Dr Bryony Bamford on the Relational Lives Podcast

Our Clinical Director, Dr Bryony Bamford, recently joined the Relational Lives Podcast for an episode titled “Loving Someone in Denial: Eating Disorders and the Strain on Relationships.”

In this thoughtful conversation, Bryony discusses how eating disorders can affect relationships, particularly when a loved one may be struggling to recognise or accept the seriousness of their difficulties. The episode explores why denial can be part of an eating disorder, how this can affect communication, trust and connection, and what families and partners can do to offer support in a compassionate and constructive way.

Bryony also speaks about early warning signs, treatment options, the role of family in recovery, and the wider cultural pressures that can shape difficulties with eating and body image.

This episode may be especially helpful for parents, partners, family members and friends who are supporting someone with an eating disorder and are unsure how best to respond.

Listen to the episode here or watch the video below:

Podbean link – PodbeanLoving Someone in Denial: Eating Disorders and the Strain on Relationships 

Spotify link – SpotifyLoving Someone in Denial: Eating Disorders and the Strain on Relationships

View The Full Transcript Below

Understanding Eating Disorders and Denial

Heads Up: This episode contains themes around eating disorders. Please take care while listening if this is a sensitive subject for you.

What do you do when the person you love is clearly struggling but insists they are completely fine?

Today we have a listener letter from a partner who feels stuck in exactly that place—watching someone they love become increasingly controlling with food while being met with denial every time they try to talk about it. It’s confusing, it’s painful, and it leaves them questioning their own reality.

To help us unpack this, we’re joined by Dr Bryony Bamford, a clinical psychologist and the founder and clinical director of the London Centre for Eating Disorders and Body Image. Bryony has worked extensively with individuals experiencing eating disorders, as well as with the partners and families around them, supporting people through the fear, frustration, and helplessness that can come with it.

The Listener Letter

Dear therapists,

I need your help with what to do. My partner barely eats. She stopped eating carbs, her portions are tiny, she counts calories, weighs her food, and also runs a lot. When I try to point it out, I’m the problem. She says she’s fine, that she’s just being healthy, and that I need to stop worrying.

I start questioning myself, like maybe I’m overreacting. But deep down, I know I’m not. I can see what’s happening. It’s very clear it’s becoming a serious problem, and she’s lost a lot of weight. Everything around food feels tense now. Every meal feels loaded. I’m constantly thinking about what she’s eating or not, and whether I should say something or keep quiet.

If I do say something, it turns into defensiveness or she shuts down. If I don’t, I feel like I’m just standing by while things get worse. I think the denial is the hardest part. I don’t know how to help someone who genuinely doesn’t think anything is wrong.

Should I keep pushing back? Should I back off? Say something, say nothing? Every option feels wrong. People tell me she needs to hit rock bottom before she recognises the problem, but I’m scared that by then it’ll be too late for us—and maybe even for her. I just need to understand what I’m supposed to do when the person who needs help doesn’t believe they need it.

Host: It sounds incredibly tough for them. What’s described in that letter is a really, really common experience for friends, families, and loved ones of people struggling with an eating disorder. That denial part can be so incredibly hard to navigate.

The Impact of Eating Disorders on Relationships

Dr Bryony Bamford: Yes. When we think about eating disorders, they are one of the only mental health conditions where denial of the seriousness and the impact of the illness is actually part of the core diagnostic criteria. They are quite distinct from other conditions; the very fact that people lack full insight into the seriousness of the illness is part of what makes it an eating disorder, certainly in the case of anorexia.

Host: So a loved one is almost always going to encounter that lack of understanding and feel exactly like this listener.

Dr Bryony Bamford: Absolutely. It is central to the disorder that it is minimised or not seen as a difficulty.

Another important element is that eating disorders are often functional for the person struggling with them. We describe them as ego-syntonic, meaning they are wanted in some way. With other mental health conditions, you don’t usually encounter people saying, “I really want to keep my depression,” or “I really want to keep my anxiety.” But with eating disorders, you do. You see people who are incredibly scared of giving up aspects of their disorder because, certainly at the start, those behaviours serve a purpose or provide a felt benefit.

Because of this, you have a very dangerous physical and psychological illness—eating disorders have the highest mortality rate of any mental health condition—paired with a desire to keep it and a lack of insight into its severity. Looked at through that lens, it’s completely understandable why family members find it so confusing, scary, and difficult to help.

Host: It must create immense tension in relationships.

Dr Bryony Bamford: Absolutely, because food punctuates our every day, multiple times a day. It is integral to survival. It’s also helpful to think about what happens to the brain when it becomes starved. People become extremely rigid, obsessional, and anxious, and their isolation increases. Personalities change significantly under starvation, and family members are the ones witnessing that daily distress at meal times.

We aren’t born automatically knowing how to help someone with an eating disorder. There are many misconceptions—not least the idea that they are about vanity, a desire to eat healthily, or just weight, rather than recognising the deep mental health aspect.

