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

What if we spent less time trying to get rid of eating disorder symptoms and more time understanding why they're there in the first place?
In this episode, I'm joined by Nancy McWilliams, psychologist, psychoanalyst, and author with more than 50 years of experience in psychotherapy. I've been reading her work for over a decade, so getting to have this conversation was a pretty big deal for me.
We talk about what eating disorders might be doing for someone emotionally, why food can become a way to manage feelings we don't know how to name, and how early relationships can shape the way we experience food, control, and connection. We also get into why simply identifying a feeling doesn't magically make it go away. Wouldn't that be convenient?
Quotes
"We have a lot of research now that shows how much patients want self-understanding, not just symptom reduction. And sometimes when you're successful at reducing symptoms, the patient gets under stress, and they don't know what to do, and they get the symptom back." - Nancy McWilliams
"What matters to the patient is not the brand name of the therapy; it's the quality of the relationship." - Nancy McWilliams
"If you're able to just help a person speak their truth, you're doing something positive for them. Maybe they won't be able to conquer their eating disorder this year. Maybe they'll have to bottom out in some way and come back in a couple of years, but they'll remember that you were kind and compassionate and that you weren't judgmental." - Nancy McWilliams
"I think every time you make a genuine connection with another person, even if they couldn't use you at that time to move forward toward better mental health, it matters to them." - Nancy McWilliams
"People are always on their phones, even if they're sitting around the same table. They're not actually eating together." - Rachelle Heinemann
Frequently Asked Questions
1. What is psychodynamic therapy for eating disorders?
It's a way of working that looks at what's underneath the eating behaviors, like the emotions, relationships, and past experiences that might be driving them. Nancy explains that most people come to therapy wanting to understand themselves, not just reduce a symptom. The relationship with the therapist is a big part of the work.
 
2. Is focusing on eating disorder symptoms enough?
Sometimes it has to come first. Nancy is clear that if someone is in bad health, you work on getting them to eat. She also points out that when symptoms are reduced without understanding what's behind them, they can come back under stress. Her take is that both matter.
 
3. Why do people develop eating disorders?
It's different for everyone. Nancy shares examples like eating to feel soothed when a home wasn't comforting, chasing thinness because of what the culture rewards, eating when angry or sad, and using food to feel in control when everything else feels out of control. Early experiences with feeding and family meals can also shape our relationship with food.
 
4. Is an eating disorder an addiction?
Nancy says parts of eating disorders look a lot like addictions, and similar brain processes get activated. She explains that psychoanalysts learned decades ago that with addictions, understanding yourself isn't enough on its own. You have to focus on the behavior directly too.
 
5. Why do I use food to cope with my emotions?
When we weren't given words for intense feelings, we often don't know what we're feeling. We just feel activated. Food can quiet that, whether it's anger you don't recognize as anger, anxiety, or sadness you don't know how to grieve. Nancy shares a client who felt enraged after being criticized at the dinner table but only knew she felt terrible, and eating was what made her feel safe.
 
6. Why can't I name what I'm feeling? Is "overwhelmed" a feeling?
According to Nancy, overwhelmed isn't a feeling; it's what we say when we don't have words for one. Feelings sound like angry, sad, disappointed, resentful, or envious. She mentions a therapy program where adolescents were asked to name five feelings a day, and she describes the approach as helping enormously.
 
7. What makes therapy work for eating disorders?
Nancy points to the relationship, not the brand of therapy. Studies keep finding that therapist qualities like warmth, genuineness, hope, and compassion matter most. Trust takes time to build, especially for someone starting at zero, and that's okay.
Resources
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Related Episodes
Episode 126. Lying, Deception, and Eating Disorders with Tom Wooldridge, PsyD, ABPP, FIPA, CEDS-S
Episode 171. Healing the Hidden Wounds of Disordered Eating with Dr. Katheryn Zerbe 
Episode 107. The Rules of the Therapy Game with Dr. Dana Satir, CEDS
Episode 82. Secrets and Eating Disorders with Dr. Kathryn Zerbe
Episode 64. When Words Fail and Bodies Speak with Tom Wooldridge PsyD, ABPP, FIPA, CEDS-S
Episode 26. Eating Disorders and the Mind/Body Disconnect with Danielle Novack, Ph.D

