Counseling for the Spouse of an Eating Disorder Sufferer

Couple enjoying sunset and discussing Eating Disorders in Transgender Community

When a chronic illness, such as an eating disorder is a part of a marriage, it can be challenging to keep the relationship together [1].

Me, You, and Us

Typically healthy relationships contain three people, the “Me, You, and Us.” Eating disorders can break down the “Us” and the “Me” leaving just the symptoms of the disorder.  Eating disorders can consume the whole person, such as thoughts, behaviors, and emotions.  Many individuals who struggle with an eating disorder state that they find it extremely difficult to focus on anything except the eating disorder.  This can leave a healthy spouse feeling as if they are left to care for marital responsibilities alone.

Research has shown that a close relationship with a partner can positively affect recovery from an eating disorder [1].   Being able to seek out and obtain counseling can be a part of achieving and maintaining a close relationship.

It can be difficult for the person suffering from an eating disorder to be fully engaged since eating disorders can affect cognitive functioning. Being able to switch from task to task, to talking, to being present, can be very difficult.

At What Stage Are You?

Individuals can be at any stage of the Change Process Model. The sufferer may be at one of these phases of change: Pre-contemplation, Contemplation, Preparation, Action, or Maintenance phase.

Often in the Pre-contemplation stage, the spouse is in denial of their issue. They may deny there are problems within the relationship or self.

It can difficult for the healthy spouse to watch their partner self-destruct. It is normal at this phase for the spouse to feel helpless, angry, and to try to control the eating disorder behaviors.

Married couple, enjoying each other

You may also feel guilty about seeing friends or engaging in pleasurable activities away from your partner. Being able to connect to supportive people outside the relationship is essential for your self-care.

In the Contemplation stage, the eating disorder spouse begins to admit there is a problem and starts the work of treatment and recovery. There may be some delays and setbacks during this phase. Often the healthy spouse will begin to listen and try to support in ways that work to help the sufferer.

In the Preparation stage, the healthy spouse can clarify with their partner what they need in recovery, which roles you will need to fulfill while they are in treatment and what you will need from your partner as well.

There may be higher levels of conflict at this phase, and this is normal. Working to listen to each other and validate each other is essential. Being able to solve problems together efficiently is one way to repair your relationship.

In the Action phase, recovery usually starts. The sufferer will begin to address the underlying issues that maintain the eating disorder, learn and engage coping skills, and have more internal awareness.

Many partners at this point can share their voice, feelings, and needs within the relationship. Remember some of these topics may be difficult for both of you, but these are relevant topics to discuss.

The final stage or Maintenance stage is when your partner is relatively symptom-free, and weight restoration is achieved (if that is the goal).

At this point, you both may feel that you can return to a stable, “new normal” marriage and life. There may be some continued ‘slips’ with eating disorder symptoms, but they are manageable.

Enabling or Supporting

As the healthy spouse, it is important not to try to shoulder the burden of the eating disorder [1]. It will not help your partner and can enable some behaviors. Being able to engage in activities that are fun and not about the eating disorder can help maintain your relationship.

Spend time by yourself away from your spouse and participate in fun, stress-reducing, self-care activities as well.

Individuals who have recovered from an eating disorder report that supportive relationships were vital to their recovery [2]. Maintaining a relationship with an eating disorder is a struggle for both the sufferer and the healthy partner.

Couples who are dealing with an eating disorder tend to report significant relationship distress, reduced levels of positive interaction, and increased negative communication when compared to couples without an eating disorder [2].

Categorized Struggles

For individuals who suffer from anorexia nervosa, they tend to be emotionally avoidant and may have difficulty expressing their feelings which can affect closeness with partners.

Spouses holding hands

In those with bulimia nervosa, they tend to lack communication skills and are often impulsive. This can lead to adverse interactions within the relationship.

For those who struggle with binge eating disorder, they usually tend to experience emotional intensely and often have difficulty with boundaries and are over-involved in relationships.

Life With ED For The Spouse

Healthy spouses within the relationship have reported that they struggle to understand the eating disorder within the marriage and find it challenging to live with the behaviors of the disorder [2].

Descriptions used to describe their life with the the healthy spouse include, “powerlessness,” “backfiring when trying to support,” and “fearful of the eating disorder.”

Cognitive-Behavioral Therapy can be a useful technique in treatment for the spouse of an eating disorder sufferer. It can work on changing the person’s thoughts, feelings, and reactions to situations that occur within the marriage due to the eating disorder.

Counseling for the spouse of the sufferer can also include couples therapy where joint decisions around treatment can be made together, allowing for the spouse to be incorporated into the recovery process and seen as equal.

This type of therapy also allows the couple to work as a team in the recovery process, better allowing for the spouse to understand the eating disorder more intimately.

For some spouses, they may need further individual therapy to address their own needs, thoughts, and emotions around the eating disorder and relationship. This can be helpful to have a professional clinician to talk with and work through any unresolved issues.

Being able to maintain a steady relationship, work together as a team, and have a place to work through underlying issues can create a stable marriage.

Image of Libby Lyons and familyAbout the Author: Libby Lyons is a Licensed Clinical Social Worker and Certified Eating Disorder Specialist (CEDS). Libby has been practicing in the field of eating disorders, addictions, depression, anxiety and other comorbid issues in various agencies. Libby has previously worked as a contractor for the United States Air Force Domestic Violence Program, Saint Louis University Student Health and Counseling, Saint Louis Behavioral Medicine Institute Eating Disorders Program, and has been in Private Practice.

Libby currently works as a counselor at Fontbonne University and is a Adjunct Professor at Saint Louis University, and is a contributing author for Addiction Hope and Eating Disorder Hope. Libby lives in the St. Louis area with her husband and two daughters. She enjoys spending time with her family, running, and watching movies.


[1] Me, My Partner, and That #*&%# Eating Disorder! (n.d.). Retrieved December 19, 2017, from
[2] KIRBY, J. S., RUNFOLA, C. D., Fischer, M., BAUCOM, D. H., & BULIK, C. M. (2015). Couple-Based Interventions for Adults with Eating Disorders. Retrieved December 19, 2017, from

The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Published on February 7, 2018.

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