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st louis counseling for eating disorderSound Familiar?  

Lucy had always watched her calorie and food intake like a hawk, but lately friends were getting worried.  The only thing she seemed interested in talking about was whatever the latest dieting craze was.  At first it was Atkin’s, South Beach, then more savvy things like gluten-free, raw, and juicing.  None of these things were bad in themselves, but her fixation bordered on obsessive.  She knew at some level it was all she talked about and wanted to stop, but found herself unable.  

Anna’s hard work at home raising her 3 children went unnoticed by her husband, or at least that’s the way she felt.  Every time she suggested she needed a break, she was met with disdain and “do your duty” kinds of remarks from him.  In the middle of all of this, she binged on junk food, felt guilty, and threw it all back up.  When she started having to go to the dentist frequently to have work done on her back molars, she knew she had a problem.

Lindsey could be tyrannical in her rules and regulations, especially those surrounding food.  While others tended to see her preparation, portioning, clean eating, and exercising as a sign of model woman- and motherhood, Lindsey experienced them as an out of control spiral.  With all of the effort she put in, you’d think her self-image was good, but in fact it was gravely the opposite.  For everything she ate, she knew exactly how much exercise was needed to burn off the calories, and found herself competing with those numbers by exercising even more than what was necessary.  When her beautiful, healthy 9-year old came to her crying because she thought her mommy was “afraid of getting fat”, Lindsey was heartbroken.

Clear Conversation: Eating Disorders Defined.

There has been increased conversation about eating disorders and disordered eating in America over the past 5-10 years, and terms like Anorexia and Bullemia have become commonly understood terminology.  However, to full understand eating disorders, its worth it to posit a working definition.  Eating disorders are characterized by some kind of obsessions and compulsions related to food, tending to result in either restricting diet or failing to restrict it appropriately (i.e., eating too much), but also other obsessive or compulsive behavior surrounding eating.  Anorexia Nervosa and Bulimia Nervosa (the proper names) are really just 2 categories of eating disorders, but in a culture obsessed with food, thinness, external depictions of beauty, and perfection, there are a host of other unhealthy behaviors and thinking associated with disordered eating.

To provide the most understanding, its helpful to look at disordered eating along a continuum of eating-related feelings, attitudes, and behaviors (this information comes courtesy of The University of Illinois) :

confidence about body shape/size; flexible eating

preoccupation with body shape/size and eating

distress about body shape/size and eating

eating disorders

Body image confidence is characterized by mostly positive feelings about your body shape and size. In this range, your body is seen as a good part of you that can help you enjoy life. For body confident people, all foods are seen as fitting into an overall healthy diet, without feeling that some foods are “good” and some “bad.” Given the messages we all receive daily about what we “should” look like, it can be challenging to maintain your place at this end of the continuum.

Preoccupation with body shape/size and eating involves frequently thinking about food, eating, and your body. In this range of the continuum, you may find yourself thinking about what you ate at your last meal and feeling that you’ll need to “make up for it.” You may be a little inflexible about what you “allow” yourself to eat. There may be moments where you feel guilty or bad for what you’ve eaten. In addition, you may not like the way certain parts of your body look or you may consistently feel that you could lose a few pounds. In general, however, these feelings do not interfere with enjoying life and engaging in situations involving food.

Eating or Body Image Distress refers to a level where your preoccupation with eating and body size/shape does interfere with daily interactions and activities. You may find yourself thinking a great deal about food or your looks. In this range of the continuum, you may be fairly rigid in your eating patterns, you may work hard to change your body size/shape, and/or you may do some compensating for eating (e.g. vomiting, fasting, extreme exercising). Typically, however, you will not have experienced a significant amount of weight loss.

Eating Disorders refer to the next level, where body image/confidence, preoccupation, and distress are so significant they put you at severe health risk, up to and including death.  Common eating disorders are as follows:

Anorexia Nervosa

  • Refusal to keep age/height appropriate body weight.
  • Intensely experienced fear and/or obsessiveness about physical appearance as it relates to weight or the propensity to become overweight (e.g., fear of being fat)
  • Distorted body image, disproportionate placement of importance on body/weight on self-worth
  • Amenorrhea in women (missing at least 3 consecutive menstrual cycles)
  • Denial of low weight or results thereof (e.g., loss of menstrual cycle, hair loss, tooth decay, etc.)

