4 Major Reasons Why People Lie To Their Therapists About Their Eating Disorders


People Lie To Their Therapists Major Reasons Why

Did you know that many people lie to their therapists when it comes to their eating disorders and body image issues? Let’s find out the reasons why.

Key Points

  • Lying in therapy can be intentional, or the motivation may be less conscious.
  • Shame is the most common reason for untruthfulness or omitting eating and body image concerns in therapy.
  • People often won’t realize when they’re on their way to developing an eating disorder.

Humans are beautifully messy and complicated. Even when paying for their help, we don’t always share complete details with a therapist. Sometimes that’s intentional, and sometimes it comes from subconscious motives.

As a longtime eating and body-image specialist, I’ve repeatedly had the privilege of listening to people talk about their reasons for not being truthful or open about eating and body-image topics in therapy.

Decades ago, I did that myself—even though my food and body battles were daily downers and frustrations that could have used help. Nonetheless, I kept them from my own therapist for years.

Researchers Jacqueline Patmore and Barry Farber addressed this seemingly counterproductive phenomenon in their new study, “The Nature and Effects of Psychotherapy Clients’ Nondisclosure of Eating and Body Image Concerns.”

Related: 11 Signs You Need To Talk To A Therapist

Their team of researchers coded and analyzed responses from 45 participants who experienced eating or body image issues but lied about or concealed those difficulties during therapy.

And we’re not talking about a couple of sessions. The median time in treatment was reportedly over a year. At an average of three meetings a month, that’s more than 36 sessions.

You may be wondering: Why would people do this? Patmore and Farber’s research offers thematic explanations as to why. This post addresses the top four reasons, and I provide further commentary and possible answers based on clinical experience.

Signs of an eating disorder and why people lie to their therapists

4 Reasons Why People Lie To Their Therapists About Their Eating Disorders

1. Shame

In the study, “shame was the code that most frequently emerged” as the reason for untruthfulness or withholding eating and body-image worries. The shame-related answers fell into three main themes.

a) “Shame and or embarrassment about having an eating or body-image concern”.

Probably like the research sample, in my practice, this comes up with people who have “mild” problems to “serious” eating disorders. Here are a couple of explanations.

  • When people feel they’re failing at something seemingly as “basic” as eating or managing weight, they believe they’re “total” failures.
  • People have labeled themselves as wholly “selfish,” “shallow,” or “stupid” because they can’t stop worrying about their food or body when there are bigger, “more important” difficulties in the world.

With the intensity, pain, and vulnerability behind these beliefs, it’s no wonder people won’t bring them up—even in therapy.

b) The body itself was seen as a source of shame.

The “body itself” refers to, for example, a specific body part or body characteristics, and when people experience body distortions, their eyes genuinely deceive them. (Although that might sound incomprehensible, here’s a way to potentially relate to it: Think of a funhouse mirror. What if that’s what you saw every time you came across your reflection?)

Sadly, many people won’t realize they’re experiencing body distortions. They’ll instead trust that what they see is reality. Body distortions are part and parcel of having an eating disorder—anorexia, bulimia, and other specified feeding or eating disorder in particular.

And the most vulnerable often won’t notice if their eating habits and body distortions are turning into an eating disorder.

Of course, someone who doesn’t have a clinical eating disorder can also be deeply ashamed of their appearance. Hyperfocus on any body part can make that body part seem massively prominent.

To no avail, they usually work to “fix” the problem (excessive make-up, boot camps, surgery). As a result, they feel they need to physically and verbally hide their sources of embarrassment from themselves and others.

Related: Questions To Ask Potential Therapists About Treating Complex Trauma

c) Shame resulting from perceptions of therapists’ judgment.

When people worry about their therapist’s judgment, it hurts my heart. The therapy room should feel like a judgment-free zone. Yet, I’ve heard horror stories about how therapists have responded with shock or disapproval when hearing about, for example, purging behaviors.

