What Are Eating Disorders?

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Eating disorders are sustained less by food and more by cycles of shame, isolation, avoidance, and fear.

Well-intentioned responses can unintentionally reinforce the disorder.

Evidence-based therapies such as CBT focus on addressing underlying emotions and beliefs driving behaviours.

When we talk about eating disorders, we often talk about food. But in my experience, they are far more about isolation than what’s on the plate.

Again and again, I see how these illnesses quietly shrink someone’s world. Shame creeps in. Fear grows. People begin to believe painful things about themselves — that they are too much, not enough, or would be better if they looked a certain way. These beliefs underpin powerful feelings, and the eating disorder behaviours become a way of coping. The behaviours are almost the outcome, a manifestation of what is happening underneath.

Shame keeps people stuck. It tells them not to speak and convinces them others won’t understand. Eating disorders thrive in secrecy. I’ve worked with many people whose partners, parents, or closest friends had no idea what was happening. And you can’t always tell by looking. Not all eating disorders are visible. Someone might wear baggy clothes, someone else may appear a healthy weight while struggling intensely with restriction, bingeing, or purging. With avoidant-restrictive food intake disorder, a person may simply be labelled a “picky eater.”

However, when communication begins, something shifts. If secrecy strengthens the illness, connection weakens it. When someone feels less alone, recovery becomes safer. Eating disorder recovery is rarely a solo journey; it is often about building a team. If there’s one sentence I often say to patients, it’s this: “You don’t have to do this on your own.”

Saying you look better may not be the right move

From a CBT perspective, eating disorders are maintained by cycles. Beyond food itself, patterns of avoidance, fear of judgment, rigid beliefs, and comparison keep the problem going. Someone might avoid social situations because they fear being judged. That avoidance reduces anxiety in the short term, so they avoid again. The cycle tightens.

Social comparison plays a powerful role, too, particularly online. Algorithms show us more of what we search for—diets, exercises, body images—and it can feel relentless. The more someone compares themselves unfavourably, the worse they feel, and the worse they feel, the more they rely on eating disorder behaviours to cope. Part of recovery can involve gently broadening what we engage with online, nudging those algorithms in a different direction.

Families and friends often ask what not to do. A common well-intentioned mistake is focusing too much on food, appearance, or weight. Even positive comments can reinforce the idea that weight is what matters most. Similarly, what we call "family accommodation,” adjusting routines or cooking separate “safe” meals out of love, can unintentionally make the disorder more comfortable. But at the same time, becoming the “food police” can strain relationships and increase secrecy. That’s why informed, supported approaches are so important.

The key to supporting someone: Work together and let them lead

If I had to offer three principles for supporting someone with an eating disorder, they would be these:

First, have an open conversation. You might say: “I’ve noticed a few things and I just wanted to check you’re okay.” Or, “Mealtimes seem difficult at the moment. How are things?” Don’t dive straight in; allow space for them to tell you.

What Are Eating Disorders?

Take our Disordered Eating Test

Find a therapist to heal from an eating disorder

Second, see it as a team effort. You are working together against the illness, not against each other.

Third, go at that person’s pace. Not too quickly, not too slowly—both can cause setbacks—but meet them where they are.

It’s also vital to focus on feelings rather than food. Eating disorders are often driven by fear, shame, beliefs about control, and self-worth. The behaviours are attempts to feel better. When we attend to the emotions underneath, we begin to loosen the disorder’s grip. Encouraging professional help doesn’t have to mean ultimatums. It can be as simple as exploring what support is available or suggesting a GP appointment. Reputable information from the NHS or organisations such as Beat can help families feel informed rather than lost. Families themselves need care, too. Eating disorders are frightening and can feel as though they take over an entire household. Support groups for carers, respite, and reliable information can prevent burnout. And it is important to remember, this is an illness. No one chooses it.

The online conundrum: It is not all bad, but be careful

Online spaces can both help and harm. Some recovery-focused communities reduce loneliness; others may start with that focus but then drift towards content that reinforces the disorder. Setting thoughtful boundaries, rather than an all-or-nothing approach, is often helpful.

Challenging myths aids recovery and brings freedom

One of the biggest myths I’d like to challenge is that eating disorders are someone’s fault or that they are simply about food. They are complex mental health conditions rooted in emotion, belief, and often a search for control. Recovery, when it comes, looks like freedom. Freedom from constant thoughts about food or body. Freedom to enjoy life again without rigid rules dictating every choice. The road is hard, there’s never a quick fix, but it is profoundly rewarding. I have seen people recover even after years of severe illness. Recovery is always possible.

Community makes that journey safer. It offers information, steadiness, and the reassurance that no one has to face this alone. If you are worried about someone, the first small step is simple: Ask, “Are you okay?” It may feel small. But it could be the beginning of everything.

Rachel Coupe is a BABCP-accredited clinician and Programme Director PG Dip CBT for Eating Disorders at the Clinical and Applied Psychology Unit of the University of Sheffield.

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