Disordered Eating Counselling – Who Needs It and What to Expect

Have you heard the phrase “disordered eating” and wondered – how is that different from an eating disorder? What’s wrong with just wanting to eat really healthy or lose a little weight? Is this really something I need counselling for? 

This post will answer those questions. I’m outlining the differences between eating disorders, disordered eating, and body-led eating, sharing what disordered eating counselling can help with, and discussing what to expect as you search for and begin working with a dietitian or therapist. 

What is disordered eating?

There is not one clear definition of disordered eating that encompasses all it can mean to different people. The clearest way to identify disordered eating is to zoom out and look at the entire spectrum of eating behaviours, with body-led eating on one end, disordered eating in the middle and eating disorders at the other end. Here are some characteristics of each of those three zones on the spectrum.

Body-led eating:

  • Food choices are mainly influenced by hunger and preference
  • Absence of guilt or shame around food
  • Eating with spontaneity and flexibility
  • Eating socially without stress or concern
  • Using hunger and fullness cues to guide amount eaten at meals
  • Eating enough to maintain a biologically appropriate weight
  • No fear foods or rules around eating
  • Eating a variety of foods

Disordered eating:

  • Does not fully meet diagnostic criteria for an eating disorder
  • Preoccupation with weight, body size or eating choices
  • Obsessed with eating healthy
  • Using food or exercise as avoidance, coping or control mechanisms
  • Shame or guilt about food or body
  • Feeling a compulsion to exercise or diet
  • Behaviours or thoughts around food/body/exercise that you’d like to change because they interfere with everyday life
  • Feeling out of control or chaotic around food
  • Reduction or elimination of multiple foods or food groups
  • An unshakable belief that you “should” be dieting 

Eating disorder:

  • Meets diagnostic criteria for an eating disorder (anorexia, bulimia, binge eating, OSFED, ARFID, Pica, Rumination)
  • Food choices consistently influenced by goals of restriction, weight loss, or binge/purge behaviours 
  • Feel guilt and shame around food most of the time
  • Food (binge and/or restrict) and/or exercise are used to cope with emotions most of the time
  • Eat in isolation and avoid social occasions that involve food
  • Tend to be secretive about food and eating behaviours, or minimize problematic behaviours
  • Engage in strict diet rules and behaviours, like measuring and weighing food
  • Very limited variety of foods in diet
  • Focus on food and weight directly impacts major areas of life
  • Feel a sense of panic or loss of control when eating foods that aren’t “safe”

How do I know if I have disordered eating or an eating disorder?

You probably noticed that a lot of the characteristics of eating disorders (ED) and disordered eating overlap with each other. The bottom line is that if your relationship with food and body is distressing in any way or distracting from other aspects of your life, whether or not you meet the diagnostic criteria for an eating disorder, you are deserving of help and support. 

Who can make an ED diagnosis?

An eating disorder diagnosis can be made by physicians, nurse practitioners, or psychologists and the criteria for diagnosis is outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM). Diagnoses include Anorexia Nervosa, Bulimia Nervosa, Avoidant and Restrictive Food Intake Disorder (ARFID), Binge Eating Disorder, and Other Specified Feeding or Eating Disorder.

Are there any other kinds of eating disorders?

Some other presentations of ED are not diagnosable based on the existing criteria but may still warrant a higher level of care. Compulsive exercising is when exercise has eclipsed everything else as the top priority, is being used to control your body shape and/or exclusively gives you your sense of worth or self-respect. Orthorexia can be described as obsessive healthiness. It may look like an unconditional commitment to foods deemed “clean” or “natural,” or feeling despair and shame when health goals are compromised.

What does eating disorder counselling and treatment look like?

It’s important you get the right level of help. A dietitian, therapist or doctor can help you determine the level of care and types of providers you need on your team. Treatment protocols for eating disorders vary, but can include in-patient full-time residential programs, out-patient part-time day programs, individual counselling, medication, therapy and more. 

Some treatment programs require you to have a formal eating disorder diagnosis to qualify for admission, which can be a barrier to accessing treatment. On the other hand, private practice providers will usually see clients with or without a formal diagnosis; if you reach out saying you desire support, they are ready to help.

No matter what level of support you choose, almost everyone with an eating disorder will benefit from working with both a weight-neutral dietitian and therapist. There are many differences between the unique roles that a dietitian and therapist take on in the work of guiding you to a more peaceful place with food and your body. And there are also areas where their roles can overlap. To learn more about what each provider can help you with on your journey to finding food and body freedom, check out this post over on Instagram.

Why seek counselling for disordered eating?

I want to repeat something I wrote earlier. Regardless of where you are on the spectrum of disordered eating to eating disorder, if you desire healing, you are deserving of help and support. You don’t require a formal diagnosis for your experiences to be validated. AND for some people, having a diagnosis can be validating when it is available to them. Change and growth are possible, especially if your work is facilitated by an experienced team of weight-neutral, trauma-informed, eating disorder specialized health care professionals. 

Before getting help, you may feel alone in your struggle. Loneliness can be a painful barrier to healing, and simply having someone to open up to about your experience can help. 

Counselling can open your eyes to new perspectives. It is easy to get stuck in the same thought patterns or false truths because it’s what you’ve known your entire life. A dietitian and therapist team can help you uncover new ways of thinking about food, health and bodies.

It is difficult, if not impossible, to dig through all the available health information, especially on social media. A professional can help separate truth from click bait. They can help you combine your personal values with accurate and evidence-based health information to design a life that is health promoting and in line with your goals, values and beliefs. 

What can disordered eating counselling do?

Counselling helps you reflect on your past and understand the origin of your thoughts and beliefs. It can assist in developing coping strategies and plans for how you will address thoughts and behaviours that are keeping you stuck feeling unhappy in your body and filled with guilt and shame around food. 

