Content note: this post discusses an active eating disorder, restriction, weighing and harm in therapy.

I saw a post on Facebook the other day about the changes in a woman’s body after breastfeeding. It got me thinking. I have a long history of an eating disorder. I also hate the changes that happened to my body after breastfeeding my three children. Are the two linked? Nope.

There’s an assumption out there that eating disorders are driven by body image, by being unhappy with how you look. I’m not a researcher or a clinician, and I can only speak to my own experience. My body image ‘issues’ aren’t much different from those of most women. I don’t love that my post-breastfeeding boobs look like prunes in a plastic bag that spent too long in the microwave. Is that what drives my eating disorder? Nope.

It was never about seeing an actress and wanting to look like her. My eating disorder is how I manage my distress. When I’m in pain and I don’t know how else to express it or manage it, this is where it goes. It’s a way of punishing myself for failing to meet my own unrelenting standards. It also becomes its own loop: restriction becomes the standard I set, and if I fail to meet it, the punishment is more restriction.

My body isn’t the mirror in this. It’s the ledger. I use the scales to measure my ‘success’ against a standard that never lets up and never moves in my favour. I have a goal weight, and it’s not because I think I’ll look fabulous at it. It’s because I’ve convinced myself it’s the pot of gold at the end of a very long rainbow. The number on the scale and what I see in the mirror are two different things, and only one of them is running the show.

Some people reach for alcohol, gambling or other things when they’re in pain. Food and my body were what was within reach for me. I can’t pretend culture plays no part, though. Weight is easy to measure. Losing it gets noticed and often praised. It’s read as a sign of discipline. When I needed somewhere to channel my distress, weight was sitting right there, already loaded with meaning. Culture didn’t cause my eating disorder, but it handed me the currency.

I’ve even seen this play out in therapy. I developed an anxious attachment to my former psychologist, and the distress from that showed up exactly where my distress always does: my eating disorder worsened. Nothing about how I saw my body changed. What changed was how much pain I was in.

Through all of it, she kept reminding me she wasn’t an eating disorder clinician. That was true, but it was beside the point. I had an eating disorder clinician and a dietitian for that, alongside my GP and psychiatrist. Our work was meant to be attachment, emotional regulation and distress tolerance. The eating disorder wasn’t the focus, but those are exactly the things that fuel it. She didn’t need to treat my eating disorder. She needed to do the work I was paying her for, and respond to the distress in front of her, including the distress coming from our relationship.

That’s why ‘I’m not an eating disorder expert’ frustrates me so much. Anorexia is cited as having one of the highest mortality rates of any mental illness. Every single mental health clinician should have, at a minimum, baseline training. The skills that matter aren’t even about body image. They’re about noticing distress, taking it seriously and sitting with it.

It’s the same reason it frustrates me that so much of what’s out there for people with eating disorders still centres so much on body image. When the screening questions ask whether you think you’re fat, or how you feel about your reflection, people like me can answer honestly and slip straight through. Body image isn’t the same thing as weight on a scale.

I’m not denying that the way bodies are talked about needs to change, predominantly AFAB bodies, but not only. For some people, that talk is where the slide begins, and it needs to stop. But when you’ve got the badge of honour no one wants, a severe and enduring eating disorder,’ whatever launched you into the abyss is a distant memory. Body image has usually faded into the distance along with it.

Maybe for some people it started with what was reflected back at them, but that’s not necessarily what keeps it going. It might not be that a person thinks a smaller body will make them happy or beautiful. It might be that the number has become the only measure they trust of whether they’re good enough.

I’m not saying this is everyone’s story. For some people, appearance really is at the centre of it. However, it isn’t the only story, and when it’s treated as if it is, some of us go unseen.

This is my story.