Eating Disorders and Trauma: Understanding the Connection

Eating disorders are about food—but they're rarely only about food.

For some people, eating disorder behaviors become intertwined with experiences of trauma, safety, control, emotion, relationships, or the body itself.

That doesn't mean everyone with an eating disorder has experienced trauma. It also doesn't mean trauma automatically causes an eating disorder.

But when the two occur together, understanding their relationship can be an important part of treatment.

How Can Trauma and Eating Disorders Be Connected?

Trauma can affect the way someone experiences their body, emotions, relationships, and sense of safety.

Eating disorder behaviors may sometimes develop or intensify as a way of managing experiences that feel overwhelming.

Restriction may create a sense of control or emotional numbness.

Binge eating may temporarily provide comfort or relief.

Purging or other compensatory behaviors may become ways of managing distress.

Changes to the body may also carry complicated meanings related to safety, visibility, identity, or experiences someone has had in the past.

None of this means that someone consciously chooses an eating disorder as a coping strategy.

These patterns often develop gradually.

A behavior that initially seems to help someone manage distress can eventually become a source of significant distress itself.

Sometimes the Eating Disorder Feels Safer Than Recovery

From the outside, it can be difficult to understand why someone would feel afraid to give up something causing them so much pain.

But if an eating disorder has helped someone feel safer, more controlled, less emotionally overwhelmed, or more disconnected from difficult experiences, recovery can involve losing a coping mechanism before someone feels confident that they have alternatives.

This can create significant ambivalence.

Part of you may desperately want freedom from the eating disorder.

Another part may wonder:

What happens if I don't have this anymore?

That question deserves more than “Just use healthier coping skills.”

Treatment may need to help someone understand what the eating disorder has been accomplishing and develop other ways of meeting those needs.

Trauma Can Change the Relationship With the Body

Eating disorder treatment often asks people to become more connected to their bodies.

For someone with a trauma history, that isn't always straightforward.

Being aware of physical sensations may feel uncomfortable or unsafe.

Changes in body shape or weight may trigger unexpected emotions.

Being seen by other people may feel threatening.

Certain medical examinations, weighing practices, physical touch, or discussions about the body can also be difficult.

A trauma-informed approach recognizes that these reactions may have meaning.

The goal isn't to avoid every uncomfortable experience indefinitely. It's to approach treatment in a way that understands why certain experiences may feel threatening and builds enough safety to work with them.

Control Can Become Complicated

Eating disorders are frequently described as being “about control.”

That explanation can be overly simplistic, but control can play an important role for some people.

Trauma often involves experiences in which someone's control, choice, predictability, or sense of safety was disrupted.

Food, exercise, weight, or routines may later become areas where control feels possible.

This can make highly rigid treatment environments particularly complicated.

Structure can be necessary—and at times lifesaving—in eating disorder care.

But whenever possible, treatment can also preserve opportunities for collaboration, informed choice, and autonomy.

Structure and autonomy don't have to be opposites.

Do I Have to Process My Trauma to Recover From My Eating Disorder?

Not necessarily.

Trauma treatment and eating disorder treatment don't always need to happen simultaneously.

Sometimes the immediate priority is medical stabilization, adequate nutrition, or reducing dangerous eating disorder behaviors.

For other people, avoiding trauma entirely can eventually limit progress because trauma-related symptoms continue to influence eating disorder behaviors.

Treatment therefore needs to consider timing, stability, readiness, and the individual's goals.

There is no rule that says someone must tell their entire trauma story before they can recover from an eating disorder.

And trauma treatment shouldn't automatically be introduced simply because someone has experienced trauma.

The question is whether trauma-related symptoms are currently affecting the person's life and eating disorder—and whether addressing them is appropriate at this stage of treatment.

Can Trauma-Focused Therapy Be Part of Eating Disorder Treatment?

Yes, for some individuals.

Historically, people with eating disorders and trauma have sometimes received treatment sequentially: stabilize the eating disorder first and address trauma much later.

There are certainly situations where stabilization needs to take priority.

But treatment doesn't always have to conceptualize the eating disorder and trauma as completely separate problems.

