I know from personal and professional experience that eating disorders are not easy to talk about in general, and this can also be the case in the therapy room. Counsellors and clients can often both feel uncomfortable discussing a subject area which is challenging to understand or put into words, and it is hard to put logic to something that is on a scale of self-abuse.
The question to pose is...can we change the subject? Can we consider for a moment that the eating disorder behaviour is a symptom not a cause, a sign of significant levels of distress within? So rather than focusing on the eating habits, weight, BMI etc. can we sit with another and ask...what is it you are feeling inside?
There are many originating causes of eating disorders, for example - trauma, neglect, abuse, attachment disorders, social media influence and so forth - but the bottom line is that there is a state of internal tension that one requires a coping mechanism to deal with. There is something that the individual is unable to accept about themselves or about life...and this is where a true conversation can begin.
It could be one of any other number of coping strategies such as alcohol or drug-taking, self-harm, being sexually promiscuous etc. but eating disorders serve a particular purpose for the individual. As the exploration deepens there is an opportunity to understand, rather than try to fix why it is that particular eating or non-eating behaviour works.
If the individual is willing to become joint explorers with their family member/friend/counsellor and start sharing some of what may feel unspeakable at first, by confiding in another they are already opening up to being in relationship, being supported, having a space to start expressing what they find so challenging.
This is not to say that monitoring BMI, weight, nutrition etc is not an essential part of the support required, but if we do not connect and sit with them just as another human being, they will continue to feel alone and unable to get the help they need, so that they can begin to accept that they are so much more than these emotions and behaviours.