Furthermore, a lot of therapists have implicit thin bias. For many of us raised in Western society, our brains marinate daily in diet mentality and healthism. But few therapy training programs address diet culture or eating disorders in depth.

Tragically, therapists who are not savvy in eating and body image difficulties can unwittingly appear to judge someone’s eating habits as “discipline.”

2. To Avoid Unwanted Interventions

The study refers to “unwanted interventions” such as returning to inpatient settings, stopping treatment, or fixing eating pathology. Admittedly, these can be double binds.

For example, a therapist might refer to a higher level of care, a more specialized clinician, or nutritional support while adhering to what’s recommended to maximize treatment effectiveness.

Nonetheless, those “unwanted interventions” tend to feel like being controlled or rejected to the person receiving them.

3. The Wish to Speak About Other Clinical Difficulties

Patmore and Faber’s study showed that 69 percent of the sample went to therapy to address depression; anxiety was also frequently a presenting concern (53 percent). These people likely wanted relief from the sadness or worry that brought them to seek help.

This is another tricky situation. Unbalanced eating can create or increase depression and anxiety, the problems people want relief from.

If the people in the study didn’t mention their eating habits, they could have put time, money, and a ton of energy into therapy and not experienced sufficient relief—baffling both themselves and their therapists.

Related: How Do I Know If a Therapist is Right For Me? 10 Signs

4. The Belief That Therapy Can Not or Does Not Help

This theme tied with the “desire to speak about problems other than eating and body image,” ranking, thus pushing the top five to six technically.

The rationale seems straightforward. When someone has one foot out the door, it makes sense they wouldn’t fully disclose their personal, vulnerable secrets.

How to deal with eating disorder and why people lie to their therapists

Bottom Line

Generally, people do their best to make sense of things. While lying or omitting things in therapy might sound counterproductive, there are usually valuable reasons for it.

Western societies tend to present a one-size-fits-all standard for health, appearance-acceptability, and weight. Unfortunately, our surroundings often don’t teach us that most diets fail or that genetics greatly influence our size, weight, and looks.

Instead, people often feel like failures for their real or perceived inability to fit into those one-size-fits-all standards. They frequently blame themselves.

It’s no wonder eating and body image problems are avoided or lied about in the therapy room. Patmore and Farber’s study states that future research should “incorporate additional questions about what it’s like to have body image issues, eating issues, or an eating disorder and the factors that make disclosure difficult in and out of therapeutic settings.” We hope that this happens soon.

Eating disorders have the second highest mortality rate of any psychiatric illness (after opioid abuse). Unfortunately, many people won’t know if they’re on their way to developing an eating disorder—or even that they have one—until things are devastatingly wrong.

As a field and society, we must get better at making people with eating and body image difficulties feel safe to share their whole selves in the therapy room—in any medical office, with friends, people they trust, and family. Silence can both feel safe and be harmful at the same time.


Patmore, J. & Farber, B. A. (2022). The nature and effects of psychotherapy clients’ nondisclosure of eating and body image concerns. Eating Disorders, DOI: 10.1080/10640266.2022.2114585

Written By Alli Spotts-De Lazzer
Originally Appeared On Psychology Today
lying to your therapist
Lying to your therapist, lying to therapist, is it ok to lie to your therapist

— Share —

— About the Author —

Leave a Reply

Your email address will not be published. Required fields are marked *

Up Next

Musical Medicine: How Listening to Music Can Reduce Stress and Anxiety

How Music Can Reduce Stress Benefits Of Listening To Music

Music is truly one of the most underrated things when it comes to reducing stress and anxiety. It has the potential to help with your stress, anxiety, and even depression. Let's find out how music can reduce stress or how listening to music can reduce stress.

Key Points

Music interventions are very easy and inexpensive to integrate in both our daily lives and in medical settings.

Research shows that listening to music can have a significant effect on alleviating anxiety and stress.

Non-lyrical music with a slow tempo is one of the most effective music interventions for stress reduction.


