Having worked in eating disorder treatment for many years, I can appreciate how hard eating disorders can be for others to understand. The way in which a person can become entrapped, tormented, and completely preoccupied with weight, shape, food, body image, what others think, what others eat, and every perceived change of their body, is hard for people on the outside to fully comprehend.

Lack of understanding, and often lack of compassion, can combine and fuel the knack that people have for saying the “wrong thing.” I can’t address all of the misunderstandings or well-intentioned or thoughtless ideas or words, but I hope to provoke some thought around a few.

Appearances are deceiving, don’t often fully inform, and are dangerous to make assumptions about. Not everyone who is thin is happy. Not everyone who has an eating disorder is thin and not everyone who “looks healthy” is actually healthy.

Despite being taught to do it so well, please remember we can’t assume how or who someone is based on appearance, and in doing so we may miss the person completely.

Your intentions may be good but your words may be all wrong.

When someone is experiencing the body image distortion and feelings of “fat” that often go with their eating disorder, they rarely see themselves accurately, often feel they will be out of place in a group of others with eating disorders, and compare themselves to everyone. They never feel thin enough. Never worthy.

No one is immune to the words of others. We can be affected and wounded. There will be times when the thoughts and words in our heads relish in the fuel to turn against us. So, imagine what happens when someone hears this during a medical and emotional crisis…

“Well, you don’t look like you have a problem. You look great”.

Yes, that happens. It just happened to one of my clients. At the hospital. Where she had been sent by her doctor emergently.

The hospital staff’s words lead to a cascade of shame, feelings of being unworthy of care, feeling minimized, judged, and unseen. Her eating disorder’s first response was to further torment her and tell her to lose more weight so she would “look the part” and be “taken seriously.”It also undid some of the progress we had been making in therapy.

People with eating disorders come in all shapes and sizes. What they all have in common is the space that the eating disorder takes up in their head, the torment, and persistent struggle. They are overcome by the agenda of the eating disorder. The agenda takes as much of the person, their life, their thoughts, their relationships, their health, and their hope, as possible.

This story reminded me of one of my first clients, many years ago, struggling with an eating disorder. She was young, brilliant, intuitive, creative and completely preoccupied with social ideals of beauty and perfection… not an uncommon combination. She used to bring me magazines to convince me what I was missing and had elaborate stories of the lives, successes, happiness, and relationships of the thin models adorning the pages. She plastered them all over her walls to inspire and admire. 

She would also get furious with me when I would respond with curiosity and skepticism about what could actually go on in the lives and thoughts of the people in the images. I’d ask “I wonder if she feels loved, was she hurt today by the actions or words of others, does she feel alone?” Or, “I wonder if she feels objectified or may have an eating disorder.” She got mad at me for such ridiculous comments! But she tolerated and trusted me and came to see herself differently with the knowledge that no matter how “great,” “thin,” or “beautiful” the world saw her, it was never enough and her insides never matched. She took down the images and began to move herself in the direction of what mattered to her on the inside.

I try to be compassionate and understanding about others’ misconceptions or perhaps even ignorance, but it can be hard sometimes. Especially when it profoundly hurts and further threatens the well-being and lives of individuals struggling with eating issues.

Looks can be deceiving. What looks “great” may not always be. Let’s commit to focus beyond what we see and inquire, to be mindful of our words and misconceptions and the impact they may have. See past the appearance to the core of the person and their true needs. That is what matters, and that is what really gets the eating disorder unsettled and vulnerable to having to loosen its grip. When that can happen “great” things can happen.

About the author

Alison Bell is a counsellor and a clinical supervisor providing therapy and support to children, adolescents, adults, and families. Having worked in community eating disorder treatment and private practice for over 15 years, she has had the opportunity to specialize in the treatment of eating disorders and assist many individuals and their loved ones towards recovery. Alison is the clinical director and senior clinician of Alison Bell & Associates Counselling Group. She feels privileged to be part of so many clients’ lives, personal growth, and change.