The “Benefits” of an Eating Disorder: What Social Workers Need To Know

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Eating Disorder Awareness Week is an annual campaign to educate the public about eating disorders, including early detection, treatment, and ongoing research. It takes place from February 24 - March 2, 2025, with the theme “The Time is Now.” For further resources: https://www.nationaleatingdisorders.org/edaw/

by Mary Anne Cohen, LCSW, BCD

     Despite social work therapists offering psychotherapy, behavior modification, and teaching why diets don’t work, we are often surprised at how tenaciously our clients hold on to their eating disorder symptoms. Understanding the “benefits” of having an eating disorder can help clinicians better understand why their clients are reluctant to get better.

Holding On

     Jenny, in recovery from a binge eating disorder, was going to a family reunion. In her therapy session, she tearfully described, “I was afraid to feel my sadness at this party. My mother, with whom I spent many loving family holidays, died last year.”

     She continued, “I ate a sandwich for lunch, and the mayonnaise in the tuna salad tasted sour. I knew it might give me a stomachache, but I ate it anyway. It wasn’t my intention to hurt myself, but I became aware of the ‘helpful’ nature of a stomachache to numb me from my heartache. I realized I chose stomach pain over emotional pain.”

     Jenny’s keen awareness confirms how an eating disorder can play a role in protecting people from even deeper pain. Although it is true that most people outwardly proclaim their desire to resolve their binge eating, bulimia, or anorexia, they are often drawn to these disorders because of the comfort and distraction they provide.

     Much like other addictions, eating disorders freeze emotions and detour clients from deep hurt and grief. They divert these difficult feelings and consume enormous time and energy.

     Although there are many reasons for developing an eating disorder and many treatment strategies, little attention has been paid to the “benefit” of holding on to symptoms. To determine the benefit, I often ask my patients, “If we help resolve your eating problem, what’s the next issue that will come up for you?” Many times, it’s a lot more difficult!

     “I would have to confront my depression about my father’s cancer,” Phil realizes. “Throwing up and worrying about my weight is a good distraction from my fear about Dad.”

     “My son was diagnosed with autism, and I just don’t want to deal with it,” Shelley answers. “I am doing everything I can for Josh, but I’m nice and numb thanks to my bingeing.”

     “I’m old enough to start dating, but I’m really afraid no one will like me,” Laurel responds. “I starve myself and hope that I will eventually feel pretty enough.”

     “My husband is an alcoholic,” cries Janet. “When I’m focused on my exercise and dieting and overeating, I don’t pay as much attention to his destructive drinking. I can blot it out for a while.”

From “Benefits” to Change

     To change the hidden “benefit” of a client’s eating problem, our first step is to invite them to become curious and aware of the ways emotional eating “helps” them. We ask: Does overeating keep you company when you’re lonely? Does bingeing give you pleasure at a time in your life when you are feeling deprived? Does restricting food make your depression seem more manageable? Does having a binge disorder, bulimia, or anorexia serve as an excuse for not moving forward with your life?

     We say to our clients: If you are committed to tackling your life without an eating disorder, then we need to decode its meaning.

• Identify the benefits that your eating problem has provided.
• Name the feelings/actions/decisions you are avoiding.
• Think about the ways your eating keeps you stuck.
• Consider what the first step to improve your eating would look like.
• Consider what the first step to improve your life’s issues would look like.

          And we encourage them to remember that:

• You do not have to change your whole life at once.
• Just for today, just make it a little better.
• With self-compassion and resolve, you can improve your eating and life one step at a time, one day at a time.

Mary Anne Cohen, LCSW, BCD, is Director of The New York Center for Eating Disorders and author of French Toast for Breakfast: Declaring Peace with Emotional Eating and Lasagna for Lunch: Declaring Peace with Emotional Eating. Her latest book, published by NASW Press (2020), is titled Treating the Eating Disorder Self: An Integrated Comprehensive Approach for the Social Work Clinician. For more information, visit www.EmotionalEating.org.