 
Thank you to our sponsor! This episode includes paid endorsements and advertisements for products and services.
Therapists, listen up! What if the right EHR could transform the way you run your practice and meet needs you didn't even know you had? With TherapyNotes, managing your practice gets a whole lot easier. It brings the tools you need together in one place, from customizable note templates and electronic claims to an integrated client portal and more.
And with TherapyFuel, their assistive AI suite, you can streamline time-consuming tasks with features for progress notes, session refreshers, and more, so you can spend less time catching up and more time focused on your clients. Plus, TherapyNotes Mobile brings the features you know and love right to your mobile device, so your practice can keep moving wherever your day takes you.
Unlimited support, smart features, and flexibility on the go. Now that's practice management.
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There are certain things you assume medical professionals just know. Like how to read labs, how to diagnose things, or how to tell you what's going on with your body. But when it comes to eating, weight, and our relationship with food? There's a lot more nuance than "you should probably lose some weight" and a BMI chart.
In this episode, I'm talking about what I wish every medical practitioner understood about working with patients around food and weight. We're getting into why asking questions before giving advice matters, why your patient probably already knows what they're "supposed" to be doing, why weight advice can create shame instead of change, and why the way you deliver information can matter just as much as the information itself.
Quotes
"We need to ask questions, because we have no idea how someone feels about their weight." 
"The BMI chart tells you the average. It doesn't necessarily indicate health." 
"I'm saying we have to be a lot more deliberate. We have to be a lot more understanding and curious, understanding the limits of our training, understanding the limits of our relationship." 
"The sentiment here is: ask before you advise, because you have no idea what you're working with before you tell them to do something."
"Just saying to change how you eat or how you move is so invalidating, and it alienates them, and at the end of the day, it really keeps them from helping themselves. This is more of a question of what stops them from implementing things that they already know to do." 
"Our words matter. And the choice of words matters even more. Some people might hear it as criticism."
"It can really make or break a person and their relationship with food and their relationship with themselves when we have a critical tone."
"I can't tell you how many times people say, 'I went to the doctor and this thing stuck in my head and I cannot stop thinking about it.'"
Frequently Asked Questions
1. What is weight-neutral healthcare?
Weight-neutral healthcare focuses on a person's overall health, behaviors, symptoms, blood work, and other health indicators rather than assuming that weight itself is the primary problem that needs to be changed.
 
2. Does BMI actually indicate health?
BMI can provide information about where someone falls compared with population averages, but it does not tell you everything about an individual's health. Two people with the same BMI can have very different relationships with food, activity levels, symptoms, and overall health. 
 
3. Why can weight-loss advice be harmful?
Weight-loss advice can create shame rather than meaningful change, particularly when a practitioner doesn't understand the person's existing relationship with food, movement, or their own body. Shame can also make people less likely to open up or return for care.
 
4. How should doctors talk to patients about weight?
Doctors and other medical practitioners should ask questions before making assumptions or giving advice. Understanding how someone feels about their weight, their relationship with food, their movement habits, and what they've already tried can lead to a much more appropriate conversation. 
 
5. What is the difference between a weight-neutral dietitian and a weight-loss dietitian?
A weight-neutral dietitian focuses on developing an approach that considers the individual's relationship with food, health, and behaviors rather than automatically centering weight loss. For someone with a chaotic relationship with food, the episode recommends looking for an eating disorder dietitian, intuitive eating dietitian, or weight-neutral provider. 
 
6. Why is it important to ask questions before giving health advice?
Patients may already be doing many of the things a practitioner is about to recommend. Without asking questions first, a practitioner may give advice that is inaccurate, unnecessary, or potentially harmful to someone who already has a rigid or obsessive relationship with food or exercise.
 
7. Can a doctor's words affect someone's relationship with food and their body?
Yes. The episode emphasizes that medical practitioners have significant influence over how patients think about themselves. Even comments that aren't intended as criticism can stick with someone and affect their thoughts about their body, food, and health long after the appointment.
Resources
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Looking for a speaker for an upcoming event? Let's chat!
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Related Episodes
Episode 188. How to Recover in a Weight Loss and GLP-1 Obsessed World
Episode 149. Why Your Doctor Doesn't Need to Weigh You with Dr. Mara Gordon
Episode 133. GLP with Dr. Kim Dennis
Episode 130. So You Think Processed Foods Caused Obesity and the Answer is Weight Loss



