5 Signs Therapists Miss About Eating Disorders
I've been sitting with this topic for a while now, and honestly, it's one I don't think we talk about honestly enough in our field. Eating disorders have the highest mortality rate of any psychiatric illness, and yet an estimated 9% of the U.S. population — nearly 29 million people — will have one in their lifetime, with only about 27% of those individuals ever receiving treatment. That gap between "how common this is" and "how rarely it's caught" is exactly why I wanted to write this.
I'm not writing this to shame anyone. Most of us went through graduate programs that spent maybe one class period on eating disorders, if that. We weren't set up to catch this well. So consider this less of a callout and more of a "here's what I wish someone had told me earlier."
Why this matters more than we think
Eating disorders don't always look like what we were taught to expect. Fewer than 6% of people with an eating disorder are medically underweight, and people in larger bodies are actually at higher risk, not lower. That alone should make us rethink a lot of our intake assessments. If we're only screening the clients who "look sick," we are missing almost everyone.
With that context, here are the five signs I think we miss most often, and what I've learned to look for instead.
1. Weight is not evidence
We were trained, somewhere along the way, to treat weight as the primary data point. But weight can hold perfectly steady while someone is drowning internally, and weight can climb while someone is still counting every bite in their head. I've had clients whose charts looked "stable" for months while their inner world was anything but. If the only thing we're tracking is a number, we're going to miss the person behind it.
2. "Healthy eating" that's actually a cage
Someone shows up talking about clean eating, macros, cutting out sugar, being "really disciplined" with food. It sounds responsible. It sounds like the kind of thing we'd normally encourage. But rigidity dressed up as wellness is still rigidity, and when food rules stop bending for birthdays, vacations, or just being tired and wanting toast for dinner, that's not discipline anymore. I've learned to get curious, not congratulatory, when a client describes their eating as "finally under control."
3. Self-worth tied to body size
This one's quiet and easy to miss in a fifty-minute session. Someone can talk about their job, their relationship, their week, and never once mention food. But if you ask whether their sense of worth rises and falls with the scale, you sometimes get an answer that stops the whole room. I try to ask this more directly now instead of waiting for it to come up on its own, because it rarely does unprompted.
4. Withdrawal that looks like "just being busy”
Skipping the dinner with friends. Always having plans during lunch. Getting a little quieter, a little more irritable, slowly pulling back from things they used to care about. It's so easy to chalk this up to a hard semester or a demanding job, and sometimes that really is all it is. But sometimes it isn't, and the only way to know is to ask instead of assume.
5. Looking better is not the same as being better
This is the one I think we get most wrong, myself included. Someone gains weight, eats a meal in front of us, seems lighter in mood, and we relax. I understand the instinct. But recovery isn't always visible, and treating visible change as the finish line can leave someone still white-knuckling it internally, just more quietly now. Given that anorexia carries a suicide risk up to 18 times higher than the general population, this isn't a small thing to get wrong.
None of these five signs are dramatic on their own, and that's kind of the point. Eating disorders rarely announce themselves loudly. They ask us to look a little closer, past the meal plan, past the number on the chart, at the actual person sitting across from us
Professional Consultation for Therapists
Sometimes you don't need another training, you need another clinician to think alongside you.
These one-on-one consultation sessions are designed for therapists seeking support with case conceptualization, treatment planning, and practical interventions for clients experiencing eating disorders, disordered eating, body image concerns, OCD, perfectionism, anxiety, and related concerns.
My approach is collaborative, compassionate, and grounded in current evidence-based practices. Together, we'll explore what's keeping your client stuck, identify treatment targets, troubleshoot barriers, and generate actionable ideas you can bring back into session.
Consultation may include:
• Case conceptualization and treatment planning
• Eating disorder and body image interventions
• OCD and exposure-based treatment considerations
• Perfectionism and cognitive flexibility strategies
• ACT, CBT, DBT, and values-based interventions
• Ethical considerations and scope of practice discussions
• Resource recommendations, worksheets, and treatment ideas
• A collaborative space to process challenging clinical cases
These consultations are intended for educational and professional development purposes and do not constitute clinical supervision or establish a supervisory relationship.
Consultation Rates
30 Minutes — $75
Ideal for a focused clinical question, treatment planning, or troubleshooting a specific challenge.
60 Minutes — $140
Perfect for more in-depth case consultation, conceptualization, and intervention planning.
90 Minutes — $200
Best for complex cases, multiple consultation questions, or deeper exploration of treatment approaches.
Additional consultation time may be scheduled in 30-minute increments as availability allows.
A note on where to go from here:
If you're a therapist reading this and thinking about a client who might fit some of this, you don't have to figure it out alone. Eating disorder work benefits enormously from consultation, even for experienced clinicians, because these presentations are genuinely tricky to catch and hold. Consider scheduling a professional consultation to talk through a case, a screening approach, or your own confidence in this area.
If you're someone wondering whether what you're experiencing counts, or whether it's "bad enough" to bring up: it is, and you don't need a diagnosis to deserve support. Book a free 15-minute consultation to talk it through, no pressure, no commitment.