A nutrition therapist can facilitate you mapping out your values and goals around food and design a series of experiments to help you start living in alignment with those values. Nutrition counselling can also be an opportunity to encourage self-compassion and help you see what it looks like to prioritize taking care of your body and mind. It provides an open, safe and supportive space for you to navigate food and eating experiences you encounter in everyday life. 

And remember – recovery is not linear. It can feel like two steps forward, one step back sometimes. A counsellor can help you feel grounded in your journey and remind you of your progress when it feels like nothing has changed.

disordered eating counselling

Will disordered eating counselling help with body image?

Counselling will help you identify what your goals are related to body image. It will help you prioritize the steps of your healing to eventually cultivate the relationship with your body that you desire. 

With the MORE Method, we don’t leave body image work until the final stage of your recovery. You will be asked about your relationship with your body and any experiences of body shame right from your first session. Then, you’ll work with your dietitian to determine a plan for addressing your unique concerns in the context of your other goals. 

How to find a good fit in an eating disorder counsellor

First, look at logistics. They need to be able to see you based on where you live and where they are licensed to practice. For example, I am licensed in Ontario and only work with clients who live in Ontario. 

Next, consider what kind of counselling you desire: telehealth versus in-person. What do you prefer and what do they offer? What is doable for your schedule, availability and location?

I encourage you to read all the info available on their website and see if you feel a connection to their approach. Do they address your specific pain points or needs?

And finally, look out for red flags. If a provider is promising they can help you lose weight AND recover from an eating disorder, this could be a sign that they do not have adequate training or experience in treating eating disorders. If they promote “clean“ or “natural” eating, or use fear to scare you off of eating certain foods, they may not be able to help you develop a neutral and peaceful relationship with all foods.

Can I still want to lose weight?

Counselling is intended to be a safe place to discuss all your thoughts and desires around your body, including the desire to lose weight. At MORE Method Nutrition, we respect every person’s bodily autonomy, and that includes having desires to change the size and/or shape of your body. 

Weight loss desires can co-exist with goals for food freedom, in fact most people we work with will share they want to lose weight alongside their other food freedom goals. Using a weight-neutral approach, your dietitian may help you dig down to unpack where that desire is coming from and what purpose it serves you. 

We often start by asking you to identify the why behind your desire for weight loss. Once we understand this, we can start to explore if there are other ways of getting those needs met that don’t involve changing your body.

Eating Disorders and weight loss

If you have an active eating disorder, current struggles with disordered eating, or a history of either of these things, the risks of pursuing intentional weight loss are high. Because of this, a weight neutral provider will help you fully evaluate the pros and cons of pursuing weight loss compared to body acceptance, empowering you to make a fully informed decision for yourself. 

If you desire weight loss, please know that you will still be welcomed into anti-diet spaces! Anti-diet is not anti-dieter or anti-weight loss. If you want to read more about this, check out this post over on Instagram.

Common myths about seeing a dietitian for disordered eating counselling or eating disorder recovery

  1. You’ll be judged for your habits. FALSE! No judgment happening here. A true weight-inclusive, non-diet dietitian will never judge, shame or police your eating habits or behaviours. We will hold you with unconditional positive regard and will listen compassionately and openly. Maybe you’ve been body- or food-shamed by a healthcare provider in the past; you can trust that won’t happen with a HAES dietitian.
  2. It’s scary or intimidating. This is completely normal to feel! Our relationships with food and our bodies are highly personal and vulnerable topics to share about. You may have never opened up about this before to friends or family, let alone a complete stranger. It’s expected for you to feel some nervousness, especially if it’s your first experience with counselling or therapy. Know that you won’t be forced to talk about anything until you’re ready, we’ll meet you where you’re at and go at your own pace.
  3. You’ll be forced to make whatever changes the dietitian recommends. Nope! You will be the one in the driver’s seat navigating the healing journey. Think of your nutrition therapist as a guide. We’ll walk alongside you on your journey, and provide suggestions along the way for different routes we can take to reach your desired destination. You get to choose the route taken! Your dietitian may make a suggestion or ask if you’d like to try something, but any move you make will be your decision. 

How do I get started with disordered eating counselling?

If you are in Ontario and interested in counselling, read more about my approach, or book a free call to chat about whether we would be a good fit. We’d love to hear from you! 

If you’re outside of Ontario, you can try an online search for “eating disorder dietitian [your location]” to find a provider in your area, or see if there is a link below that can provide some helpful information to get you started.

NEDIC – Directory of ED treatment providers based in Canada

National Initiative for Eating Disorders – Provider of educational, informational, and support resources for caregivers and individuals with Eating Disorders in Canada, including caregiver webinar hub, crisis readiness tool, and disability tax credit support.

FEAST – An international non-profit organization of and for parents, caregivers, and family of loved ones affected by eating disorders. They offer a 30 day educational email series, webinars, and online peer support forums among other resources and tools.

Body Brave – Provider of virtual and free-of-charge (or covered by OHIP) eating disorder recovery services to Canadian aged 14+. No formal eating disorder diagnosis or referral is required.

Sheena’s Place – Provider of virtual and in-person (Toronto) eating disorder support groups for Ontarian’s aged 17+. No formal eating disorder diagnosis or referral is required.

Hopewell Eating Disorders Support Centre – Provider of support groups, art therapy programs, and seasonal programming intended to compliment formal treatment to residents of Eastern Ontario affected by eating disorders and disordered eating aged 17+.

Intuitive Eating Counsellor Directory – Find a Certified Intuitive Eating Counsellor near you.

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from Guilt and Obsession
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of our getting started guide!
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