Thank you to our sponsor! This episode includes paid endorsements and advertisements for products and services.
Therapists, listen up! What if the right EHR could transform the way you run your practice and meet needs you didn't even know you had? With TherapyNotes, managing your practice gets a whole lot easier. It brings the tools you need together in one place, from customizable note templates and electronic claims to an integrated client portal and more.
And with TherapyFuel, their assistive AI suite, you can streamline time-consuming tasks with features for progress notes, session refreshers, and more, so you can spend less time catching up and more time focused on your clients. Plus, TherapyNotes Mobile brings the features you know and love right to your mobile device, so your practice can keep moving wherever your day takes you.
Unlimited support, smart features, and flexibility on the go. Now that's practice management.
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This episode is for you if that sounds familiar. If you love someone in recovery or sit with people in recovery every day, stay close, because there's a lot here she might not be telling you.
A lot of recovery content swaps diets and clean eating for a new standard to measure yourself against. The comparison stays exactly the same: she's doing it right and I'm not. High achievers get hit hardest, since a model of the good way to recover is basically an invitation to ace it.
Quotes
"Nobody posts the meal that was kind of boring and just fine. That's what it looks like when food stops being the main character."
"What you're doing then is comparing your unedited inside to someone else's selected outside."
"I think the best question for us to ask is, "Do I feel less alone right now or do I feel behind?""
"Most recovery happens offline, like in private, in moments that, if we're being real here, are too small and sometimes almost too strange to post."
Frequently Asked Questions
Why do I feel worse about my recovery after scrolling social media?
Recovery content often swaps diet culture for a new standard to measure yourself against. The content is different, but the comparison is the same: she's doing it right and I'm not. Feeling behind after a scroll doesn't mean you're failing. It points to a part of you that is still looking for someone to tell you you're doing it right.
 
Is recovery content on social media helpful or harmful?
It can be both. Seeing someone else go through meals, appointments, and food challenges can feel validating and make you feel less alone. It becomes unhelpful when you start measuring your plate or your timeline against theirs.
 
What is the difference between feeling understood and comparing yourself to others in recovery?
Feeling understood happens around feelings like fear, ambivalence, and joy. Comparison starts when you look at what's on someone's plate or how far along they are. The first leaves you less alone. The second leaves you feeling behind.
 
Why do I feel behind in eating disorder recovery?
Feeling behind usually comes from "shoulds" such as "I should be eating ice cream by now" or "I shouldn't need more support." Social media may give those thoughts a face, but they usually start with what you believe recovery is supposed to look like and who you think you have to be to deserve it. A therapist or dietitian can help you work through them.
 
Is it normal to compare my recovery to someone else's?
Yes, and high achievers tend to feel it hardest. If you're handed a model of the "good" way to recover, you'll try to ace it. Social media also shows an edited, chosen version of someone's recovery, so you end up comparing your unedited inside to their selected outside.
 
What does eating disorder recovery actually look like day to day?
Mostly it's small and hard to film. It's the random Tuesday you ate lunch and didn't think about it, the fight where you said the thing instead of skipping a meal, or the moment you let yourself want something. You may not notice it in the moment, which is what it looks like when food stops being the main character.
 
How can clinicians and family members support someone who compares herself to recovery content online?
Get curious about what she is measuring herself against rather than telling her to unfollow. Listen for the "shoulds," and notice whether she is trying to be the good recovery story in the room by performing progress. The goal is a space where she can be seen, which social media can't offer.
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! 
Related Episodes
Episode 173. Being Present and Eating Disorders
Episode 172. Imposter Syndrome and Eating Disorders
Episode 147. Social Media and Eating Disorders with Lily Thrope, LCSW
Episode 146. Caring Less About What Others Think
 
