Scenario 1: Let's say that there's this young woman who comes to therapy. We'll call her Diana. Diana doesn't have an eating disorder. What brings her into treatment is panic attacks. In the course of her anxiety, let's say Diana loses weight. She's panicky, on edge, and she's not eating enough. Let's say that Diana was "at a normal weight" (whatever that is) before and that when she loses weight, she looks unhealthy. Let's also say she has a psychiatrist who's treating her for her anxiety. Then, let's say that Diana's therapist expresses concerns about her weight loss and discusses with her how she can get adequate nutrition even with low appetite. Remember, Diana doesn't have an eating disorder, so this isn't the most complicated thing. Next, let's say that Diana starts to feel less anxious. Some combination of medication and therapy is helping her, and her panic attacks remit. Let's say, that in the process of this, she gains back the weight she had lost. Let's say that Diana is again "at a normal weight" (whatever that is). Finally, let's say that she visits her psychiatrist after some time, who mentions Diana's weight gain and states that 1) Diana needs to lose weight and 2) She needs to do so by their next visit.
Scenario 2: Let's say that another woman who has been in therapy for many years for anxiety, depression, and a sub-clinical eating disorder, is seeing a relatively new psychiatrist. We'll call her Sharon. Sharon likes her new psychiatrist because she seems compassionate and responsive to her. Like many psychiatrists she's had in the past, Sharon's current psychiatrist is eager to try out new medications and doses of medications with her, in order to alleviate her symptoms. During one appointment, Sharon, who is "at a normal weight" (whatever that is), expresses concern about her psychiatrist's recent recommendation that she up the dosage of her medication in order to address her residual anxiety. "Doesn't that cause weight gain?," she asks. Sharon is concerned because she has a history of binge eating, and she doesn't want to be on anything that exacerbates this condition. "It could," her psychiatrist replies, "But that's when you just need to focus on portion control." To Sharon, who again has a history of binge eating, hearing the phrase "portion control" creates such anxiety in her that she actually wants to binge. She's had many attempts at trying to restrict what she eats (in fact, that's what led to her binge eating, according to her understanding of it all), and this does not seem to be an adequate solution.
Do you have any reactions to these scenarios? They can and do occur, highlighting the importance of consulting with professionals who have specific education and training in the field of eating disorders. A simple, innocuous comment as processed by someone with an eating disorder can do significant, unintended damage. Ideally, those struggling with eating disorders can arrive at a place in their recovery where a single comment isn't so threatening (as they may come from various sources), but until and unless this happens, it's important to select a treatment team sensitive to these concerns.