day, continue working out despite illness or injury, or feel anxious, guilty, or irritable at the thought of missing a workout, it may be a sign that your relationship with exercise has become more compulsive than flexible.
Healthy movement is something you choose because it supports your well-being. Compulsive exercise feels different. It is often driven by fear, guilt, or the belief that you need to earn food, burn calories, or make up for what you ate.
Ask yourself: If I couldn't exercise for a week because I was sick or injured, how would I feel? Feeling disappointed is normal. Feeling panicked, consumed by guilt, or unable to give yourself permission to rest may be a sign that it's worth talking to someone about your relationship with exercise.
When Your Body Determines How You Feel About Yourself
Most people have days when they don't love how they look. But body image becomes more concerning when it starts determining your self-worth.
If the number on the scale dictates whether it's going to be a good day or a bad day...If you avoid photos, social events, dating, swimming, or wearing clothes you like until your body changes...If you constantly compare yourself to others or spend a significant amount of time thinking about how to change your appearance...it may be a sign that your relationship with your body deserves attention.
You don't have to love your body every day. But you also don't have to let your body determine your value or keep you from fully participating in your life.
You Don't Need a Diagnosis to Ask for Help
One of the biggest misconceptions about therapy is that you have to wait until things are "bad enough."
You don't!!!
You don't need to know whether you have an eating disorder before reaching out. You don't need to fit a certain diagnosis or look a certain way. If your relationship with food, exercise, or your body is taking up a significant amount of your mental energy, causing distress, or making your life feel smaller, it's worth talking to someone.
If you're struggling with food, eating, exercise, or body image concerns, I provide eating disorder therapy for teens and adults in Monmouth County and throughout New Jersey via telehealth. I invite you to reach out for a free 15-minute consultation to see if we're a good fit.