When someone is medically and psychiatrically appropriate for outpatient trauma work, trauma-focused interventions may sometimes be incorporated into a broader eating disorder treatment plan.

The specific approach should depend on the individual rather than assuming one trauma treatment is appropriate for everyone.

What Is Accelerated Resolution Therapy (ART)?

One trauma-focused approach that may be incorporated into treatment when clinically appropriate is Accelerated Resolution Therapy, or ART.

ART is a structured psychotherapy that uses imagery and sets of eye movements while a person works with distressing memories, emotions, and physical sensations.

Importantly, ART does not require someone to provide a detailed verbal account of everything that happened to them.

For some people, that can make trauma-focused work feel more approachable.

During ART, the goal isn't to erase the factual memory of an experience. Rather, treatment works toward changing the distressing emotional and physiological responses that have become associated with that memory.

How Might ART Fit Into Eating Disorder Treatment?

ART isn't a treatment for every eating disorder, nor does having an eating disorder automatically mean someone needs trauma therapy.

But for some individuals, eating disorder symptoms may be connected to traumatic experiences or trauma-related beliefs and responses.

For example, someone may experience intense distress related to:

• Experiences within or changes to their body

• Feeling visible or being perceived by others

• Shame associated with the body or eating

• Past interpersonal or traumatic experiences

• Specific memories connected to food, weight, or treatment

• A persistent sense of danger or lack of safety

When those experiences continue to activate significant distress, trauma-focused treatment such as ART may become one component of a larger treatment plan.

The goal isn't simply to “process the trauma so the eating disorder goes away.”

Eating disorders are more complicated than that.

Instead, trauma work may help reduce one of the factors that continues to make eating disorder behaviors feel necessary or difficult to change.

Timing Matters

Being able to offer trauma treatment doesn't mean it should always happen immediately.

Before incorporating ART or another trauma-focused intervention, treatment needs to consider medical and psychiatric stability, current eating disorder behaviors, available coping resources, the person's goals, and whether outpatient treatment remains appropriate.

Sometimes trauma work makes sense now.

Sometimes it makes sense later.

And sometimes another treatment approach is more appropriate.

Individualized treatment means being willing to make that distinction.

What If I Don't Think My Trauma Was “Bad Enough”?

People often minimize trauma in much the same way they minimize eating disorders.

Other people had it worse.

It wasn't really trauma.

I should be over it.

Nothing that terrible happened.

Trauma isn't a competition.

At the same time, therapy doesn't need to label every difficult life experience as traumatic.

A more useful question may be whether an experience continues to influence how you relate to yourself, your body, other people, food, or safety.

If it does, it may be worth understanding.

Trauma Isn't Always the Explanation

There is an opposite mistake clinicians can make too.

Once trauma is identified, it can become tempting to explain every eating disorder behavior through that lens.

But eating disorders are complex.

Biology, genetics, temperament, anxiety, OCD, perfectionism, ADHD, cultural pressures, weight stigma, relationships, dieting, athletic environments, and many other factors can contribute.

Trauma may be one part of someone's story without being the entire story.

Individualized treatment means resisting the urge to force every person into the same explanation.

Recovery May Mean Building Something, Not Just Removing Something

When an eating disorder has functioned as a way to cope, treatment can't focus exclusively on taking behaviors away.

We also need to ask:

What needs to exist in their place?

More emotional regulation?

A greater sense of safety?

Stronger boundaries?

More meaningful relationships?

A different relationship with the body?

More tolerance for uncertainty or distress?

Greater autonomy?

Recovery can involve building a life in which the eating disorder no longer has to perform as many jobs.

For people whose eating disorders and trauma have become intertwined, addressing both may help treatment move beyond simply asking someone to stop a behavior—and toward understanding what has made that behavior so difficult to leave behind.

Trauma-Informed Eating Disorder Treatment in Westport, Connecticut

Dr. Joy Zelikovsky provides individualized, trauma-informed outpatient eating disorder treatment at Shoreline Eating Disorder Center in Westport, Connecticut.

