When it comes to eating disorder treatment, one of the biggest questions people have is simple: What does it actually look like? The reality is that there's no single answer. Every person's story with food, body image, and recovery is unique, which means treatment has to be flexible, supportive, and tailored to the individual. Still, there are common building blocks that show up again and again, and understanding them can make the process feel a little less overwhelming.

The number one goal is eating disorder symptom reduction. That means consistent and adequate nourishment as the first and most important goal.

"No two eating disorders are going to look alike. No two people's stories are going to look alike." - Rachelle Heinemann

"The relationship we have with our people is going to be the catalyst for change." - Rachelle Heinemann

"Just because the numbers are good doesn't mean there isn't still an eating disorder." - Rachelle Heinemann

"Even if somebody starts to show signs of decreased symptoms, it doesn't necessarily mean that the work is over." - Rachelle Heinemann

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Ever feel like nothing in your closet feels good, no matter how many outfits you try on? Or maybe you've found yourself spiraling about what people will think when they see you at a reunion, a wedding, or even just in the office.

In this episode of Understanding Disordered Eating, I'm joined by my good friend and colleague, Sydney Green, MS, RD, to unpack the truth about body image: what it really means, how it shows up in daily life, and why it's so intertwined with our relationship to food.

"If you're on outfit seven, nothing's feeling good… can we just go with comfort? Can we just go with, okay?" - Rachelle Heinemann

"Body image is the last to go… which again, I don't even know what that means, although it's true, but it doesn't really mean much without unpacking it." - Rachelle Heinemann

"The successful woman is looking super chic, and she's really thin, and if I don't look like that, then I'm not successful. I'm not driven. I'm not motivated." - Sydney Greene

"A huge salad… our stomach is not meant to digest that. We're not rabbits. It just sits there. We get bloated. It doesn't feel good." - Sydney Greene

"Body image is not a symptom. It's like how we feel about ourselves… there's so much more richness to how we feel about our body." - Sydney Greene

"There's an actual word for some of this in research, it's called fat talk… women get together and talk about, pick apart their body, kind of like that Mean Girls scene." - Sydney Greene

"When somebody is struggling with body image, maybe the point is not to immediately erase it. Maybe we have to see it and acknowledge it and say, you're not alone." - Rachelle Heinemann

Connect with Sydney here: https://www.sydneygreenehealth.com/

Find her on Instagram!: @greenehealth

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What does it really mean to be fully recovered from an eating disorder?

For decades, the conversation has been clouded by vague definitions, conflicting philosophies, and the fear that "recovery" might not even be possible. In this powerful conversation, I sit down with Carolyn Costin, a renowned therapist, author, and pioneer in the eating disorder field, to dig into what recovery actually looks like, why she believes full recovery is possible, and how to strengthen the "healthy self" rather than fight against the eating disorder voice.

Carolyn Costin MA, MEd., MFT, CEDS, FAED, is a world renowned, highly sought-after eating disorder clinician, author, and international speaker. Recovered from anorexia in her twenties, as a young therapist Carolyn recognized her calling after successfully treating her first eating disorder client. Carolyn was first to publicly take the position that people with eating disorders can become fully recovered.

"When you are recovered, you will not compromise your health or betray your soul to look a certain way, wear a certain size, or reach a certain number on the scale." - Carolyn Costin

"We are not born with an eating disorder. We were born with this core healthy soul self in there." - Carolyn Costin

"Instead of getting rid of the eating disorder self, I help strengthen people's healthy self." - Carolyn Costin

"When someone has had an eating disorder, I want to be cautious for a while, but I know so many people now being in this for so long who are recovered and shit's happened in their life… and not slipped back." - Carolyn Costin

"I don't weigh myself. It's like a feminist statement." - Carolyn Costin

"We have to be careful… but my experience is people who are recovered actually navigate it better because we've already been through all that and it's like we have a bit of a shield up for it." - Carolyn Costin

Visit Carolyn's website - www.CarolynCostinInstitute.com

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Have you ever wondered where the line really is between disordered eating and a true eating disorder? It's not always as clear as we'd like to think. In fact, so much of what we consider "normal" in diet culture—tracking every bite, stressing over body image, or skipping meals in the name of health—can feel harmless at first… until it slowly starts taking over more and more of your life.

If you've ever asked yourself, "Is this just disordered eating, or is it something more?", this conversation is for you.