Up Next

Invisible Wounds: 10 Ways Unresolved Attachment Trauma Manifests in Adults

Possible Signs Of Unresolved Attachment Trauma

Your childhood trauma wounds can haunt you for the rest of your life. Unresolved attachment trauma in adults is more common than you think, however, knowing the signs of attachment trauma in adults can help you understand yourself more and take the necessary steps to heal.

Key Points

Childhood trauma often refers to traumas experienced in the family of origin during the formative years of our development.

Although many traumas result from abuse or neglect, not all are.

Some childhood traumas, such as emotional neglect, were not done purposefully. Some parents might not even have known.


Up Next

What Causes Anxiousness? 9 Factors That Lie At The Root Of Anxiety

What Causes Anxiousness Reasons For Your Anxiety

Do you often feel worried or afraid for no apparent reason? Do you find it difficult to relax? Do you feel that everyone is observing you most of the time? Then you just might struggle with anxiety. But what causes anxiousness? Let’s find out.

What is anxiety?

Anxiety is a natural response to stress and a normal part of the human experience. It is a feeling of fear, unease, and apprehension that can be accompanied by physical sensations such as a rapid heartbeat, sweating, and trembling. 

Anxiety can make us worry unnecessarily leading to intrusive, obsessive and uncontrollable thoughts. It can result in feelings of fear, tension, rapid heart rate, sweating,

Up Next

Successful Tips for Taking a Mental Health Day: When and Why You Should Consider It

Signs Its Time For Taking A Mental Health Day

You deserve to prioritize your mental health, and sometimes that means taking a step back from the daily grind. That's where taking a mental health day comes in - a day off work or other responsibilities to focus on yourself and your well-being. 

Is it okay to take a mental health day?

Mental health is just as important as physical health, yet it's often overlooked or pushed aside. However, ignoring your mental health can have serious consequences, affecting everything from your work and relationships to your overall quality of life. 

Taking a mental health day is absolutely okay and normal.

It's absolutely fine to take a break from work or other responsibilities to prioritize

Up Next

Perception Of Pain: 7 Reasons Why Some People Feel Pain More Strongly

Perception Of Pain Reasons Why Some People Feel Pain More Strongly

Feeling pain is natural as a human being. However, do some people feel pain more? Sometimes, some people's perception of pain is stronger compared to others. Why do some people feel pain more than others?

Key Points

People feel pain because of how the brain interprets input transmitted to it from all of the senses.

There are significant individual differences in perceptions of pain.

Listening to music has the ability to reduce one's perception of pain.

Pain has a protective role. Because of pain, we can receive warnings that trigger our reflexes to escape potential dan

Up Next

When Birthdays Aren’t Happy: Understanding and Coping with Birthday Depression

Depressed On My Birthday Understanding Birthday Depression

Do you feel sad and upset on your birthday? Do you ask yourself “Why do I feel depressed on my birthday?” Birthdays are often considered to be joyous occasions, a day filled with excitement, celebration, and anticipation of the year ahead. 

However, for some people, birthdays can be a source of sadness and depression. In fact, there is a term for this condition: birthday depression.

A lot of people tend to experience birthday depression on the days prior to their special day, on their birthday and even after the day has passed. Let’s find out why this happens and how to cope with it.

What is birthday depression?

Birthday depression meaning:

Up Next

Coping With Postpartum Psychosis: What New Mothers Need To Know

Postpartum Psychosis Causes And Effective Treatments

The birth of a child is supposed to be a joyous occasion, but for some new mothers, it can trigger a serious mental health condition called postpartum psychosis. 

What is postpartum psychosis?

Postpartum psychosis is a rare but serious mental health disorder that can affect women in the weeks following childbirth, leaving them struggling with intense feelings of confusion, anxiety, and despair.

Fortunately, with the right support and treatment, recovery is possible. We must raise awareness about this condition and make sure that new mothers have access to the care and resources they need to heal and thrive.