Dr. Zelikovsky is trained in Accelerated Resolution Therapy (ART) and may incorporate ART into eating disorder treatment when trauma-focused work is clinically appropriate. Treatment considers eating disorder symptoms alongside the experiences, relationships, emotions, co-occurring concerns, and trauma-related responses that may influence them.

When appropriate, care is coordinated with registered dietitians, medical providers, psychiatrists, and other members of the treatment team.

In-person treatment is available in Westport, with telehealth available for appropriate clients throughout Connecticut.

A complimentary 15-minute consultation is available to discuss your needs, previous treatment experiences, and whether Shoreline may be a good fit.

This article is for educational purposes and is not intended to diagnose an eating disorder or trauma-related disorder or replace individualized medical, nutritional, or mental health care.

How to Choose an Eating Disorder Therapist: 7 Questions to Ask

Deciding to look for an eating disorder therapist can be difficult enough.

Then you start searching.

One therapist specializes in anxiety and lists eating disorders among fifteen other conditions. Another describes themselves as an eating disorder specialist. Someone else has a particular certification you've never heard of. Some accept insurance, others are private pay, and everyone seems to use different approaches to treatment.

How are you supposed to know who is actually the right person to help you?

There isn't one “best” eating disorder therapist for everyone. But eating disorders are complex mental and physical health conditions, and specialized training and experience matter.

Here are seven questions that can help you evaluate whether a therapist may be a good fit.

1. How Much of Their Practice Is Actually Focused on Eating Disorders?

Many therapist directories allow clinicians to select a long list of conditions they treat.

That doesn't necessarily mean the therapist has extensive experience treating every condition listed.

There's an important difference between a therapist who is comfortable discussing body image or disordered eating and someone whose clinical practice includes substantial work with diagnosed eating disorders.

When you're considering a therapist, it's reasonable to ask:

How much of your work involves treating eating disorders?

You might also ask which eating disorder presentations they most commonly treat and what specialized training they've received.

This doesn't mean every person with an eating disorder needs the clinician with the longest résumé.

But the more complicated the presentation, the more important specialized experience may become.

2. How Do They Determine Whether Outpatient Therapy Is Appropriate?

A good outpatient therapist shouldn't assume that everyone who contacts them belongs in outpatient treatment.

Eating disorders can involve significant medical, nutritional, and psychiatric risks. Sometimes weekly therapy is appropriate. Other times, someone may need an intensive outpatient program (IOP), partial hospitalization program (PHP), residential treatment, inpatient stabilization, or additional medical and nutritional support.

Ask a prospective therapist:

How do you determine whether someone is appropriate for outpatient treatment?

You want someone who is willing to tell you when their own service isn't enough.

That isn't rejection.

It's part of responsible eating disorder care.

3. How Do They Work With the Rest of the Treatment Team?

Eating disorder treatment frequently involves more than psychotherapy.

Depending on your needs, your treatment team might include a registered dietitian, physician, psychiatrist or psychiatric prescriber, and other specialists.

Ask:

Do you collaborate with other members of my treatment team?

You can also ask whether the therapist has established relationships with eating disorder-informed medical providers and dietitians if you don't already have those professionals.

Effective collaboration doesn't mean every provider must agree about everything.

It does mean that significant medical, nutritional, and psychological concerns shouldn't be treated as though they exist in completely separate worlds.

4. What Is Their Approach to Weight and Body Size?

This is an especially important question.

Eating disorders occur across the weight spectrum, and someone's appearance cannot tell us whether their eating disorder is serious.

Yet people in larger bodies may encounter treatment recommendations that focus on intentional weight loss even while they are receiving care for an eating disorder.

It is reasonable to ask a therapist directly:

How do you approach weight and body size in eating disorder treatment?

You may want to understand whether their approach is weight-inclusive, how they conceptualize health and weight, and how they handle situations where recommendations from different providers conflict.

You deserve to understand the philosophy guiding your treatment.

5. What Happens If I'm Not Completely Ready for Recovery?

Not everyone enters therapy feeling 100% committed to changing every eating disorder behavior.

In fact, ambivalence can be an important part of an eating disorder.

