Dr. Rachel Evans is a Chartered Psychologist with a PHD in the psychology of eating. She is certified in hypnotherapy, neuro-linguistic programming, emotional freedom technique and T.I.M.E techniques. She works in a different way to a traditional therapist and believes that a more focused, personalised approach and support system are essential for people struggling with eating disorders to recover fully.
Evans’ methods and drive to help clients recover and heal comes not only from her 11 years of integrated studies but also from her personal experience with orthorexia, atypical anorexia and bulimia.
For years in her early twenties, Rachel was controlled by a need to eat healthily and work out because she thought that people would respect her healthy living advice more if she looked a certain way. Her relationship with food worsened during periods of isolation and increased stress throughout her masters and PHD courses, and this affected her personal relationships, her mood and her mental health.
She experienced periods of controlled eating, intense working out and binge-purge cycles, but through therapy, CBT sessions and applying insights from her PhD studies into forming new habits, she was able to make a full recovery.
“Since recovering, I realised that I am worth so much more than my weight and there is more to life than being a certain dress-size,” Rachel said. “If other people can't see that, then I don't want those kinds of people in my life. Also, I have worked on reducing perfectionism and learning new ways to cope when I do put pressure on myself and feel stressed.”
How easy is it for people to access services to help recover from an eating disorder?
Overall, I think it is easier to access services if you meet the criteria for an eating disorder such as anorexia or bulimia; however, NICE suggests that ‘atypical’ presentations are the most common, which means that many people may find it difficult to access services via the NHS.
The pandemic has seen a rise in people seeking help for eating disorders and there are around 1.6 million people on the waiting list for NHS mental health services. I have seen with clients that access to NHS services depends on the severity of the illness and provision in the local area. This was the case before the pandemic, however, I think that response times even from local GPs are slower and waiting times to receive support are longer even for those in great distress.
What motivated you to become a psychologist? Was it your own experience with eating disorders or was this career path something you always wanted to do?
I wanted to help people from a young age and enjoyed studying psychology for A-level and then my undergraduate degree. Having my own experience with an eating disorder after my Masters in Health Psychology was horrible but helpful because it gave me clarity about what area of psychology to specialise in, and I think it helps me connect with clients on a deeper level.
How do your treatment techniques help people, and how may they be different from that of other psychologists? Why is a personalised approach most effective for dealing with eating disorders?
I believe that a personalised, integrative and multi-disciplinary method, including nutrition and psychology, is the best way to help people to recover and remain recovered from an eating disorder. This means tailoring services to the individual and drawing on different theories and techniques as part of treatment, as well as different body systems. I believe that everyone’s experience of an eating disorder is unique and people are unique; therefore, people are more likely to engage with and benefit from a treatment approach that takes into account their individual differences.
The main way that I work with clients is through the 6 month Nourish Programme, which enables clients to make a firm commitment to recovery and weekly therapy sessions. Within Nourish, I help clients understand the past causes of their eating disorder, give them tools and new ways of thinking that enable them to make changes in the present and help them visualise a future that is free from an eating disorder. Some styles of therapy are heavily focused on understanding the past but offer less strategies to help immediately in the present, whereas other styles of therapy are more focused on the present. My clients love using Neuro-Linguistic Programming techniques, breathing exercises and thought questioning to help them make changes week-to-week. We use hypnotherapy to gain a deeper understanding of subconscious beliefs underlying the eating disorder, where they came from and how to change them into more helpful beliefs to support the client's vision of the future.
What motivated you to work in a different way to a traditional psychologist?
I have been able to totally rebuild my life after an eating disorder and feel secure that I will never go back to those old worries and behaviours. It’s really important to me to be able to help clients to do the same. That’s why I am dedicated to providing a holistic approach and comprehensive approach to recovery. Unlike traditional psychologists, I provide support via email or voice notes daily from 8am-10pm; replying is my top priority so that clients never feel alone in their recovery journey.
