Understanding Disordered Eating: For anyone whose relationship with food feels harder than it should

In this episode, Heather Ferguson is back, and we're taking that conversation a whole lot deeper. We're talking about what happens when we slow down enough to pay attention to what's happening in the body, how trauma can show up when someone doesn't have the words to explain what they're experiencing, and why recognizing the connection between trauma and an eating disorder doesn't automatically tell us how to support someone through healing. 
Heather Ferguson, LCSW, is a psychoanalyst, faculty member, and supervisor at the Institute for the Psychoanalytic Study of Subjectivity and the National Institute for the Psychotherapies. As a certified hypnotherapist and EMDR practitioner, she incorporates embodied techniques into her psychoanalytic work. She writes about eating disorder treatment, the role of intergenerational trauma transmission, and how embodied techniques can deepen psychotherapeutic engagement. Heather is co-editing a forthcoming book with Susan Klebanoff entitled Revisiting Ferenczi's Unwelcome Child in Turbulent Times. She maintains a private practice in New York City.
There's a lot packed into this conversation, and honestly, I could have kept asking questions for another hour. So grab your headphones and listen to the full episode.
Quotes
"So many of our patients are in that hypoarousal, more dissociated, collapsed state with disordered eating, particularly those that are really disordered and are maybe underfed, that their sort of neocortex is not online, that their thinking brain is not fed enough, and they are kind of shut down." - Heather Ferguson
"I think helping patients learn the sequence of what happens; An emotion, a feeling state, a sensation and maybe their own protective defenses that may be the shutdown neurobiologists talk about the dorsal response, the collapse." - Heather Ferguson 
"And I should say that I also use my body as information." - Heather Ferguson
"We have mirror neurons, right? We map empathically, and we often imagine and feel with our patients." - Heather Ferguson
"EMDR is not magical; it's just intense." - Heather Ferguson
"And I think to sort of indicate how it's ingenious, how there's so much shame, and you know this." - Heather Ferguson
"Let's not forget. We don't have to always fix it." - Heather Ferguson
"Everyone doesn't walk around with equal freedom and safety in their bodies." - Heather Ferguson
"There's two versions of the stuckness. There's the person who stays in this almost intellectual place of, 'This is the body that I want. This is the body that I don't have.' And there's no amount of work or talking about it that's going to change that. Then there's a different version of stuck. They've identified their associations with poor body image. They understand how their history connects here, and then they're like, 'Okay, we've talked about it.' And they're still stuck." - Rachelle Heinemann
Frequently Asked Questions
1. Can trauma cause an eating disorder?
Trauma can be a significant risk factor for developing an eating disorder, although there isn't always a simple cause-and-effect relationship. Trauma can influence emotions, body image, self-esteem, and coping, and eating disorder behaviors may become a way of managing experiences that feel overwhelming.
 
2. What is the connection between trauma and eating disorders?
Trauma and eating disorders can become closely intertwined. Eating disorder behaviors may temporarily help someone numb, avoid, control, or cope with difficult thoughts and feelings. Over time, those behaviors can become part of the cycle that keeps both the distress and the eating disorder going.
 
3. Can an eating disorder be a coping mechanism?
Yes. Eating disorder behaviors can serve a purpose for someone, even when those behaviors are harmful. Restriction, bingeing, purging, or other behaviors may provide temporary relief from anxiety, difficult emotions, shame, or a sense of being out of control. Understanding what a behavior is doing for someone can be an important part of treatment.
 
4. How does trauma affect body image?
Trauma can affect the way someone experiences and relates to their body. For some people, body dissatisfaction, shame, or attempts to change or control their body can become connected to difficult experiences. Body image can also be influenced by lots of other factors like social expectations and other lived experiences.
 
5. What is trauma-informed eating disorder treatment?
Trauma-informed treatment considers a person's history and the ways trauma may influence their thoughts, emotions, behaviors, and relationship with their body. It means creating space for that history without assuming every eating disorder has the same origin or that every client needs the exact same treatment approach.
 
6. Can you treat trauma and an eating disorder at the same time?
Yes, trauma and eating disorders can be addressed through an integrated treatment approach. The timing and approach matter, especially when someone is actively struggling with eating disorder behaviors or is medically compromised. Treatment needs to be mindful not to do trauma work before they're ready.
 
7. Why is body awareness important in eating disorder recovery?
Learning to notice sensations, emotions, and physical responses can help someone better understand what is happening internally and how that connects with their behaviors. For some people, this creates a bridge between intellectually knowing something and actually experiencing it in their body, which can be an important part of the therapeutic process.
Resources
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There are some questions that sound simple until you actually sit with them.
This is one of those questions:
"Can I work with a dietitian who specializes in eating disorders and also helps me lose weight?" 
At first glance, it feels like a yes-or-no question. But underneath it is a much bigger conversation about recovery, autonomy, body image, health, medical advice, and the beliefs we've been taught about weight.
In this episode, we're unpacking why this question is so complicated for both clients and providers, and why giving a quick answer often skips over the part that matters most.
The real conversation usually isn't just about a referral. A question like this can come from many different places.
Whether you're in recovery, supporting someone who is, or you're a clinician navigating these conversations, this episode will challenge the way you think about weight loss and eating disorder treatment.
Quotes
"Respecting the request and knowing what to do and what you end up choosing to do turns out to be two different things."
"Questions always have something living underneath them."
"The whole premise of eating disorder treatment is neutralizing your relationship with food."
"When something feels intolerable... it says, 'I can't tolerate this feeling, so I need to manage it through food.'"
"Neutralizing the relationship with food is almost impossible because there's always an outside agenda running every food choice."
"There's a difference between someone whose health is genuinely at stake and somebody in real body image distress who just wants relief."
"It isn't about getting it right or wrong. It's about opening up a conversation, opening up the exploration, and seeing what's there."
"The referral is secondary. The conversation and the exploration is the primary."
Frequently Asked Questions
Can you lose weight during eating disorder recovery?
There isn't a one-size-fits-all answer. The more important question is why weight loss feels necessary. In eating disorder treatment, providers often explore what's driving the desire to lose weight before discussing referrals or treatment options. The conversation behind the request is often more important than the request itself.
 