You may desperately want certain parts of your life back while simultaneously feeling terrified of what recovery could mean.

Ask:

How do you work with someone who isn't sure they're ready to fully recover?

Pay attention to how the therapist answers.

You want someone who can take eating disorder risks seriously without requiring you to pretend you feel differently than you actually do.

Treatment should create enough safety for honest conversations about motivation, fear, autonomy, risk, and what you want your life to look like.

6. Can They Treat the Problems That Exist Alongside the Eating Disorder?

Eating disorders rarely exist in a vacuum.

Someone may also experience anxiety, OCD, trauma, depression, ADHD, perfectionism, relationship difficulties, or other concerns.

Sometimes these issues are deeply intertwined with the eating disorder.

Ask:

How do you approach co-occurring concerns during eating disorder treatment?

You don't necessarily need a therapist who specializes in every diagnosis you've ever received.

But treatment should be able to recognize when another condition is influencing your eating disorder—and when additional expertise or collaboration may be necessary.

This can become especially important if you've received eating disorder treatment before but continue to struggle.

Sometimes the next phase of therapy needs to address more than eating disorder behaviors alone.

7. Do I Actually Feel Comfortable Talking to This Person?

Credentials matter.

Experience matters.

Specialized training matters.

And the therapeutic relationship matters too.

You should be able to ask questions.

You should feel that your therapist is listening rather than simply applying a predetermined treatment plan.

That doesn't mean therapy should always feel comfortable. Eating disorder treatment can involve difficult conversations, disagreement, uncertainty, and being challenged.

But there is a difference between being challenged within a relationship that feels collaborative and feeling as though treatment is simply being done to you.

A brief consultation can help you get an initial sense of how a therapist communicates and whether their approach feels compatible with what you're looking for.

What About Credentials?

The alphabet soup after a therapist's name can be confusing.

Psychologists, professional counselors, clinical social workers, marriage and family therapists, and other licensed mental health professionals may all provide psychotherapy.

Beyond professional licensure, some clinicians pursue additional eating disorder-specific training or certification.

Credentials can provide useful information about someone's education and training, but they aren't the only thing to consider.

Ask about the clinician's actual experience.

How long have they treated eating disorders?

What populations do they work with?

Do they understand different levels of eating disorder care?

How do they stay current with the field?

How do they approach situations that don't fit neatly into a standard treatment protocol?

Those answers can tell you more than a list of letters alone.

You Are Allowed to Ask Questions Before Choosing

You aren't being difficult by interviewing a prospective therapist.

Eating disorder treatment requires an investment of time, emotional energy, trust, and often significant financial resources.

It is completely reasonable to understand what you're signing up for.

A good therapist should be willing to answer questions about their experience, approach, fees, policies, collaboration with other providers, and what treatment might look like.

And sometimes a consultation leads to the conclusion that another provider would be a better fit.

That's okay too.

The goal isn't simply to find an eating disorder therapist.

It's to find someone with the expertise, treatment philosophy, and therapeutic approach that make sense for you.

Specialized Eating Disorder Therapy in Westport, Connecticut

Dr. Joy Zelikovsky provides specialized outpatient eating disorder treatment at Shoreline Eating Disorder Center in Westport, Connecticut.

Treatment is individualized and may be particularly appropriate for adolescents and adults with complex eating disorders, previous treatment experiences, co-occurring concerns, or ambivalence about recovery.

Dr. Zelikovsky takes a weight-inclusive approach and collaborates with medical providers, registered dietitians, psychiatrists, and higher levels of care when appropriate.

In-person treatment is available in Westport, with telehealth available for appropriate clients throughout Connecticut.

A complimentary 15-minute consultation provides an opportunity to ask questions, discuss what you're looking for, and determine whether working together may be a good fit.

This article provides general educational information and is not a substitute for individualized medical, nutritional, or mental health care.

Do I Need a Higher Level of Care for My Eating Disorder?

One of the most difficult questions in eating disorder treatment can be:

Is outpatient therapy enough for me right now?

Sometimes the answer is yes.

Sometimes someone needs more support than weekly outpatient appointments can reasonably provide.