"You don't have to have a diagnosable or a life-threatening eating disorder in order to qualify to get help." - Rachelle Heinemann

"Think of it like an iceberg. Disordered eating is the part you can see… but an eating disorder is the entire iceberg—this massive, dangerous thing that's hidden." - Rachelle Heinemann

"With disordered eating, the rules are upsetting if you can't follow them. With an eating disorder, the rules feel like commands, and breaking them feels like a moral failure." - Rachelle Heinemann

"To me, one of the most important pieces to keep an eye out for is how your relationship with food is impacting your life—your work, your friendships, even your ability to leave the house." - Rachelle Heinemann

"No matter if you have a full-blown eating disorder or you struggle with yo-yo dieting, there is help out of it. You don't have to wait." - Rachelle Heinemann

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While we're on summer break, we're bringing back some of the most impactful episodes that deserve a second listen—and this one is just too good to pass up. This is our last re-release for the summer. We will be back with new episodes on September 9th, so be sure to tune back in.

In this episode, we're going deep into the neurobiology of eating disorders with Dr. Jeffrey DeSarbo, a renowned psychiatrist and medical director of ED-180, one of the largest private eating disorder treatment centers in the U.S.

If you've ever wondered why eating disorder recovery can feel so hard, or what's really going on in the brain beneath the behaviors, this episode will open your eyes and deepen your understanding. Dr. DeSarbo explains the science in a way that's relatable, clear, and deeply compassionate. From the neurological impacts of restriction, binging, and purging to the effects of compulsive exercise and body image distress, we're unpacking it all.

This conversation is a must-listen for clinicians, individuals in recovery, and anyone curious about the "why" behind the "what."

In this episode, we're talking about:

• Dr. Jeffrey De Sarbo's unique path from finance to psychiatry, and how he became a leading expert in eating disorder neurobiology.

• Why eating disorders are "half medical, half psychiatric"—and how this complexity makes them uniquely challenging and important to understand.

• What neurobiology really means, and how our brains function through electrochemical energy.

• The role of genetics and epigenetics in eating disorders, and why some people are more biologically predisposed than others.

• How brain scans show measurable differences in individuals with eating disorders, especially in how different regions of the brain communicate.

• Why "just eat" or "just stop" is a myth, and how deeply biological factors resist simplistic solutions.

• How behaviors like binging can physically change the brain, creating patterns that mimic addiction and drive compulsion.

• What restriction does to the brain, including loss of gray and white matter and cognitive impairment, even when someone appears high-functioning.

• The dangerous effects of purging, from electrolyte imbalances to cardiac issues, and why "feeling fine" doesn't mean you're medically safe.

• The neurobiology of compulsive exercise, and how stress hormones and overtraining harm the brain's ability to function and recover.

• Why body image distress is not just emotional but neurological, with altered blood flow patterns and measurable differences in perception.

• How neurobiology informs the recovery process, and why rewiring the brain is both essential and entirely possible—with time, persistence, and support.

"Eating disorders are not a choice. It's something that happens." - Dr. DeSarbo

"Oftentimes, when we work with our eating disorder patients, they have 10,000 plus hours of eating disorder thought processes—so they become experts." - Dr. DeSarbo

"Restriction with anorexia nervosa is giving you a compromised brain." - Dr. DeSarbo

"You're invincible until you are not—and then it is too late." - Rachelle Heinemann

"What percentage of your free thoughts, when you're not busy actively doing something, do you spend thinking about or worrying about food, weight, body image, calories, exercise?" - Dr. DeSarbo

ED180

The Brain and Neurobiology of Eating Disorders

Translating ED

Nora Volkaw

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We're diving into the archives this summer to bring you some of our most memorable and impactful conversations — and today's episode is just too good to pass up. While we take a short summer break, we're re-sharing these standout episodes. So stay tuned all summer long for these gems!

This week, we're bringing back Episode 27 with Dr. Danielle Novak — a deep and moving conversation that fuses psychoanalytic insight with the complexities of eating disorders.

Dr. Novak, a clinical psychologist with over 20 years of experience and currently in psychoanalytic training at NYU, joins us to unpack one of the most elusive and critical aspects of disordered eating: the role of dissociation. This isn't just theory — it's a raw, compassionate exploration of how symptoms aren't random, but deeply protective mechanisms developed from unspoken, often unconscious emotional pain.

If you've ever felt disconnected from your body, confused by your reactions, or wondered why food has such a powerful grip in moments of distress, this conversation will resonate deeply.

In this episode, we're talking about:

• How eating disorders develop and are maintained as protective responses, not simply destructive habits.

• What dissociation really means and how it can show up subtly or severely in our everyday lives.

• How trauma — both big "T" and small "t" — plays a central role in dissociation and the onset of eating disorders.

• The ways emotions get stored in the body and expressed through symptoms when they can't be spoken.

• How restriction, binge-purge cycles, and overexercise act as coping mechanisms for overwhelming feelings.

• Why symptoms may provide temporary relief, but ultimately prevent us from connecting with our emotions and others.

