NCS | Eating Disorders - Spotting the signs, and the importance of…

This week is Eating Disorder Awareness Week. Alan, from our Organisational Member Therapy Partners, has written about spotting the sign of eating disorders, and the importance of early intervention & professional help.

Guidance for counsellors supporting clients struggling with eating disorders

My name is Alan and I am the founder of Therapy Partners and Rewrite your Story the charity that supports clients struggling with disordered eating.

At both organisations, we help people recover from eating disorders and achieve long-term health and wellness. As an organisation, Therapy Partners ran a successful pilot with the NHS using Evidenced based CBTE and Family therapy Rewrite Your Story | Children's Charity | Kent ( and we have a wealth of knowledge and expertise in treating a range of eating disorders, including anorexia, bulimia, and binge eating disorder. We take a compassionate and evidence-based approach to treatment, working collaboratively with clients to identify and address the underlying causes of their eating disorder.

In this blog, I intend to share some insights into eating disorders, including common myths and misconceptions. The importance of early intervention and the benefits of seeking professional help. The blog will be a resource for anyone who wants to learn more about eating disorders and the road to recovery.

We hope you find our blog informative and helpful, we encourage you to leave comments and questions to continue the conversation about this important topic.


As therapists we have a duty of care and to be vigilant and proactive in spotting the signs of eating disorders in our clients. This blog looks at the common signs of an eating disorder and how to spot them together with evidence-based treatment options and further reading and signposting.

According to Beat, around 1.25 million people in the UK are affected by an eating disorder. These disorders have the highest mortality rate of any mental illness. It is important that Therapists work within their own levels of competence and that relevant evidence-based treatment options are used to treat these conditions.

Spotting the Signs

The first step in addressing an eating disorder is spotting the signs. Common signs of eating disorders include:

  • Significant weight loss or gain
  • Obsession with body weight and shape
  • Refusal to eat certain foods or entire food groups
  • Preoccupation with calories, fat, and nutrition
  • Excessive exercising
  • Social withdrawal
  • Irregular menstruation or absence of menstruation
  • Changes in behaviour and mood

It is also important to note that eating disorders do not discriminate - they can affect anyone, regardless of age, gender, ethnicity, or socio-economic background.

Ten Top Tips to spot eating disorders.

Below I have listed some tips for counsellors to identify eating disorders.

  1. Understand the different types of eating disorders: eating disorders are not limited to anorexia and bulimia. Binge-eating disorder, orthorexia, and other specified feeding or eating disorders (OSFED) are also common. According to Beat, the UK's leading charity for people with eating disorders, 64% of their helpline contacts have OSFED.
  2. Look for physical symptoms: Physical symptoms of eating disorders may include rapid weight loss, fluctuation in weight, thinning hair, dry skin, and dental problems. According to the NHS, anorexia has the highest mortality rate of any psychiatric disorder with around 10% of people with anorexia dying as a result of the disorder.
  3. Be aware of psychological symptoms: eating disorders often have underlying psychological causes such as anxiety, depression, low self-esteem, or trauma. According to a survey by Beat, 93% of people with eating disorders reported experiencing anxiety.
  4. Monitor changes in eating patterns: People with eating disorders may restrict their food intake, binge eat, or engage in purging behaviours such as vomiting or using laxatives. According to a survey by Beat, 67% of people with eating disorders reported engaging in fasting
  5. Consider cultural and social factors: Cultural and social factors such as pressure to conform to a certain body type, social media influence, and exposure to diet culture can contribute to the development of eating disorders. According to a study by the Mental Health Foundation 40% of adults in the UK have felt pressure to conform to a certain body shape.
  6. Be mindful of gender differences: eating disorders are often thought of as affecting only women but they can affect people of any gender. According to a study by Beat 25% of people with eating disorders identified as male.
  7. Pay attention to exercise habits: Exercise can be a healthy behaviour but it can also be used as a compensatory behaviour for disordered eating. People with eating disorders may exercise excessively or compulsively. According to a survey by Beat 71% of people with eating disorders reported engaging in excessive exercise.
  8. Listen for language indicating disordered eating: People with eating disorders may use language that indicates disordered eating, such as talking about "good" and "bad" foods, expressing guilt or shame around eating, or making negative comments about their body. According to a survey by Beat, 74% of people with eating disorders reported feeling ashamed of their eating habits.
  9. Be aware of co-morbidities: eating disorders often co-occur with other mental health conditions such as anxiety, depression, and obsessive-compulsive disorder. According to a study by the Royal College of Psychiatrists, up to 75% of people with eating disorders have another psychiatric disorder.
  10. Use appropriate screening tools: There are a number of screening tools available to help identify eating disorders, such as the SCOFF questionnaire and the Eating Attitudes Test (EAT-26). These tools can be useful in screening for disordered eating and identifying those who may need further assessment and support.

Recommended Treatment Plans

The National Institute for Health and Care Excellence (NICE) in the UK provides evidence-based guidelines for the treatment of eating disorders. Here are the recommended treatment plans for eating disorders, along with references for further reading:

1) Anorexia Nervosa:

  • For adults with anorexia nervosa, NICE recommends a stepped care approach, starting with guided self-help, followed by a course of cognitive behavioural therapy (CBT) or specialist supportive clinical management (SSCM), and then more intensive treatment if necessary.
  • For young people with anorexia nervosa, NICE recommends family-based treatment (FBT) or adolescent-focused therapy (AFT), followed by CBT if necessary.
  • For both adults and young people, NICE recommends nutritional support and monitoring throughout treatment.
  • References:
    • NICE guideline [NG69]: eating disorders: recognition and treatment.
    • NICE guideline [NG72]: eating disorders: assessment and management of anorexia nervosa, bulimia nervosa and related eating disorders.

