Eating disorders are life-threatening mental illnesses that are often stereotyped and misunderstood. Thus, it is critical that clinicians who treat eating disorders are highly knowledgeable about evidence-based treatments. If you are not knowledgeable about treating eating disorders or interested in obtaining supervision from an expert, it is important to refer out to a specialist.
For an individual with anorexia nervosa, a critical part of recovery is learning how to eat foods that cause them to feel anxious. Often individuals with anorexia have a large list of foods that give them significant anxiety. As a psychotherapist who specializes in treating people with eating disorders, the following are three tips for helping a client with anorexia nervosa face their “fear foods.”
1. Enlist the help of a registered dietitian.
Eating disorders are complex and life-threatening mental illnesses, therefore it is important to enlist the help of a multidisciplinary team to ensure that their needs are being met. When treating a client with an eating disorder, it is important to collaborate with a registered dietitian that specializes in eating disorders.
A dietitian can provide your client with guidance to ensure that their nutritional needs are being met. Often clients with a recent diagnosis of anorexia may need to begin the weight-restoration process and a dietitian is an important component of this process.
Additionally, they can help to provide psychoeducation surrounding the need to face “fear foods.” Further, some dietitians are willing to eat “challenge foods” with their clients during appointments. This act can be incredibly helpful for those who are struggling with facing their “fear foods.”
2. Partner with the client to create a graduated hierarchy of the “fear foods.”
It may also be helpful to sit down with the client and assist them in creating a list of their “fear foods.” I like to call this list a “challenge foods hierarchy.” On the top of the list, the client can list the “challenge” foods that give them the least amount of anxiety. On the bottom of the list can be the most anxiety-provoking foods for the client.
Once the list has been created, it is helpful to review coping strategies for dealing with anxiety. Then, partner with the client to challenge them to gradually face a different “fear food,” starting at the top of the list. It is important to stress to the client that they may need to face a particular “fear food,” multiple times before their anxiety decreases. Additionally, explain that they must try to refrain from engaging in any kind of compensatory behavior following the exposure (i.e. exercise, purging, restricting, etc).
If a client is open to the idea, it can also be helpful for the clinician to plan to eat different “fear foods” with the client in session. You could also get the client to write out some of the unhelpful thoughts that they are having about each food, and then to write a more helpful thought underneath each statement.
3. Help them to practice self-compassion.
Self-compassion is simply giving ourselves the same kindness and care that we would provide to a loved one who was struggling. When working with a client who is struggling to face their “fear foods,” it can be helpful to explore with them ways that they can practice self-compassion throughout the process.
You can help the client to explore ways in which they may be being unkind to themselves. For instance, many clients “beat themselves up” for having anxiety surrounding food or for not doing a food challenge “perfectly.” You can assist them in coming up with some more positive self-statements, such as “I am so brave for facing this food that scares me,” or “It’s about progress not perfection.”
Tying it Together
Working with clients with eating disorders can be challenging, but also incredibly rewarding. Watching someone escape the prison that is their eating disorder and gain strength in their recovery is an amazing experience.
It is also critical that you share with your client that full recovery is possible. Also, that they are not choosing to feel and behave this way. However, they can choose to work on their recovery and gradually conquer their fear foods.