The nature and effects of psychotherapy clients' nondisclosure of eating and body image concerns

Client nondisclosure about their eating disorders may result in significant delays in receiving treatment and subsequent poorer long-term outcomes. Despite these consequences and the high mortality rate among eating-disordered clients, there is a dearth of research on the concealment of or lying about symptomatology among this population. The present, qualitative study examined a sample of respondents (n = 45) who reported dishonesty in therapy about eating issues and body image concerns and provided information about their motives for, and perceived consequences of, being dishonest about these issues. Thematic analysis of responses to two open-ended questions was conducted by a six-member coding team. Shame was found to be the most commonly offered reason for nondisclosure, specifically, shame about the body, shame about the pathological behavior, and shame from anticipated therapist judgment. A second commonly reported motive was clients' sense that they wanted to avoid unwanted therapeutic interventions into their behavior. Most respondents did not perceive their nondisclosure to negatively affect their therapy. Therapists, we conclude, should generally be more active in their pursuit of accurate information when they suspect clients are engaged in eating disordered behaviors, doing so in a manner that mitigates feelings of shame.