Eating Disorders: A Practitioner's Guide to Psychological Care

Dr Vivienne Lewis

Eating disorders involve complex psychological processes linked to self-worth that may challenge many mental health and allied practitioners, no matter how experienced. It is a topic little taught in clinical practice, and much of the information on the subject can seem contradictory or even inaccurate. Yet it is vital when working with such a client to have a solid understanding of what helps people improve their relationship with food and feel good about their bodies and themselves.


Based on extensive clinical experience and the latest evidence base, this new work from noted eating disorder specialist Dr Vivienne Lewis supports mental health practitioners who may be unsure how best to deal with the issue in their daily practice. Throughout the book, clients' voices shine through in numerous brief real-life stories, illustrating the personal and practical impacts of eating disorders and successful recovery. It is relevant for psychologists, counsellors, nurses, youth workers, psychiatrists, doctors, dieticians and trainees and includes sections on:

  •   Understanding complex client presentations.
  •    Challenging common myths about eating disorders.
  •    Structuring therapeutic sessions.
  •    Motivating clients to change.
  •    The importance of supervision.

Clinical psychologist Dr Vivienne Lewis has spent more than 20 years in private practice and academia, specialising in treating people with eating disorders and training other health professionals. Her knowledge, skills and compassion have helped children, young people, and adults face and defeat the destructive mental and physical effects of eating disorders and improve body image. Vivienne knows the professional challenges of working with these clients well but also understands the reward for practitioners is seeing someone who is very unwell go on to live a healthy and fulfilling life.



More books by Dr Vivienne Lewis


About the Author

About the Author
Dr Vivienne Lewis is a Clinical Psychologist at the University of Canberra specialising in the area of body image, disordered eating, and eating disorders. Her research focuses on the influence of appearance perceptions on wellbeing and mental health in males and females. Dr Lewis also has a private practice where she sees clients of all ages dealing with body dissatisfaction, eating disorders, stress, depression and anxiety. She is part of the University of Canberra experts guide and regularly features in the media. ( en/persons/vivienne-lewis) Dr Lewis is a member of the professional body, the Australian Psychological Society College of Clinical Psychologists. She is a Board Approved Supervisor and supervises clinical students, registrars and full qualified psychologists. She also offers workshops and supervision to a range of professionals working with people with disordered eating and body image issues and is a strong advocate for body respect and celebrating body diversity. She has previously written a self-help book for people battling body image issues called Positive Bodies: Loving The Skin You're In and one for adults including parents and teachers, helping children and young people with body image issues, eating disorders and mental health called No Body's Perfect: A helper's guide to promoting positive body image in children and young people.

Table of Contents



Chapter 1: What is an Eating Disorder

Anorexia Nervosa

Bulimia Nervosa         

Binge Eating Disorder

Other Specified Feeding and Eating Disorders


Body Dysmorphic Disorder


Rumination Syndrome           

What is disordered eating?

Chapter Summary


Chapter 2: Helping People With Eating Disorders

Why don’t professionals want to work with people with eating disorders?            

Why I love working within the area of eating disorders

How do I become competent in treating people with eating disorders?

The Importance of Supervision

What if I have an eating disorder myself?

Does being underweight or overweight make me unsuitable  to work with people with eating disorders?

Chapter Summary


Chapter 3: The Dangers of Eating Disorders

Impact on the Heart

Impact on the Gut

Neurological Effects   

Endocrine System Effects

Effects on the Liver

Bulimia is Dangerous


Treatment for Overexercising

Talking about the Benefits of not Engaging in Eating-disordered Behaviour

Chapter Summary


Chapter 4: Who develops eating and body image issues and why?

What causes someone to develop an eating disorder?

Being Teased for Appearance

The Role of the Family

The Media


As a health provider, what do I do about these risk factors?

The Impact of Covid-19 and Social Isolation on Eating

Risk Factors for the LGBTQIA (Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Asexual) Community

Eating Disorders and Indigenous Australians

Treatment and Your Own Experience

Chapter Summary


Chapter 5: Professionals Issues of Awareness and Treatment


The Role of the Dentist

The Role of Teachers

Suicidal Adolescents and Working with Parents

Private Treatment Centres

Inpatient Treatment

Chapter Summary


Chapter 6: Eating Disorder Assessment

What do clients and patients talk about that might indicate they have an eating disorder?

Taking a History and Case Formulation

An Example of a Case Formulation

Males with Eating Disorders  

Chapter Summary


Chapter 7: Guiding Parents Through Their Child’s Eating Disorder

Anger and Eating Disorders

Parents Need Respite — What’s it really like as a carer?

Mealtime Tips for Parents and Carers

Siblings Need Respite

The Importance of School

Chapter Summary


Chapter 8: Therapeutic Treatment Session Breakdown

Enhanced Cognitive Behavioural Therapy (CBT-E)

Stage One: The First Session and Initial Interview

Stage 2: Beginning Sessions Two to Six (or a few more)       

Stage Three: Behaviour and Thinking Change

Stage Four: Keeping Progress Going and Planning for Relapses       

Stage Five: Spacing Out Sessions and Ending Therapy

Some General Points to Consider About Treatment

Chapter Summary


Chapter 9: Cognitive Behavioural Strategies for Increasing Body Satisfaction

Changing Behaviour to Change Feelings

Dealing With Body Distress and Anxiety

Changing Thinking     

Chapter Summary


Chapter 10: Feeding and Sleeping

Why do we need calories and food?

Re-feeding Dangers

You’ve got to Have a Team

The Importance of Sleep in Recovery

Chapter Summary


Chapter 11: Raving About RAVES

Step 1: Regularity

Step 2: Adequacy

Step 3: Variety

Stage 4. Eating Socially

Step 5: Spontaneity

Chapter Summary


Chapter 12: Helping Clients Socially

Sex Avoidance and Hormones

The use of language

Chapter Summary


Chapter 12: Recovery

Stages of Change

Ready for Action

Chapter Summary


Chapter 14: Your Language and the Client’s Language

‘You look healthy.’

Feeling Fat

‘You don’t look like you have an eating disorder.’

Feeling Worthy of Treatment

‘I look ugly in that photo.’

‘Everyone diets.’

‘You’ve got a big appetite.’

‘I’m body positive.’

Dealing with Compliments

What you Should Never say to Someone with an Eating Disorder

A Word About Health Professional’s Session Notes

Chapter Summary


Chapter 15: Special Topics


Having a Baby

Working with Couples

Food is not a Moral Issue

Chapter Summary


Chapter 16: Binging and Distress Tolerance

Strategies for Dealing with Binge Eating and Emotions

Learning about Hunger

Helping Clients Cope with Distress

Chapter Summary


Some Helpful Resources