Cultural Influences and Body Image

Host: Culturally and on social media, there is always this changing ideal of the “perfect” body shape and size. If someone starts restricting food, loses weight, and receives compliments like, “Oh, you’re looking good,” that can feed right into the functionality of the disorder.

Dr Bryony Bamford: Yes, eating disorders can start as relatively harmless attempts to lose weight or be healthy. Very few people start out with the intention of developing a severe eating disorder.

However, we live in a culture that sells the idea that any body size or shape is achievable if you work hard enough. We don’t have those conversations about height because we accept it is genetically informed. Well, our weight and body shape are also predominantly genetically informed.

Diet culture and the wellness movement moralise food into “good” and “bad” choices, selling the idea that restriction is healthy. While this doesn’t cause an eating disorder on its own, it absolutely heightens the risk for those who are biologically or psychologically predisposed to developing one.

Identifying the Line Between Healthy Eating and Eating Disorders

Host: Where is the line between healthy eating and an eating disorder?

Dr Bryony Bamford: There isn’t a rigid line in the sand. It is really about the degree of rigidity and the meaning behind deviating from your choices. Most people who eat healthily maintain flexibility. Someone with an eating disorder develops incredibly rigid rules over time, and breaking a food rule causes massive emotional and psychological distress—such as intense fear, guilt, or shame.

What truly defines an eating disorder is the over-evaluation of shape and weight. This means food, shape, and weight become central to a person’s entire self-worth and identity, to the detriment of everything else.

If you map out a healthy person’s self-worth as a pie chart, it contains multiple segments: their career, friendships, hobbies, and personality traits. For someone with an eating disorder, food, shape, and weight take up almost the entire pie.

Host: That explains the massive impact on relationships. Hobbies, eating out, and relaxing together are deprioritised as the eating disorder takes over. The world becomes incredibly small.

Dr Bryony Bamford: Exactly. Eating disorders thrive in isolation. Sufferers lose friendships and relationships, and family dynamics become highly fractured.

Food is also the centre of our social lives—going out for dinner, cooking for each other, celebrating. When a person finds those experiences threatening because they don’t know the exact ingredients or menu, they pull away entirely.

Navigating Denial and Communication Strategies

Host: What can a loved one actually do when their attempts to talk are met with complete denial and defensiveness?

Dr Bryony Bamford: It helps to understand where the denial is coming from. It stems from a profound fear of change and a fear of having their primary coping mechanism taken away. It can also feel like a threat to their self-worth; when you say something is wrong, they may experience it as judgement or criticism, which naturally triggers defensiveness.

Furthermore, eating disorders develop slowly. You don’t notice your child’s height changing day by day because you are with them constantly. Similarly, when you live inside an eating disorder every day, you don’t notice the gradual shift. Because disordered eating habits are so normalised in our culture, we are essentially asking them to reject messages they’ve been told are “healthy” truths.

One of the least helpful things you can do is get into a debate or argument over how unwell they are. That just causes the defensiveness to grow stronger.

How to Bring It Up:

• Pick a calm time: Do not have these conversations when emotions are already heightened or around meal times. Ensure there is plenty of time to talk.
• Focus on your own experience: Use “I” statements rather than pointing fingers. Instead of saying, “You’ve lost too much weight and you’re not eating,” (which feels attacking), try saying, “I’m feeling really worried and scared because I love you, and I feel like you’re becoming more isolated and anxious lately.” Naming the emotions underneath is far more effective than attacking the behaviours.
• Have multiple micro-conversations: It doesn’t have to be one long, dramatic talk. If it isn’t going well, it is okay to pause and say, “It feels like it’s really hard for us to talk about this right now. Let’s leave it here, but it’s important to me that we come back to it.” You are sowing a seed.

Host: That ties into the Stages of Change (or the Wheel of Change), where people move back and forth between pre-contemplation, contemplation, preparation, and action. Meeting them where they are is so vital because forcing change or forcing someone into therapy prematurely rarely works.

Dr Bryony Bamford: Exactly. Sufferers can seek help at any stage. If they come to us in the pre-contemplation stage, it’s usually because a partner or family member asked them to. I highly encourage that.

The Role of Family in Treatment and Recovery

Dr Bryony Bamford: Family members cannot fix this on their own—it requires specialist professional support—but they are integral to a successful recovery.

If your loved one is in deep denial, don’t ask them to commit to a year of intense therapy or promise to recover right away. Simply ask if they would be open to doing an initial assessment with a specialist. We are very used to working with people in the pre-contemplative stage. We look at both sides: What does the disorder do for you? What do you value about it? What are your fears around changing? It is only by exploring what the disorder is giving them, and finding alternative ways to meet those emotional needs, that they can begin to contemplate doing things differently. It gets around the defensiveness.

Host: How do you navigate the dynamic when a couple comes to you?