And sometimes the answer changes over time.

Eating disorder treatment exists across different levels of care because people's medical, nutritional, psychiatric, and behavioral needs vary considerably. Needing more support doesn't mean you've failed at outpatient treatment—or that you have to wait until you're in crisis before considering other options.

What Are the Different Levels of Eating Disorder Treatment?

Eating disorder treatment generally ranges from traditional outpatient care to increasingly structured levels of support.

Outpatient treatment typically allows someone to continue living at home and participating in much of their regular life while meeting with members of their treatment team, which may include a therapist, registered dietitian, medical provider, psychiatrist, or other professionals.

Intensive outpatient programs (IOP) generally provide several hours of treatment on multiple days each week. This can offer additional therapeutic and meal support while allowing someone to maintain more of their usual daily routine.

Partial hospitalization programs (PHP) provide substantially more structure throughout the day, often including therapeutic programming, supported meals, nutritional care, and medical or psychiatric oversight.

Residential treatment provides 24-hour support in a specialized treatment environment.

Inpatient hospitalization provides intensive medical and psychiatric monitoring and may be necessary when someone requires acute stabilization.

The appropriate level of care isn't determined by diagnosis alone.

How Do We Know When Outpatient Treatment Isn't Enough?

There isn't one number, symptom, weight, or behavior that answers this question for everyone.

Level-of-care decisions should consider the whole clinical picture.

That may include:

• Medical stability

• Nutritional status

• Frequency and severity of eating disorder behaviors

• Psychiatric safety

• Ability to interrupt behaviors outside of treatment

• Ability to nourish yourself adequately

• Available support at home

• Co-occurring psychiatric or medical conditions

• How much the eating disorder is interfering with everyday life

• Whether meaningful progress is possible at the current level of care

Someone may technically be participating in outpatient treatment while spending most of the week unable to implement what is being discussed in sessions.

In those situations, the issue may not be a lack of effort.

There simply may not be enough support.

You Don't Have to “Look Sick” to Need More Help

One of the most harmful eating disorder myths is that someone's appearance tells us how sick they are.

It doesn't.

People across the weight spectrum can experience serious eating disorders and medical complications.

Similarly, someone doesn't have to reach a particular weight—or appear visibly ill—before a higher level of support can be appropriate.

Level-of-care decisions should be based on an individualized assessment of medical, psychiatric, nutritional, and behavioral needs rather than appearance alone.

Functioning Doesn't Always Mean You're Okay

People with eating disorders can sometimes continue functioning remarkably well while struggling significantly.

You may still be working.

Going to school.

Taking care of your family.

Meeting deadlines.

Showing up for appointments.

From the outside, things may look relatively normal.

Meanwhile, enormous amounts of mental energy may be going toward food, exercise, weight, body image, rituals, planning, compensating, or recovering from eating disorder behaviors.

Being able to function in some areas of your life doesn't automatically mean outpatient treatment is sufficient.

The more useful question is how much effort it takes to maintain that functioning—and what is happening underneath it.

A Higher Level of Care Isn't a Punishment

People are sometimes reluctant to consider more intensive treatment because it feels like evidence that they weren't trying hard enough.

It isn't.

Imagine trying to recover from a significant physical injury while receiving one hour of rehabilitation each week.

If you eventually needed more intensive rehabilitation, we wouldn't necessarily conclude that you had failed.

We might recognize that your needs exceeded what one hour of treatment could provide.

Eating disorder treatment can work similarly.

Sometimes a person needs more meal support, therapeutic contact, structure, medical monitoring, or containment than traditional outpatient care can reasonably offer.

That's information about the level of support needed, not someone's motivation or worthiness of treatment.

What If I Don't Want a Higher Level of Care?

This is where treatment decisions can become particularly complicated.

A clinician may believe that someone would benefit from more intensive treatment while that person feels unwilling—or unable—to pursue it.

There may be significant practical barriers.

Treatment can interfere with work, school, caregiving responsibilities, finances, relationships, or other commitments.

Insurance coverage and access may create additional limitations.

Someone may also have had previous treatment experiences that were frightening, invalidating, or simply ineffective.