2) Bulimia Nervosa:

  • For adults with bulimia nervosa, NICE recommends a course of enhanced cognitive behavioural therapy (CBT-E), or guided self-help if CBT-E is not available.
  • For young people with bulimia nervosa, NICE recommends FBT, AFT or CBT, depending on their age and severity of symptoms.
  • NICE also recommends medication (selective serotonin reuptake inhibitors or SSRIs) for adults with bulimia nervosa who have not responded to psychological treatment.
  • References:
    • NICE guideline [NG69]: eating disorders: recognition and treatment.
    • NICE guideline [NG72]: eating disorders: assessment and management of anorexia nervosa, bulimia nervosa and related eating disorders.

3) Binge Eating Disorder:

  • For adults with binge eating disorder, NICE recommends a course of guided self-help or individual CBT.
  • NICE also recommends medication (lisdexamfetamine or topiramate) for adults with binge eating disorder who have not responded to psychological treatment.
  • References:
    • NICE guideline [NG69]: eating disorders: recognition and treatment.
    • NICE guideline [NG100]: eating disorders: recognition and treatment of eating disorders.

4) Orthorexia:

Orthorexia is a term used to describe an unhealthy obsession with eating only "healthy" or "pure" foods. The term was first coined by Dr. Steven Bratman in 1997 to describe his own experience with an extreme fixation on healthy eating.

Orthorexia is not currently recognized as a formal diagnosis by the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-5), but it has been proposed as a new diagnostic category in the DSM-5.

People with orthorexia may spend excessive amounts of time planning, shopping for, and preparing their meals. They may also avoid eating out or socializing with others if they feel that they cannot adhere to their strict dietary restrictions. Over time, this preoccupation with healthy eating can lead to malnutrition, social isolation, and other health problems.

Orthorexia shares some similarities with other eating disorders, such as anorexia nervosa and bulimia nervosa, but it is distinct in its focus on the quality of food rather than the quantity. Orthorexia can also co-occur with other eating disorders, anxiety disorders, or obsessive-compulsive disorder.

It is important to note that these treatment plans are general recommendations and may need to be tailored to individual needs. A specialist in eating disorders should be consulted for advice on the most appropriate treatment plan for an individual.

In terms of other support

  • Family-Based Therapy (FBT) FBT is a form of therapy that involves the whole family, with the aim of providing support and education to both the individual and their loved ones. This approach is particularly useful for younger individuals with eating disorders.
  • Nutritional support with a registered dietitian can be an important part of the recovery process, as it helps individuals to establish a healthy relationship with food and learn about proper nutrition.
  • Medication In some cases, medication may be prescribed to address underlying mental health conditions that are contributing to the eating disorder.
  • Peer support/ support groups can provide individuals with a sense of community and help them to feel less isolated in their struggle.


As therapists, it is important that we are knowledgeable about the signs and symptoms of eating disorders and that we are able to provide effective treatment options for our clients. By being proactive in our approach and working collaboratively with our clients, we can help them to overcome their eating disorder and achieve a healthier, happier life. If you or someone you know is struggling with an eating disorder, please do not hesitate to seek support.

If you have any comments or need further help, I can be contacted via our website.

Therapy and Counselling in Maidstone Kent | Therapy Partners

or email


References: Orthorexia

  • Bratman, S. (1997). Health food junkies: Orthorexia nervosa—Overcoming the obsession with healthful eating. Broadway Books.
  • Dunn, T. M., Gibbs, J., Whitney, N., & Starosta, A. (2017). Prevalence of orthorexia nervosa is less than 1%: Data from a US sample. Eating and Weight Disorders-Studies on Anorexia, Bulimia and Obesity, 22(1), 185-192.
  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
  • Brytek-Matera, A., & Donini, L. M. (2019). Orthorexia nervosa: A current review. Nutrition, 67-68, 110-115.

Useful Websites

Living with an eating disorder can be a difficult and isolating experience. However, there are many resources available in the UK that can offer support and guidance. Here are some websites that may be helpful:

  1. Therapy Partners - Therapy and Counselling in Maidstone Kent | Therapy Partners - Therapy Partners, we are a team of fully trained and accredited multi-agency professionals who are passionate about providing the best care and support for our clients. We understand that everyone's needs are unique, which is why we offer a variety of services to help you achieve your goals.
  2. Beat Eating Disorders - ( - Beat is a UK-based charity that provides support and information to anyone affected by eating disorders. They offer a range of services, including a helpline, online support groups, and one-to-one web chat sessions.
  3. Rewrite Your Story -Eating Disorders Support (PETS) - Rewrite Your Story Supporting people with eating disorders was the catalyst for founding Rewrite Your Story, and as such, it is a cause very close to our hearts
  4. National Centre for Eating Disorders - ( - The National Centre for Eating Disorders is a UK-based organization that provides information and resources for those affected by eating disorders. They offer a variety of services, including online therapy, self-help courses, and workshops.
  5. NHS Eating Disorders - ( - The NHS website offers information on the different types of eating disorders, as well as advice on where to seek help and treatment. They also provide information on support services available through the NHS.
  6. Overeaters Anonymous - ( - Overeaters Anonymous is a UK-based support group for individuals struggling with compulsive eating and other related issues. They offer a range of services, including online meetings and local support groups.

If you or someone you know is struggling with an eating disorder, please reach out for help. These resources are here to offer support and guidance through your recovery journey.

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