Dr Bryony Bamford: While the individual will need one-on-one specialist therapy, recovery doesn’t happen in a vacuum. Therapy sessions occur once or twice a week, leaving a massive number of hours outside the clinic where the client must face their fears—like sitting down to eat.

Family members and partners are the ones there in those tough moments. They need psychoeducation to understand their role and learn how to manage the intense emotions that arise.

It’s also crucial to support the partner or carer. Witnessing a loved one go through extreme distress is traumatising. Recent research highlighted incredibly high levels of PTSD in people who have supported family members through an eating disorder.

Navigating Severe Medical Risks

Host: What if things get dangerous physically, but the person still refuses to acknowledge the problem?

Dr Bryony Bamford: At that point, you must prioritise physical safety and seek medical guidance. Eating disorders carry severe, real-world medical risks, including high mortality rates for both restrictive and binge-purge behaviours.

At a bare minimum, their physical health needs regular monitoring—including blood tests, ECGs, and blood pressure checks. If a GP becomes severely concerned about physical markers, they will refer the patient to a specialist consultant psychiatrist or, in extreme cases, arrange a hospital admission to medically stabilise them.

At the severe end of the spectrum, medical intervention is life-saving. Even when someone is cognitively and physically compromised, psychological care should always run alongside medical monitoring so they continue to feel heard and understood.

Understanding Bulimia and Its Complexities

Host: Do you primarily treat anorexia and bulimia at your clinic?

Dr Bryony Bamford: We see all forms of eating disorders. Many public health services (like the NHS) have incredibly rigid access criteria based on weight due to funding limitations. This creates a terrible dynamic where people are told they are “not ill enough” for treatment, which triggers them to go away and get worse just to qualify. In private practice, we don’t use those criteria; we see anyone who wants to improve their relationship with food, self, and body image.

It’s also important to note that diagnostic categories are highly fluid. Sufferers frequently move between anorexia, bulimia, and other presentations throughout their lives.

While bulimia also centres on an over-evaluation of shape and weight, it introduces cycles of binge eating and compensatory behaviours. What many people don’t realise is that restriction directly drives the binge.

Think of it like being stuck outside on a scorching hot day without water. You become entirely preoccupied with thirst. When you finally get a glass of water, you don’t take a polite sip; you gulp it down. The exact same mechanism happens with food. When you rigidly ban food groups like carbohydrates—which our bodies absolutely require for basic energy and brain function—your brain triggers intense physiological cravings.

Host: I’ve seen that with clients. Once you safely address and remove the food restriction, the binging often naturally stops or drastically reduces.

Dr Bryony Bamford: Yes, but that is the scariest part for the individual. Sufferers want to stop the binging, but they desperately want to keep the restriction. We have to do motivational work to help them lower their fear of normal eating. Once the physiological binging stops, we can finally look at the emotional binges underneath.

Another massive misconception is that bulimia only involves self-induced vomiting. The actual diagnostic criteria include any attempt to compensate for a binge—including excessive exercise, laxative abuse, or entering cycles of further extreme starvation.

The Difference in Treating Children and Young People

Host: Does treatment look different for a child or adolescent?

Dr Bryony Bamford: Yes. For young people, the interventions with the absolute highest evidence base are family-based interventions (such as FBT or FT-AN). You cannot expect a child to face terrifying levels of anxiety around food in isolation; they need their parents and carers actively leading the restructuring of meals at home.

We also treat children with far more urgency. We do not tell a young person to “come back when they are ready.” Restriction is incredibly dangerous for a developing body and brain, and early intervention provides the absolute best chance of a full recovery.

If families cannot access or afford specialised care, I highly recommend reading up on family-based treatment and utilising resources like Eva Musby’s website, which guides parents on how to support a child and create behavioural changes at home while fighting for professional resources.

Host: It also feels vital to ensure that if someone does seek private care, they find a true specialist.

Dr Bryony Bamford: Absolutely. General therapy can inadvertently do harm if the practitioner doesn’t understand the complex maintenance cycles of eating disorders. If a therapist’s biography claims they treat 10 or 15 different distinct mental health disorders, they are a generalist, not an expert in this field. Look for counsellors who specialise exclusively in eating disorders.

Key Takeaways for Supporting Loved Ones

Host: To wrap up, what are three core takeaway tips for someone in our listener’s shoes who is struggling to support a partner in denial?

Dr Bryony Bamford:

The Emotional Underpinnings of Eating Disorders

Dr Bryony Bamford: At the end of the day, eating disorders are emotional disorders. Food is simply used to regulate, block, or express painful emotions, or to control a fractured sense of self-worth. We ultimately have to treat what is driving those food behaviours from underneath to create lasting recovery.

Host: Thank you so much for your time, Bryony. We will include the link to your website and educational resources in our show notes. To our listeners, please remember to follow, like, and subscribe to help us share this vital information with others who need it.