And sometimes a person just isn't ready.

Those concerns deserve to be taken seriously.

At the same time, medical and psychiatric risks need to be taken seriously too.

This can require difficult but important conversations about what is recommended, what risks are present, what the individual is willing to consider, whether alternatives exist, and what can reasonably and ethically be managed in outpatient care.

What If I've Already Been to Residential, PHP, or IOP?

Having previously received a higher level of care doesn't automatically mean you need to return to one every time symptoms increase.

It also doesn't mean you should never return.

The question is what you need now.

Sometimes outpatient treatment after a higher level of care focuses on maintaining progress, navigating real-life challenges, addressing underlying concerns, and building greater independence.

At other times, symptoms may increase to a point where additional structure becomes necessary again.

Returning to a higher level of care doesn't erase the work you've already done.

Recovery isn't a pass-or-fail process.

You Don't Have to Wait Until Things Become an Emergency

People with eating disorders frequently minimize their own needs.

You may think:

Someone else is sicker.

I'm still functioning.

My labs weren't that bad.

I'm not thin enough.

I'm not doing the behavior every day.

I should be able to handle this myself.

But treatment isn't an award given to whoever becomes the sickest.

And needing more support doesn't require reaching the worst possible point first.

Earlier intervention can sometimes prevent further deterioration and provide support before someone's world becomes even more restricted by the eating disorder.

How Is the Right Level of Care Determined?

Level-of-care decisions are best made through individualized assessment.

A therapist may be one part of that process, but eating disorders can affect multiple areas of health. Medical and nutritional evaluation may therefore also be essential.

Depending on the situation, consultation with a physician, registered dietitian, psychiatrist, or specialized eating disorder program may be appropriate.

An evaluation also doesn't automatically commit you to entering a particular program.

It provides information.

Sometimes the recommendation will be to continue outpatient treatment.

Sometimes it will involve adding additional members to the treatment team or increasing support.

And sometimes a more intensive level of treatment may provide something outpatient therapy simply cannot.

The goal isn't to place everyone into the highest possible level of care.

It's to identify the amount and type of support that appropriately matches someone's current needs and safety.

Specialized Eating Disorder Treatment in Westport, Connecticut

Shoreline Eating Disorder Center provides specialized outpatient eating disorder treatment for adolescents and adults in Westport, Connecticut.

Dr. Joy Zelikovsky works collaboratively with clients and, when appropriate, medical providers, registered dietitians, psychiatrists, families, and higher levels of care. Treatment decisions consider the individual's needs, goals, autonomy, medical and psychiatric safety, and whether outpatient treatment remains appropriate.

In-person treatment is available in Westport, with telehealth available for appropriate clients throughout Connecticut.

A complimentary 15-minute consultation is available to discuss your treatment needs and whether outpatient care at Shoreline may be a good fit.

This article provides general educational information and cannot determine the appropriate level of care for an individual. Eating disorders can cause serious and potentially life-threatening medical complications. If you are experiencing an immediate medical or psychiatric emergency, seek emergency care.

Make Room for Growth

Confidence doesn’t always arrive with a bold entrance. Sometimes, it builds quietly, step by step, as we show up for ourselves day after day. It grows when we choose to try, even when we’re unsure of the outcome. Every time you take action despite self-doubt, you reinforce the belief that you’re capable. Confidence isn’t about having all the answers — it’s about trusting that you can figure it out along the way.

The key to making things happen isn’t waiting for the perfect moment; it’s starting with what you have, where you are. Big goals can feel overwhelming when viewed all at once, but momentum builds through small, consistent action. Whether you’re working toward a personal milestone or a professional dream, progress comes from showing up — not perfectly, but persistently. Action creates clarity, and over time, those steps forward add up to something real.

You don’t need to be fearless to reach your goals, you just need to be willing. Willing to try, willing to learn, and willing to believe that you’re capable of more than you know. The road may not always be smooth, but growth rarely is. What matters most is that you keep going, keep learning, and keep believing in the version of yourself you’re becoming.