Thank you to our sponsor! This episode includes paid endorsements and advertisements for products and services.
Therapists, listen up! What if the right EHR could transform the way you run your practice and meet needs you didn't even know you had? With TherapyNotes, managing your practice gets a whole lot easier. It brings the tools you need together in one place, from customizable note templates and electronic claims to an integrated client portal and more.
And with TherapyFuel, their assistive AI suite, you can streamline time-consuming tasks with features for progress notes, session refreshers, and more, so you can spend less time catching up and more time focused on your clients. Plus, TherapyNotes Mobile brings the features you know and love right to your mobile device, so your practice can keep moving wherever your day takes you.
Unlimited support, smart features, and flexibility on the go. Now that's practice management.
Use code UDE to get your first two months of TherapyNotes FREE.
Please note, this promotion is only valid for brand new TherapyNotes customers. 
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 LEAVE A REVIEW + help someone who may need this podcast by sharing this episode.
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In this episode, I'm digging into what might be underneath that "you just don't get it" reaction, from body image and fear of failure to grief, control, and the feeling that someone else is trying to make decisions about your body. Because sometimes, the eating behaviors we're trying so hard to change are serving a purpose we haven't fully understood yet.
I'm also talking to clinicians about what to do when a client pushes back against advice that's technically correct. Spoiler: labeling someone noncompliant and moving on probably isn't going to get you very far.
Quotes
"You can't be talked out of doing something that's doing a job."
"Having a reaction to something, whether it's rolling your eyes or writing it off or shutting down, doesn't mean that it makes it incorrect. It just means you're having a reaction and we can try to understand what it is."
"Whether it's a plan you're not ready to see fail, the loss you haven't let yourself feel, the one place that you get to steer, or the last thing that's still yours to decide, the way that you eat is holding something for you, which is why a "lecture" bounces off."
"And as long as it's still ahead of you, it's still possible. Anything is possible. You're full of hope."
"Even when the advice is completely correct, doing it on someone else's timeline can really feel like losing the last thing that was yours to decide"
"It's not just about delivering the information; it's understanding how the person is receiving it."
"Don't argue with the advice, and don't just swallow it. Ask what just happened internally when you heard that sentence. Ask what it might be protecting."
Frequently Asked Questions
Why is it so hard to eat more when you have an eating disorder?
Knowing that you need to eat more doesn't automatically make it easier to do. Fear of weight gain, body image concerns, and anxiety about changing familiar eating patterns can make eating more consistently feel overwhelming.
 
Why do I feel guilty after eating?
Guilt after eating can be connected to food rules, body image concerns, fear of weight gain, or beliefs about what and how much you should eat. Exploring what those feelings mean to you can help you better understand your relationship with food.
 
How can I eat more consistently with an eating disorder?
Eating more consistently often involves understanding what makes regular eating difficult, including fears around food, body image, and weight changes. Working with an eating disorder-informed clinician or dietitian can help you develop a plan that supports your nutritional needs and recovery.
 
How does body image affect eating disorder recovery?
Body image concerns can make recovery challenging when eating more consistently feels connected to giving up a hoped-for body size or weight. Working through those fears and the grief associated with changing body expectations can be an important part of recovery.
 
Why do I resist advice even when I know it's right?
Resistance can happen when advice feels threatening to something important, such as a sense of control, hope, independence, or ownership over your body. Understanding what your reaction might be protecting can help you explore the resistance instead of simply fighting against it.
 
What is the difference between restrictive eating and emotional eating?
Restrictive eating involves limiting food intake, while emotional eating generally refers to eating in response to emotions. These experiences can overlap with other eating patterns, and neither label alone tells the whole story of someone's relationship with food or nutritional needs.
 
How can therapists help clients who resist eating disorder treatment?
Therapists can explore a client's reaction with curiosity rather than immediately labeling it as noncompliance or avoiding the conversation. Asking what happened when the advice was offered, what felt difficult about it, and what the reaction might be protecting can help uncover barriers to recovery.
Resources
Sign up for my upcoming webinar: Foundations of Eating Disorder Treatment
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! 
 
Related Episodes
Episode 191. Why You Can Be Doing Everything Right and Still Feel Worse
Episode 146. Caring Less About What Others Think
Episode 120. Disordered Eating VS Eating Disorder, Which Is It?
Episode 111. How To Eat When You Don't Feel Like It
 
Thank you to our sponsor! This episode includes paid endorsements and advertisements for products and services. 
Therapists, listen up! What if the right EHR could transform the way you run your practice and meet needs you didn't even know you had? With TherapyNotes, managing your practice gets a whole lot easier. It brings the tools you need together in one place, from customizable note templates and electronic claims to an integrated client portal and more.
 And with TherapyFuel, their assistive AI suite, you can streamline time-consuming tasks with features for progress notes, session refreshers, and more, so you can spend less time catching up and more time focused on your clients. Plus, TherapyNotes Mobile brings the features you know and love right to your mobile device, so your practice can keep moving wherever your day takes you.
Unlimited support, smart features, and flexibility on the go. Now that's practice management.
Use code UDE to get your first two months of TherapyNotes FREE.
Please note, this promotion is only valid for brand new TherapyNotes customers. 
Sign up now! https://bit.ly/3Vyypvl
Promo Code: UDE