Bulimia Nervosa

  • Episodes of recurrent binge eating
  • Use of laxatives, diuretics, enemas, fasting or excessive exercise recurrently to prevent weight gain
  • Disproportionate placement of importance on body/weight on self-worth

Other Forms of Eating Disorders

  • Binge Eating: Larger than normal amounts of food consumed in a short time frame with felt anxiety and a lack of control over the eating.
  • Overeating: Eating when not hungry, or eating alone because they are embarrassed about the portions of food they are consuming or the amount of money spent on food.  Also characterized by excessive fantasizing about next meal.
  • Orthorexia: Fixation on eating “pure” or “right” or “proper” food rather than on the quantity of food consumed.
  • MORE…This list is not exhaustive.  Essentially, any unhealthy behavior, rules, rituals, or thinking surrounding eating, weight, exercise, etc. may in some way be disordered!
st louis eating disorder counselingHow can I know if I have an eating disorder or disordered eating?

People who struggle with disordered eating tend to experience some behavioral, emotional, psychological, social, and/or physical symptoms in common. The following checklist includes many of these symptoms, but isn’t intended to be a diagnostic tool per se.  The checklist is not intended to determine whether you have an eating disorder. Its purpose is to help you think more specifically about your behaviors and feelings, regardless of your problem level. If you feel concerned about any of these items, print the list out and place a checkmark by each one that troubles you – then give us a call!


  • Routinely restricting calorie or food intake for the primary purpose of feeling more in control (e.g. “I’m going to limit how many calories I eat” or “I will only eat ‘good’ things”).
  • Eating episodes during which you feel out of control regarding your eating.
  • Feeling compelled to exercise (sometimes excessively) in order to compensate for food eaten.
  • Self-induced vomiting.
  • Temporary fasting in order to compensate for food eaten.
  • Drug use to control eating or weight gain (e.g. diet pills, amphetamines, laxatives, diuretics, etc.)
  • Rituals around food (e.g. not allowing food to touch your lips; cutting your food into small pieces).
  • Frequently weighing yourself.
  • Counting calories.


  • Depressed mood
  • Mood swings
  • Irritability
  • Guilt about eating
  • Intense fear of fat
  • Low self-esteem
  • Eating when upset
  • Emotional discomfort after eating
  • Difficulty tolerating the feeling of being full
  • Shame about eating behaviors


  • Perfectionism
  • Preoccupation with food
  • High need for structure
  • Rigid eating schedule
  • Alternating between being in control of eating and “letting go”
  • Difficulty concentrating
  • Fluctuating body image (i.e. having “fat days” and “thin days”)


  • Frequently eating alone
  • Eating in secret
  • Avoiding friends
  • Avoiding situations where food is involved
  • Strained relationships due to food related issues.
  • Difficulty being assertive


  • Amenorrhea (i.e. menstruation has stopped)
  • Throat problems
  • Frequent weight fluctuations
  • Significant weight loss or gain
  • Swollen glands
  • Hair loss
  • Puffy cheeks
  • Broken blood vessels under eyes
  • Fainting/dizziness
  • Fatigue
  • Unexplained tooth decay
  • Development of fine hairs all over your body
The tricky part: Denial.
Perhaps the trickiest part about helping someone with an eating disorder is that it is one of the few illnesses in the world that attempts to convince the person suffering that everything is fine.  Denial is a part of the illness.  If you’re reading this and the stuff above sounds like you, there’s no easy way around this: you have a problem.  Breaking through dennial can be the most difficult step, but you can do it!  This isn’t really about food — it’s about you, and you matter.

Need some guidance with all of these?  We can help!

Our therapists aren’t just expert counselors – they’re agents of change!  They can help you develop a healthy relationship with food and eating by improving your thinking, addressing underlying issues of shame, guilt, and anger, and addressing trauma that may inform your struggle.  You can get your life back!


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ST. LOUIS COunseling Locations


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