Eating Disorders and OCD: When Treatment Needs to Address Both

Eating disorders and obsessive-compulsive disorder (OCD) can sometimes look remarkably similar.

Both can involve rigid rules, repetitive behaviors, intrusive thoughts, avoidance, checking, reassurance seeking, and a powerful feeling that something is wrong unless a particular behavior is completed.

For someone experiencing both an eating disorder and OCD, it can become difficult to tell where one ends and the other begins.

And sometimes, treatment needs to address both.

Why Do Eating Disorders and OCD Seem So Similar?

Imagine someone who needs to check a food label repeatedly before eating. They may feel intense anxiety if they cannot check it or may avoid the food entirely when they aren't certain what's in it.

From the outside, this looks like one behavior.

But what's driving it?

Someone with an eating disorder might be checking because they're afraid of calories, weight gain, or losing control over what they eat.

Someone with OCD might be checking because they're afraid the food is contaminated or contains an ingredient they believe could cause harm.

And for some people, both processes may be happening at the same time.

Understanding the reason behind a behavior can be just as important as identifying the behavior itself.

When Food Rules Become Rituals

Eating disorders often create rules.

You may need to eat at particular times, use specific utensils, prepare food in exactly the same way, eat foods in a certain order, repeatedly check labels, or follow increasingly complicated rules about ingredients and portions.

Some of these rules may be directly related to weight, shape, or eating disorder fears.

Others may feel more like compulsions, a behavior you feel driven to perform to reduce anxiety or achieve a feeling that something is finally “right.”

You might even recognize that the rule doesn't make logical sense and still feel unable to break it.

That's one of the reasons treating co-occurring OCD and eating disorders can become complicated.

Not Every Food Fear Is About Weight

Once someone has an eating disorder diagnosis, there can be a tendency to assume that every food-related behavior is part of the eating disorder.

But people avoid food for many reasons.

Someone may fear contamination or food poisoning. Another person may have an intense fear of vomiting. Someone else may experience intrusive thoughts about accidentally harming themselves or another person through food.

Sensory experiences can also affect eating, as can conditions such as ARFID.

At the same time, not every rigid food behavior is OCD. Eating disorders themselves can produce significant rigidity, anxiety, and ritualized behavior.

This is why good assessment involves more than asking what someone does.

We also need to understand what they believe will happen if they don't do it.

What About Intrusive Thoughts?

OCD is characterized in part by obsessions, recurrent, unwanted thoughts, images, or urges that can cause significant distress.

Compulsions are behaviors or mental acts someone feels driven to perform, often in an attempt to reduce that distress or prevent something feared from happening.

Eating disorders can also involve persistent, distressing thoughts.

Thoughts about food, weight, shape, exercise, calories, health, or eating may occupy enormous amounts of someone's day.

This can make it difficult for people to determine whether they're experiencing an eating disorder thought, an OCD obsession, or both.

The label matters less than understanding the pattern well enough to determine what kind of intervention is likely to help.

Reassurance Can Become Part of the Cycle

Reassurance seeking is another area where eating disorders and OCD can overlap.

You might repeatedly ask:

Was that too much food?

Are you sure this is safe to eat?

Did I exercise enough?

Do I look different?

Are you sure I didn't eat something that will make me sick?

Receiving reassurance may temporarily reduce anxiety.

But the relief often doesn't last.

Soon, the uncertainty returns and another reassurance is needed.

Over time, treatment may involve learning how to tolerate some of that uncertainty rather than continually trying to eliminate it.

Why Treating Only One Condition May Not Be Enough

Treatment becomes more challenging when interventions that make sense for one condition accidentally reinforce another problem.

Eating disorder treatment often involves creating enough structure and consistency around nutrition to support recovery.

OCD treatment, meanwhile, frequently focuses on reducing compulsive behaviors and increasing someone's ability to tolerate uncertainty.

For someone experiencing both, treatment may need to distinguish between helpful structure and rigidity that has become part of a compulsive cycle.

For example, following an appropriate nutrition plan may support eating disorder recovery.

Checking that plan repeatedly, needing absolute certainty that it has been followed perfectly, or becoming unable to tolerate a small deviation may be maintaining anxiety rather than reducing it.