PS: I'm teaching Foundations of Eating Disorder Treatment in 60 Minutes on Thursday Oct 22 at 1pm ET on Zoom. If eating disorder cases keep landing on your caseload without training, this hour is for you. $49 individual, $129 for a whole practice, recording included. Details and registration.
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That feeling of I'm not enough can show up in a lot of ways.
In this episode, we're getting curious about what not feeling enough is actually telling you. Sometimes what you're jealous of isn't really the person, their body, their career, or their life. It might be the ease, confidence, connection, pride, or freedom you think they have. 
And when we don't stop to figure that out, those feelings can get redirected into something else. For some people, that might mean restriction, bingeing, purging, compulsive exercise, or constantly promising that tomorrow will be the day they finally get it together.
Quotes
"One passing thought or even a variety of passing thoughts isn't a verdict on you."
"This is like an urgency to it, and it's sort of like an urgency with this energy that has nowhere to go."
"Jealousy or comparing or noticing something that you lack, that's all information in the direction that you would like to go, whether it's conscious or not."
"A lot of people pursue restriction in the effort to feel like they have been good or good enough for the day."
"In some senses, purging, fasting, exercise is a way to get rid of the feeling like I'm too much, which ironically is kind of the same thing as not feeling enough."
"The promise to be better and then not following up on it is just sort of another manifestation of chronic insecurity, not feeling good enough."
"The biggest question is what it's actually costing you and whether that cost matches what you say you want."
"Once you name it, you'll notice it's not really about that other person, it's not really about you, and it's not even about not being enough. It's about the thing that you don't have."
"I think that there is a lot of utility in being curious about what is the area in particular that I don't feel good enough, that I feel insecure, because that lets us know where we can actually make movement as opposed to just staying with affirmations stuck to our mirror that might not resonate."
Frequently Asked Questions
1. Why do I always feel like I'm not good enough?
Feeling "not good enough" can show up when you compare yourself to other people, a previous version of yourself, or the expectations you have for your life. The important question is what specifically feels lacking. Getting curious about that can help you identify what you actually want or need instead of simply criticizing yourself.
 
2. How does low self-esteem affect eating disorders?
Low self-esteem and feelings of inadequacy can become connected with eating disorder behaviors. The episode explores how the urge to feel "good enough" can sometimes get redirected into restriction, bingeing, purging, fasting, or compulsive exercise. These behaviors may provide temporary relief from difficult feelings without addressing what is underneath them.
 
3. Why do I compare myself to other people?
Comparison can sometimes point to something you want or feel you are missing. Instead of stopping at "I wish I were like her," the episode encourages getting specific about what you are actually noticing, such as ease, confidence, connection, pride, or more room to breathe.
 
4. Can feeling insecure lead to disordered eating?
It can be one way difficult feelings get redirected into eating disorder behaviors. The episode discusses how restriction, bingeing, purging, fasting, and compulsive exercise can sometimes function as ways to manage or escape feelings of insecurity, inadequacy, or being "too much."
 
5. Why do I feel like I need to change my body to feel good enough?
Sometimes the desire to change your body becomes tied to a deeper belief that reaching a certain size, weight, or appearance will finally make you feel good enough. The episode challenges that connection by asking what you are actually hoping to gain from the change and what pursuing it may be costing you.
 
6. Is wanting to improve myself a bad thing?
No. The episode makes an important distinction between wanting something different for yourself and becoming consumed by the belief that you have to change in order to be enough. Wanting to improve can provide useful information. The bigger question is whether the cost of pursuing that goal matches what you actually want from your life.
 
7. How can I stop feeling like I'm not enough?
Rather than immediately trying to silence the thought, start by getting specific. Ask yourself what you believe another person, an earlier version of yourself, or an "ideal" version of you has that you want. It might be ease, connection, confidence, pride, trust, or something else. Once you identify it, you can begin thinking about how to build that thing in your own life. 
Resources
Sign up for my upcoming webinar: Foundations of Eating Disorder Treatment
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! 
 
Related Episodes
Episode 211: The 2 Fears Running Your Eating Disorder (And Why They Contradict Each Other)
Episode 198: People Pleasing and Eating Disorders
Episode 105: The Root of Your Emotional Eating
Episode 11:  Utilizing Curiosity to Develop Resilience and Eliminate Harmful Comparison with Jennifer Glass, LCSW
 
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