• How building awareness and creating a "pause" between urge and action can begin to reconnect dissociated parts of the mind.

• The vital role of the therapeutic relationship in healing dissociation and restoring emotional expression.

• Why treatment often begins with symptom stabilization but must eventually move into deeper emotional territory to be truly transformative.

"I tend to believe that eating disorder behaviors are often sort of stand-ins for feelings that cannot be felt as feelings or expressed through words or through other means." - Dr. Danielle Novack

"People don't learn how to regulate emotions. Emotions are just put away in a box and not looked at and not dealt with, and become separated from what's conscious." - Dr. Danielle Novack

"Often people describe restriction as giving them a sense of like numbness and detachment that often feels preferable and safer than actually feeling their feelings." - Dr. Danielle Novack

"Without knowing what's going on in our body, we can't possibly create important connections." -Rachelle Heinemann

Dr. Danielle's Website

It Takes A Village By Dr. Danielle Novack

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While we take a little breather, we're diving into the archives to bring you some of the most powerful, thought-provoking episodes from the past. These conversations are just too good to leave behind—and today's is no exception.

We're throwing it back to Episode 57, a deeply moving and intellectually rich conversation with Heather Ferguson, one of the most respected voices in trauma-informed psychoanalysis and eating disorder treatment. Heather's insight into the nuanced connection between trauma and disordered eating is unmatched, and in this conversation, we scratch the surface of a topic that could easily fill a semester-long course.

From childhood trauma and body memory to dissociation, shame, and the slow, compassionate path to healing, this episode is a must-listen whether you're a therapist, a survivor, or simply curious about the deeper psychological layers behind disordered eating.

In this episode, we're talking about:

• What trauma really means—including the difference between "Big T" and "small t" trauma—and how it shows up in unexpected ways.

• How the context and response to a traumatic event can shape the severity and meaning of the trauma.

• How eating disorders can act as survival strategies: tools for self-soothing, control, and numbing.

• What it means when an eating disorder serves both soothing and self-punishing functions.

• Why the healing process must include not just the mind, but the body—and how we create space for that in therapy.

• How early trauma and misattunement can shape our beliefs about ourselves and our bodies.

• How intergenerational trauma, secrecy, and silence can pass psychological pain down through families.

• Why creating a coherent narrative and reclaiming agency are essential to healing.

• How somatic awareness and slowing down automatic behaviors are key to shifting patterns of disordered eating.

• How cultural, familial, and historical narratives about food and bodies impact how trauma and eating disorders manifest.

• Why curiosity, compassion, and shared storytelling are central to transformative healing.

"The eating disorder became a self-management tool, a self-regulating tool, a strategy to manage states of hyperarousal and anxiety, to have a sense of efficacy and control." – Heather Ferguson

"Most of us with a psychoanalytic frame of mind think about eating disorders serving both functions, that is, they can both downregulate and soothe the nervous system, but it can also be self-harming and self-punishing." – Heather Ferguson

"That's part of what gets mapped around trauma – 'I'm bad, I deserve punishment.' It's illogical, it's sort of how the psyche makes sense of this – that you are the bad one, and you somehow induce the traumatic event." – Heather Ferguson

"The eating disorder, in a way, can be a window into understanding the trauma." – Heather Ferguson

Heather's Website

Heather's email: [email protected]

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We're continuing our summer throwback series with a powerful episode that's simply too important to leave behind. While we're taking a short break this summer, we'll be resurfacing some of our most impactful conversations — the ones that made us think, challenged the status quo, and sparked meaningful dialogue. Today's rerun is one of those episodes.

Originally aired as Episode 72, this conversation with Jessica Setnick dives headfirst into the controversial 2023 guidelines issued by the American Academy of Pediatrics (AAP). These guidelines made headlines — and not in a good way. Recommending behavioral interventions and even weight loss medications and surgery for children as young as 2, 12, and 13, respectively, the AAP ignited a firestorm of concern within the eating disorder treatment community.

Jessica, a fierce advocate and long-time voice in the eating disorder field, joins me to unpack what these guidelines really say, why they're so troubling, and how they reflect a deeper cultural problem rooted in weight stigma. We question authority, untangle complex motivations (hello, pharma profits), and explore what weight-inclusive, ethical pediatric care should actually look like.

In this episode, we're talking about:

• Why the AAP's new guidelines on pediatric weight management are sparking outrage in the eating disorder community.

• The alarming recommendations to introduce weight loss medications by age 12 and surgery by 13.

• The pervasive weight stigma built into these guidelines, including the problematic use of BMI as a screening tool.

• How profit motives, particularly from big pharma, may be influencing the creation of these "medical" guidelines.

