Eating disorders are among the most serious mental health conditions I work with. They have the highest mortality rate of any psychiatric illness. That's not something I say to frighten you. It's why I take them seriously and why I use a specialist approach rather than generic CBT.
I use CBT-E, Enhanced Cognitive Behavioural Therapy, which was developed specifically for eating disorders by Professor Christopher Fairburn at Oxford. It's the treatment with the strongest evidence base for bulimia nervosa, binge eating disorder, and other eating disorders. It also works well for many people with anorexia nervosa.
Why standard CBT isn't enough for eating disorders
Standard CBT works brilliantly for anxiety and depression. But eating disorders have their own maintaining mechanisms that need a specialist approach. The over-evaluation of weight and shape, dietary restraint, compensatory behaviours, body checking, food rules. These aren't just symptoms. They form a self-maintaining system that standard CBT protocols don't adequately address.
CBT-E was designed to tackle this system directly. It has four stages, each with a specific purpose, and the treatment is structured to disrupt the eating disorder at its core rather than just managing symptoms around the edges.
Eating disorders I treat
Anorexia nervosa
Anorexia involves restriction of food intake leading to significantly low body weight, an intense fear of gaining weight, and a distorted perception of body shape or size. It's not about vanity. It's often about control, safety, or coping with feelings that feel unbearable.
Treatment for anorexia is longer, typically 40 sessions, because weight restoration needs to happen alongside the psychological work. I'll be honest with you about the medical risks and work with your GP to monitor your physical health throughout.
Bulimia nervosa
Bulimia involves cycles of binge eating followed by compensatory behaviours like vomiting, excessive exercise, laxative use, or fasting. The shame around these behaviours keeps people silent for years. Some of the people I've worked with had never told a single person before walking into my clinic.
CBT-E is highly effective for bulimia. The research shows that around 50 to 60% of people achieve full remission, and many more improve significantly.
Binge eating disorder
Binge eating disorder involves recurrent episodes of eating large amounts of food with a feeling of being out of control, without the compensatory behaviours seen in bulimia. It's the most common eating disorder and one of the most misunderstood. People assume it's a lack of willpower. It isn't. It's a psychological condition with identifiable triggers and maintaining factors.
What CBT-E treatment looks like
CBT-E runs in four stages over approximately 20 weeks for most people, or 40 weeks for those who are underweight.
Stage one focuses on engagement and behaviour change. We establish regular eating, introduce self-monitoring, and start disrupting the key maintaining behaviours. This stage is intensive and sets the foundation for everything that follows.
Stage two is a brief pause to take stock. We review progress, identify any barriers, and plan the next phase of treatment.
Stage three targets the core maintaining mechanisms. This is where we address the over-evaluation of shape and weight, dietary restraint and food rules, and the events and moods that trigger problem behaviours. For some people, we also work on perfectionism, low self-esteem, or interpersonal difficulties if they're fuelling the eating disorder.
Stage four focuses on ending well. We review what you've learned, plan for the future, and develop strategies for managing setbacks. Relapse prevention is built in from the start, but this final stage makes it concrete.
Getting past the shame
I know that eating disorders come with enormous shame. People hide them for years. Decades sometimes. The thought of telling someone feels impossible.
I've worked with eating disorders throughout my career. Nothing you tell me will shock me or make me think less of you. Eating disorders are illnesses, not character flaws. You didn't choose this. And you can recover from it.
The hardest part is making the first call. Everything after that gets more manageable.
Pricing and next steps
Sessions cost £60 for 50 to 60 minutes. I offer concessions for military veterans, serving personnel, and blue light workers.
Book a free 15-minute phone consultation or call me on 07469 870 295. That first conversation is confidential and completely without obligation.
You can also read about my general CBT approach or related areas like anxiety, depression, and self-esteem, which often accompany eating disorders.