What factors can lead to someone developing an eating disorder?
The bio-psycho-social model suggests that there are three kinds of factors that lead someone to develop an eating disorder and for it to be maintained. Biological, such as genetics, hormones, and nutrition status. Psychological factors such as predisposition (e.g., sensitive, perfectionist), anxiety, low self-esteem and trauma. Social factors, such as upbringing, cultural norms and social media.
Are there any signs family or friends should look out for if they are concerned someone close to them may be struggling with an eating disorder?
Although everyone who experiences an eating disorder will experience it in a unique way, there are some thoughts and feelings towards food, as well as observable behaviours that may indicate an issue:
Hyper-focus or preoccupation with food and/or exercise – You might notice that someone suddenly places more importance on food or exercise. For example, it’s their main topic of conversation or they must know all the calories/ingredients in something before they consider eating it.
New routines and rigid food rules that must be adhered to despite any inconvenience caused. For example, being less flexible when making plans to eat with others or needing to eat at very specific times.
Feelings of anxiety, guilt and shame towards food – They might express these feelings in words or you might see that they look agitated or unsettled.
Restrictive eating (e.g., not meeting energy requirements or cutting out whole food groups) and/or feeling out of control around food (e.g., eating large quantities very fast and often in secret).
Purging after meals, via vomiting, laxatives and/or diuretics – You might be concerned if someone visits the bathroom after meals or is buying a lot of laxatives.
No longer eating meals with the family – maybe because they don’t want the same type of food anymore or they are self-conscious when eating in front of other people
More sensitive, aggressive or irritated than normal when asked questions about food or exercise
Rapid weight gain or weight loss (although this could be due to a lot of other reasons)
What advice do you have for anyone who may be struggling with an eating disorder?
If you have acknowledged that you’re struggling then seek help from your GP or a qualified health professional, such as a dietician or psychologist who is trained to work with clients recovering from an eating disorder. I often hear clients say they don’t think they are ill enough to get support or that they don’t deserve to get help. People of all shapes, sizes, ages, race, ethnicities, genders, sexual orientations have disordered eating or eating disorders: there isn’t a certain ‘look.’ If you are struggling, then you absolutely deserve to be supported through recovery.
As someone who has recovered from an eating disorder, I know that it often feels like there is no one who understands what you’re going through and no hope of changing. Please let me assure you that there are people who understand how you’re feeling and why you’re stuck in certain habits and cycles. I believe that full recovery is possible and it is so much easier to recover with support.
If you notice the warning signs of disordered eating or an eating disorder it is important to get help. Eating disorders tend to take on a life of their own; what started as a few unhelpful beliefs and habits turns into rituals and routines that you feel like you must follow or else the worst will happen. Early intervention can help prevent harmful behaviours from developing and prevent the worsening of physical symptoms such as impaired immune system, dry and brittle hair/nails and amenorrhea (losing your period).
Also, think of it this way, when you’re not feeding your body and brain what it needs, then you’re likely to feel tired, unable to concentrate, and often people feel apathetic and care less about what used to be important; it’s far easier to make a change before you get to that point.
If people are on a waiting list for a long period of time before they can see a doctor, is there anything they can be doing to help themselves in the meantime?
Firstly, I would say to take some time to appreciate yourself for reaching out for help because that often feels like a massive step. Secondly, it’s ok to feel annoyed or disappointed that you have been put on a waiting list when you are asking for help right now.
You might be able to access individual or group support sooner via a local eating disorder or mental health charity, so it’s worth researching what is available in your area. You can also think about who in your family or social network might be able to help support you and keep you motivated to work towards recovery.
There are some free resources and support groups that you can access in the meantime, for example, through the BEAT website, and I have a podcast called Just Eat Normally that shares recovery stories and expert advice.
Dr. Rachel Evans can be contacted via https://eatingdisordertherapist.co.uk/