By: Brandi Stalzer, LIMHP, LPC, Clinical Supervisor, OMNI Behavioral Health Eating Disorder Clinic

One of my favorite quote goes a little something like this, “Courage in women is often mistaken for insanity.”  It has helped me through times I have, personally, needed to be courageous, but after getting into the eating disorder field, this quote carries on a different meaning for me.  It was originally stated by a psychiatrist hired to declare, American suffragist, Alice Paul, mentally incompetent after she was arrested and began a hunger strike in her fight for women’s right to vote.  Now, I am most certainly not recommending that those reading this article begin their own hunger strike (let me repeat that – there are more effective ways to advocate your rights than a hunger strike), but it is a reminder every day in the work that I do with the clients I serve that there is a function behind every human behavior – even behavior that on the surface appears “insane.”

Family and friends of those suffering from an eating disorder often come into therapy with a “fix it” mentality, and often do not see that in order to treat the disorder more than just decreasing an unwanted behavior (e.g., reduce purging) or increasing a desired behavior (e.g., eating adequate meals) needs to occur. The function of those behaviors needs explored, and more adaptive ways of addressing the function should be identified.  Although research is limited in the field of eating disorders most functions currently identified can be categorized as serving interpersonal, intrapersonal, and biological needs.

Eating disorders can be a way to communicate that something is wrong in their life.  The damage that is caused by an eating disorder can be a very obvious way of saying “I’m not okay.”  Other individuals describe that the praise that they obtain for shaping their body differently can be very rewarding.

Many of the individuals that I work with have difficulty managing their emotions or the sensations they experience when they emote or eat.  Eating disorders can be a way to avoid those uncomfortable feelings or sensations.  Additionally, individuals who are prone to depressive symptoms often have thoughts about being ineffective.  An eating disorder may serve to feel accomplished in something else.

For clients that are in a state of malnourishment, cognitive functioning often decreases due to the lack of nutrients in the body.  Tasks such as recalling information readily become increasingly more difficult to do.  Often clients rely on previous behaviors, because it requires less cognitive functioning to recall familiar behaviors.  Even clients who can see the benefits of treating their disorder may engage in disordered eating patterns out of repetition to serve a biological function, such as utilizing less cognitive functioning.

So, what can family and friends do to support therapeutic work in eating disorder treatment?

  1. Listen to the individual’s own perception of how their eating disorder serves them.
  2. If they are part of the function, identify their own part in managing the environment.
  3. Recognize that your loved one’s eating disorder may have multiple functions.
  4. Remembering your role in your loved one’s care.  Your loved one’s therapist and the individual will work to identify ways to replace the function with something more effective.  Depending on the needs of the client, it is likely your role is more supportive than someone who needs to find solutions.
  5. In addition to recognizing that increasing a desired behavior or decreasing an unwanted behavior, know that continued work needs to occur to treat the underlying causes of the disorder.  To date, Enhanced Cognitive Behavioral Therapy has been found to be the most efficacious method in the treatment of eating disorders.
  6. Lastly, understanding that change can be slow and takes time.

Brandi Stalzer is a licensed independent mental health practitioner and is the Clinical Supervisor at OMNI Behavioral Health’s Eating Disorder Clinic.  For more information on ways OMNI Behavioral Health can be of service to you or a loved one, please visit or contact her at or 402-333-0898.


Fairburn, C. G. (2009). Cognitive behavior therapy and eating disorders.

Lavender, A., & Schmidt, U. (2006). Cognitive-behavioural case formulation in complex eating disorders. Case formulation in cognitive behaviour therapy: The treatment of challenging and complex cases, 238-262.