Should someone with an eating disorder work with a weight loss dietitian?
It depends on the individual's situation, but the episode explains why this isn't a simple yes-or-no decision. Before making a referral, it's important to understand whether the request is rooted in medical concerns, body image distress, or something else entirely.
 
Why is weight loss complicated during eating disorder treatment?
Eating disorder treatment focuses on building a more neutral relationship with food rather than making food choices based on weight goals. When weight loss becomes the primary focus, it can make it difficult to separate food choices from external rules and emotional distress.
 
Can you pursue health and eating disorder recovery at the same time?
The episode discusses how health concerns deserve thoughtful exploration rather than blanket assumptions. Some people have legitimate medical questions, while others are primarily seeking relief from body image distress. Understanding which situation applies is an essential part of treatment.
 
Why do people want to lose weight during eating disorder recovery?
For some, the desire comes from concerns about physical health. For others, it's an attempt to escape the emotional pain of body image distress. Although the request may sound the same, the reasons behind it can be very different and deserve careful exploration.
 
What is the goal of eating disorder treatment?
The goal is to develop a healthier, more neutral relationship with food by reducing reliance on rigid food rules and learning to make decisions based on internal needs rather than external pressures. This creates space for healing instead of continuing the cycle of using food to manage emotional distress.
 
What should therapists do when a client asks for weight loss during recovery?
Instead of immediately saying yes or no, therapists can use the request as an opportunity to explore what's underneath it. The episode emphasizes that maintaining the structure of treatment while creating space for honest conversation often leads to more meaningful progress than providing a quick answer.
Resources
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This week is the last of our summer throwback series. Next week, we will be back with an all-new episode. Until then, check out this vault episode.
Originally aired as Episode 166, this vault episode takes an honest look at our relationship with exercise and movement, and why it can become far more complicated than it appears on the surface. For many people, movement stops being something that supports well-being and starts feeling like an obligation, a way to earn food, manage anxiety, maintain control, or even punish themselves.
In this episode, we explore the warning signs of compulsive exercise, how movement can become intertwined with eating disorders and perfectionism, and what it means when skipping a workout feels emotionally unbearable. We also talk about the physical and emotional costs of staying stuck in that cycle and the first steps toward building a healthier, more flexible relationship with movement.
Resources
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Now accepting new clients! Find out if we're a good fit! 
 
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You can connect with me on Instagram @rachelleheinemann, through my website www.rachelleheinemann.com, or email me directly at rachelle@rachelleheinemann.com

This week, we are continuing with our summer throwback series.
Originally aired as Episode 174, this vault episode explores a question many people ask: What's the difference between disordered eating and an eating disorder? The line isn't always obvious, especially in a culture where restrictive habits, food rules, and body dissatisfaction are often normalized. In this episode, I break down the key differences, the warning signs to watch for, and when seemingly "healthy" behaviors may be crossing into something more serious.
Whether you're questioning your own relationship with food or trying to better understand a loved one's experience, this conversation offers practical guidance and reassurance. More than focusing on labels, we explore why the impact these behaviors have on your daily life is what truly matters.
Resources
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Now accepting new clients! Find out if we're a good fit! 
 
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You can connect with me on Instagram @rachelleheinemann, through my website www.rachelleheinemann.com, or email me directly at rachelle@rachelleheinemann.com

While we take a little summer break, we'll be rereleasing some of our most powerful and thought-provoking conversations, and this one tops the list.
Originally aired as Episode 175, this conversation remains one of our most impactful discussions on what it truly means to recover from an eating disorder. In this vault episode, I sit down with renowned eating disorder therapist and author Carolyn Costin to explore one of the field's most debated questions: Is full recovery really possible? Together, we unpack what recovery actually looks like, how to strengthen the healthy self, and why hope exists even for those who have struggled for years.
Carolyn also shares insights from decades of clinical experience, including her perspective on recovered clinicians, the evolution of eating disorder treatment, and the tools that have helped countless people move toward lasting recovery. Whether you're on your own recovery journey, supporting someone you love, or working in the eating disorder field, this conversation offers an encouraging and timeless perspective on healing.
Resources
Be sure to sign up for my weekly newsletter!
Brave on Purpose! - Grab my new book here!
Grab my Journal Prompts Here!
Looking for a speaker for an upcoming event? Let's chat!
Now accepting new clients! Find out if we're a good fit! 
 
LEAVE A REVIEW + help someone who may need this podcast by sharing this episode.
Be sure to sign up for my weekly newsletter here!
You can connect with me on Instagram @rachelleheinemann, through my website www.rachelleheinemann.com, or email me directly at rachelle@rachelleheinemann.com