Couples Therapy as Support in Eating Disorder Treatment

1/22/26 | By: Stephanie Wilkes

When your significant other is struggling with an eating disorder, it's common to feel confused about how to help them. Partners can often feel trapped between watching helplessly and inadvertently making things worse for both parties. Research shows that eating disorders have a major impact on romantic relationships, and relationship dynamics can either support or hinder recovery (Van den Broucke, Vandereycken, & Vertommen, 1995). Couples therapy is a powerful, evidence-based adjunct to individual treatment that can transform partners from helpless bystanders into effective allies while strengthening the relationship itself.

How Eating Disorders Affect Relationship Dynamics

Breakdown in communication: Couples navigating an eating disorder within the relationship may experience distance resulting from avoidance, secrecy, or dishonesty. Or on the flip side, couples may become exhausted by conversations constantly revolving around food and recovery.

Erosion of trust: Partners of those managing an eating disorder may find that the non-linearity of recovery feels like broken promises. This can lead to a lack of trust and security within the relationship. For some, this may trigger an urge to pursue more control, and for others, it may lead to emotional retreat.

Diminished intimacy: When communication and trust break down, emotional and physical closeness tend to suffer too. Additionally, the partner with the eating disorder may have concerns about how they look or how their body feels, which can lead to a lack of presence during physical intimacy or avoidance altogether.

Caregiver load: Whether they're acting as support, finding themselves in a monitoring role, or acquiescing to accommodate eating disorder behaviors, partners of people with eating disorders may experience anxiety, depression, loneliness, and burnout (Anastasiadou, Medina-Pradas, Sepulveda, & Treasure, 2014).

The Evidence Behind Why Relationship Dynamics Matter

Bidirectional impact: As mentioned above, the stress of an eating disorder can strain communication and intimacy in relationships, but research also shows that unrelated relationship tensions can act as a trigger for eating disorder symptoms (Treasure & Schmidt, 2013).

Accommodation research: Studies show a link between partners modifying behaviors to accommodate or monitor the other partner's eating disorder and both higher symptom severity and lower relationship satisfaction (Sepulveda et al., 2008).

Expressed emotion: The heightening of eating disorder-related anxiety within a couple's relationship, whether due to increased tension, feelings of resentment, patterns of criticism, or something else, predicts poorer recovery outcomes and a higher chance of relapse. By breaking apart this emotional entanglement, we can stop the cycles that make recovery more difficult for both partners.

How Couples Therapy Helps

Enhanced support: When stepping into the therapy room together, individuals can learn to provide effective support grounded in empathy that promotes autonomy for the partner with the eating disorder rather than dependence. This type of support can lead to a greater sense of connection while helping each partner remain differentiated within the relationship. Meta-analyses demonstrate that partner involvement enhances treatment adherence and symptom reduction (Bulik, Baucom, Kirby, & Pisetsky, 2011).

Reduced accommodation: Couples will often inadvertently fall into patterns that uphold eating disorder behaviors, and it can be hard to recognize that it's happening. In couples therapy, the therapist can help you recognize where these patterns are emerging and find ways to disrupt the problem sequence.

Improved communication: Couples often come into therapy with the goal of improving general communication, but it's especially crucial to build these skills around topics that carry a lot of complicated emotion. In sessions, a therapist can help a couple develop the language and expand their comfort level around topics that may be hard to broach, in addition to building techniques that minimize engaging with criticism or defensiveness (Gottman & Levenson, 1992).

Addressing underlying conflicts: Identifying relationship issues that trigger or maintain symptoms is essential. Longitudinal studies reveal that relationship quality both predicts and is impacted by recovery outcomes. Even after symptom remission, distressing relationship dynamics that formed around the eating disorder often persist, highlighting the need for relationship-focused intervention (Whisman, 2013).

Partner psychoeducation: Understanding the disorder reduces blame and increases empathy, creating space for both partners to approach recovery with greater compassion and realistic expectations.

What Couples Therapy Looks Like

Psychoeducation: Understanding how eating disorders function independently and within a relationship system.

Communication skills: Building techniques to increase vulnerability and decrease criticism and defensiveness to drive toward a greater sense of safety and connection.

Breaking accommodation patterns: Learning the difference between support and enabling, identifying where accommodation is occurring, and building tools to help each partner set healthy boundaries.

Rebuilding intimacy: Deepening both physical and emotional connection, for example, through reconnecting to roles as intimate partners rather than patient and caregiver, engaging emotionally outside of the eating disorder, and addressing physical intimacy concerns related to psychological or bodily impacts from the eating disorder.

Conflict management: Expanding methods for managing stress and reducing hostility, which, in turn, helps prevent symptom relapse in response to the inevitable ups and downs in relationships.

Finding Your Way Forward

Though they may feel deeply personal to those who have them, eating disorders don't exist in a vacuum. They can have a profound impact on intimate relationships, and those relationships can either bolster or undermine recovery. Couples therapy can help address both how the eating disorder affects the relationship and how relationship patterns sustain symptoms.

If some of these dynamics sound familiar and you're interested in working to get unstuck from unhelpful cycles so that you can experience supportive allyship, reach out to set up a consultation.

Reach Out

If you’re considering professional support, we’re here to help. Please reach out to schedule a free, no-commitment consultation. There’s no fee and no obligation—just click the button below to get started.

You can also call or text us at 202-656-3681, or email us directly. Give yourself the opportunity for the support you deserve.