• The real consequences of these interventions: malnutrition, stunted growth, cognitive impacts, and the risk of lifelong eating disorders.

• The false logic that shrinking a child's body will reduce weight stigma and why that belief is not just wrong, but dangerous.

• The importance of separating weight from health, and why any medical concerns should be treated based on symptoms, not size.

• How weight changes can be relevant when viewed contextually, but should never be the sole focus of medical intervention.

• Why trusting your gut and challenging medical advice is not only okay, but it might be necessary for protecting your child's wellbeing.

• Where to find weight-inclusive providers and what to ask when choosing a new pediatrician.

"Anyone who works in the eating disorder field at all – and probably many humans – knows multiple people, if not themselves, who have had failed weight loss interventions when they were children that then resulted in bigger problems." – Jessica Setnick

"The key is not to just single out the big kids. Any kid with an eating disorder should be evaluated. Any kid with a medical condition should be evaluated." – Jessica Setnick

"Shrinking children does not change their medical conditions." – Jessica Setnick

"'Does my child have a medical condition, or are you saying my child is too big? Because if it's a medical condition, we'd like to get treatment independent of his size. But if you're saying his size is a problem, that's not a conversation I'm willing to have.'" – Jessica Setnick

AAP Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity

News release for the AAP new guidelines

Understanding Disordered Eating, Ep. 30: Eating Disorders are the Solution Not the Problem with Jessica Setnick, MS, RD, CEDRD-S

Jessica on Facebook

Jessica on Instagram

Jessica Setnick: Understanding Nutrition

Jessica's Website

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We're kicking off our summer throwback series with an episode that's just too good not to share again. 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 73, this conversation with Dr. Judith Brisman is one of those rich, soul-stirring interviews that stay with you long after it ends. Dr. Brisman is an icon in the eating disorder treatment world. With over 35 years in the field and deep roots in psychoanalytic thought, she brings both clinical depth and human compassion to the most complex questions about food, desire, and emotion.

In this conversation, we explore why we turn to food to manage our feelings, how disordered eating often becomes the language of our unmet emotional needs, and what happens within family systems when an eating disorder is present. Dr. Brisman helps us understand not just the "what" but the "why" behind it all, offering a compassionate and grounded approach to recovery that emphasizes self-discovery, choice, and relational repair.

In this episode, we're talking about:

• How Dr. Judith Brisman became a pioneer in the treatment of eating disorders by blending behavioral work with psychoanalysis.

• How food becomes symbolic for desire and the complex ways we try to manage our wants and needs through eating behaviors.

• The link between emotional regulation and disordered eating, including compelling patient stories that bring theory to life.

• The role of family dynamics in shaping (and healing) disordered eating patterns.

• How feelings like anger, helplessness, and fear often get hidden behind food behaviors—and how therapy can bring these to light.

• Why recovery is not just about stopping behaviors, but about uncovering the inner voices and desires we've been afraid to face.

• What family-based treatment looks like and how parental roles and patterns can both support and hinder recovery.

• How to use moments of emotional overwhelm—like the urge to binge or restrict—as doorways into deeper self-understanding.

• How simple questions like "What do you want to eat?" can begin the process of helping someone find their voice again.

"Families all get into patterns, some of which work, some of which don't work. An eating disorder in the family is an opportunity to say, okay, what might need to be changed right now? What might need to be inspected?" – Dr. Judith Brisman

"We don't just see a parent in their role, and a child in their role; we see everybody in their roles, and how the dynamics come together." – Rachelle Heinemann

"Knowing [your emotions and patterns] allows for choice." – Dr. Judith Brisman

"It's not so important to identify the cause of the eating disorder… maybe it's interesting, but that's not going to end all or be the key… It's more about what's happening today, the identification, and what choice that provides." – Rachelle Heinemann

Dr. Judith Brisman's Website

Surviving an Eating Disorder: Strategies for Families and Friends

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Let's be honest—most of us would love to be the kind of person who "lives in the moment." You know, one of those magical unicorns who wakes up excited for the day, mindfully savors every bite of their avocado toast, and breathes through stress like it's non-existent. But instead, we're over here eating lunch in front of our inbox, wondering why we feel like a disembodied ghost hovering somewhere between a meeting and a meltdown.

"I just don't wanna feel like I am dissociating my entire life." - Rachelle Heinemann

"Food is inherently soothing, and it works because it's distracting and soothing at the same time." - Rachelle Heinemann

"Without practicing in very neutral low-stakes moments, it's gonna be almost impossible for us to notice when we're triggered." - Rachelle Heinemann

"We really have to think about all of this in the context of our specific lives and what we need so that we can work toward a version of ourselves that lives in however much of the present moment we actually want to live in." - Rachelle Heinemann

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