Anorexia, Restrictive Eating and OSFED Counselling
Anorexia and restrictive eating can affect people in many different ways. For some, the difficulties are obvious and severe. For others, the eating disorder may be much less visible, particularly if weight has not fallen below the range traditionally associated with anorexia.
What matters is not simply what somebody weighs, but what is happening around food, eating, body image, fear, control and physical health.
You may find yourself eating less and less, avoiding certain foods, becoming increasingly anxious around meals, exercising rigidly, or feeling frightened by the idea of gaining weight. Food may begin to take up an enormous amount of mental space, even while you are eating very little.
Restrictive eating disorders can become very entrenched, and they often develop gradually. What begins as dieting, “healthy eating” or an attempt to feel more in control can slowly become something that feels increasingly difficult to step away from.
What restrictive eating can look like
Everyone’s experience is different, but you may recognise some of the following:
Regularly eating less than your body needs
Skipping meals or delaying eating
Cutting out increasing numbers of foods
Becoming very rigid about what, when or how much you can eat
Feeling anxious, guilty or frightened after eating
Fear of gaining weight or changing shape
Frequently weighing yourself or checking your body
Exercising in a rigid or compulsive way
Feeling cold, tired, dizzy or physically weak
Finding it difficult to concentrate
Becoming increasingly preoccupied with food, calories or nutrition
Avoiding eating with other people
Feeling that being thinner, lighter or more controlled is linked to your sense of worth
Feeling frightened by hunger or trying to ignore it
Some people will recognise many of these experiences and others only a few.
Anorexia nervosa
Anorexia nervosa involves persistent restriction of food intake together with an intense fear of gaining weight or behaviours that interfere with weight restoration. There is often a significant disturbance in the way weight and shape are experienced or in the importance placed on them.
It is important, however, not to assume that everybody with anorexia will look a certain way.
People can be medically compromised and psychologically very unwell at a wide range of body weights.
Restricting and binge-purge subtypes
Anorexia is sometimes described in terms of different subtypes.
In the restricting subtype, weight loss is primarily associated with restriction, fasting or excessive exercise.
In the binge-eating/purging subtype, restriction is also present, but there may additionally be episodes of binge eating or purging behaviours such as vomiting or laxative misuse.
These categories can be useful clinically, but they are not fixed identities. Eating-disorder behaviours can change over time, and somebody’s presentation may move between restriction, bingeing and purging at different stages.
For me, the most important thing is understanding the pattern that is happening for you now rather than trying to make you fit neatly into a label.
Atypical anorexia and OSFED
Some people experience all of the psychological and behavioural features of anorexia but do not meet the traditional low-weight criterion.
This is often referred to as atypical anorexia and falls under the broader diagnosis of Other Specified Feeding or Eating Disorder, or OSFED.
The word “atypical” can unfortunately make the condition sound less serious. It is not.
A person can be severely restricting, intensely fearful of weight gain, physically unwell and completely consumed by eating-disorder thoughts while living in a body that appears average-sized or larger.
OSFED can also include other eating-disorder presentations where symptoms cause significant distress and impairment but do not fit neatly into the diagnostic criteria for anorexia, bulimia or binge eating disorder.
A diagnosis can sometimes help make sense of what is happening, but you do not need to fit perfectly into a diagnostic box in order to deserve help.
Why restriction can become so powerful
Restricting food can initially create a sense of achievement, control or safety.
For some people, it becomes a way of managing anxiety, difficult emotions, uncertainty or a sense that other areas of life feel out of control.
But restriction also affects the brain and body.
When the body is not receiving enough energy, hunger signals can become disrupted, concentration and mood can deteriorate, and thinking can become increasingly rigid and preoccupied with food.
Ironically, the less someone eats, the more mentally dominant food can become.
This can make the eating disorder feel increasingly powerful and can make it difficult to distinguish between your own thoughts and the voice of the eating disorder.
Hunger does not always feel like hunger
One of the confusing aspects of restrictive eating is that hunger cues can change.
After prolonged restriction, some people no longer experience obvious hunger sensations. Instead, hunger might show up as irritability, tiredness, anxiety, difficulty concentrating, thinking constantly about food or becoming very interested in cooking and feeding other people.
A lack of hunger does not necessarily mean that the body does not need food.
Part of recovery can involve gradually rebuilding trust in the body and establishing a regular eating pattern rather than relying solely on hunger signals in the early stages.
What might be underneath the eating disorder?
There is rarely one simple reason why somebody develops anorexia or another restrictive eating disorder.
For some people, perfectionism, anxiety or a need for control are important. For others, there may be difficult relationships, trauma, identity issues, neurodivergence, significant life changes or a history of feeling that their needs took up too much space.
The eating disorder may have begun as an attempt to solve a problem.
Over time, however, it can become a problem in its own right.
In therapy, we can begin to understand what the restriction is helping you manage, while also working towards reducing the hold that the eating disorder has over your life.
How I work with restrictive eating
My approach is integrative, which means that I adapt the therapy to the person rather than working from one fixed model.
With restrictive eating, the psychological work and nutritional rehabilitation often need to happen alongside one another.
Depending on your needs, our work may include:
Establishing a more regular and adequate eating pattern
Understanding restriction and eating-disorder rules
Exploring fear around food and weight gain
Looking at body image and body checking
Developing greater awareness of eating-disorder thoughts
Working with perfectionism, self-criticism and control
Exploring difficult emotions and relationships
Understanding what the eating disorder has come to represent or provide
Working with anxiety around change and recovery
Rebuilding awareness of hunger, fullness and other body signals
Understanding neurodivergence where this may be relevant
Developing an identity and sense of self that is less dominated by food, weight and shape
I draw on person-centred therapy, CBT and CBT-E informed approaches, transactional analysis, psychodynamic thinking and psychoeducation, while always adapting the work to the individual in front of me.
I also hold a Master Practitioner qualification in Eating Disorders and Obesity and have specialist training and experience in working with eating disorders.
Medical support is important
Restrictive eating can have significant physical consequences.
When the body does not receive enough energy, it can affect the heart, hormones, bones, digestive system, temperature regulation, concentration and many other aspects of physical health.
Because of this, if you are experiencing anorexia or significant restriction, I require GP involvement alongside the therapy so that your physical health can be appropriately monitored.
With your consent, this may include communication with your GP or other professionals involved in your care.
This is not about taking control away from you. It is about making sure that the psychological work takes place as safely as possible.
You do not have to be underweight to need help
One of the most damaging myths about restrictive eating disorders is that you have to look extremely thin before your difficulties are serious enough to matter.
You do not.
Significant weight loss, restriction, fear of food, compulsive exercise and eating-disorder thoughts can all have a profound effect on physical and psychological wellbeing at any body size.
If eating is becoming increasingly restricted, if food and weight are dominating your thoughts, or if the idea of changing your eating feels frightening, it is worth seeking support.
Online counselling for anorexia, restrictive eating and OSFED
I offer online counselling for adults across the UK.
Working online can provide a consistent and private space to explore eating-disorder thoughts and behaviours, alongside the practical work of recovery.
If you would like to talk about whether counselling might be helpful, you are welcome to get in touch.