Eating distress can take many forms. A person might describe restricting their food, eating in ways that feel out of control, persistent thoughts about food, body shape or nutrition, eating in secret, rigid rules around eating and meals, or a sense that food has become emotionally charged. Although the eating behaviour may be the most evident part that presents, it is rarely the whole story.
Eating behaviour can sometimes communicate psychological distress that has not been possible to express. There is not a conscious choice made to express psychological pain through food or eating. Rather, changes in eating may be one way in which emotional conflict, uncertainty, loss, anxiety or other distress becomes felt and communicated, often outside conscious awareness.
It is useful as a psychotherapist to approach eating distress with curiosity rather than consider treating the behaviour as the problem. It is not simply a question of how the eating behaviour can be improved but much more important to ascertain the underlying issues that contribute to the eating behaviour that presents.
Careful analysis and your consistent curiosity about eating behaviour. Being curious about the pattern can provide useful insights. How does the behaviour present? When does it become more intense, and when does it ease? Are there particular situations, relationships, feelings or times of day that seem to trigger or exacerbate it? What happens before and after it? These observations can help build a fuller picture of the unconscious and emotional processes that may lie beneath the behaviour.
The person’s history with food and eating also matters. Exploring early experiences of food, family meals, care, comfort, control, body comments and messages about weight can help us understand the individual’s food script (Leach, 2006): the meanings and expectations that have developed around eating over time. This is not about looking for a simple cause. It is about making sense of the complex nature of the relationship with food and eating that has formed for this individual.
The therapeutic relationship is central to this work. As a person feels safer to bring their experience into words, to be listened to without judgement and to make connections between feelings, relationships and eating, the need for symptoms to communicate in the same way may begin to lessen. Change is rarely immediate or linear, but a compassionate, gentle, sustained therapeutic relationship can create the conditions in which different ways of coping become possible.
It is equally important not to locate eating distress solely as originating only within the individual. The environment in which people live can add significantly to existing stigma, stress and pressure around food, eating, weight and body image. Day-to-day relationships may involve criticism, comparison or a feeling of being watched. Social media can intensify exposure to narrow and prejudicial ideals and messages about what bodies should look like. Weight stigma, body stigma and prejudice can leave people feeling judged, excluded or unseen.
These influences will affect everyone differently, and what evokes shame will be a very personal experience for the person feeling it. However, although everyone is not affected in the same way, these influences can compound existing stress and make it harder to develop a settled relationship with food and the body. An appropriate approach to working with eating distress needs to hold both the inner and outer worlds in mind: a person’s own history and emotional life, alongside the relationships, cultural messages and social conditions that shape their experience.
Eating behaviour requires our careful consideration. However, focusing only on the behaviour can overlook what is really being expressed beneath it. It means really seeing the person and what is causing the symptoms that present. When we remain curious about what eating distress might really mean, we start to really see our client and understand what might be required for potential healing and lasting change to take place.
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