The goal isn't to eliminate all structure.

It's to help someone develop greater flexibility within their life.

Both Conditions Can Make Your World Smaller

One of the most painful similarities between eating disorders and OCD is how gradually they can restrict someone's life.

At first, there may be a few rules.

Then certain foods become impossible.

Restaurants become stressful.

Travel becomes complicated.

Spontaneous plans feel overwhelming.

Social events require extensive preparation—or are avoided entirely.

Relationships can begin revolving around reassurance, food, exercise, rituals, or attempts to prevent anxiety.

Eventually, someone may realize that a tremendous amount of their life is organized around trying not to feel uncertain or afraid.

Treatment isn't simply about getting rid of a particular thought.

It's about helping someone reclaim parts of life that anxiety, rituals, and eating disorder behaviors have gradually taken over.

What Does Treatment Look Like When You Have Both?

There isn't one treatment plan that works for every person with an eating disorder and OCD.

Treatment may involve collaboration among an eating disorder therapist, registered dietitian, medical provider, psychiatrist, or other specialists depending on the individual's needs.

It may also incorporate evidence-based approaches used for OCD alongside specialized eating disorder treatment.

Most importantly, treatment should account for the whole clinical picture rather than forcing every symptom into a single diagnosis.

Sometimes the most useful question isn't:

“Is this my OCD or my eating disorder?”

Instead, we can ask:

“What is this behavior doing for me, what keeps it going, and how much of my life is it controlling?”

Those questions can provide a much more useful place to begin.

Specialized Eating Disorder Treatment in Westport, Connecticut

Dr. Joy Zelikovsky provides individualized outpatient eating disorder treatment at Shoreline Eating Disorder Center in Westport, Connecticut, including treatment for individuals experiencing eating disorders alongside OCD, anxiety, trauma, and other co-occurring concerns.

Treatment is designed around the individual rather than assuming every eating disorder—or every person's relationship with recovery—looks the same.

In-person treatment is available in Westport, with telehealth available for appropriate clients throughout Connecticut.

A complimentary 15-minute consultation is available to discuss your needs and whether working together may be a good fit.

This article is for educational purposes and is not intended to diagnose OCD or an eating disorder or replace individualized medical or mental health care.

I've Been in Eating Disorder Treatment Before. Why Am I Still Struggling?

Finishing eating disorder treatment, or spending months or years in therapy, doesn't always mean that the eating disorder disappears.

You may be eating more consistently but still thinking about food constantly. You may understand your eating disorder intellectually but find yourself returning to familiar behaviors when life becomes overwhelming. Perhaps you've completed residential, PHP, or IOP treatment and made significant progress, only to find that maintaining those changes outside of treatment is much harder than expected.

Sometimes people reach a particularly frustrating point: “I know what I'm supposed to do. So why am I still struggling?”

That experience doesn't necessarily mean that treatment failed. It may mean that the next phase of treatment needs to look different.

Eating Disorder Recovery Isn't Always Linear

Eating disorders are complicated conditions. Although nutrition and behavioral stabilization are essential components of treatment, an eating disorder rarely exists completely independently from the rest of someone's life.

Anxiety, obsessive-compulsive symptoms, trauma, perfectionism, ADHD, depression, relationships, identity, sensory experiences, and major life transitions can all interact with eating disorder symptoms.

As treatment progresses, the question sometimes shifts from:

“How do we interrupt the eating disorder?”

to:

“What continues to make the eating disorder necessary, useful, or difficult to give up?”

Those can require different therapeutic conversations.

You May Have Outgrown the Treatment You Previously Needed

Different phases of recovery may require different kinds of support.

Earlier treatment may appropriately focus heavily on medical stabilization, nutritional rehabilitation, reducing dangerous behaviors, establishing regular eating, or preventing hospitalization.

Later, someone may need more individualized work around the factors that continue to maintain their eating disorder.

For example, a person may no longer meet criteria for a higher level of care but still experience significant distress around food, exercise, weight, body image, relationships, or uncertainty.

The absence of an acute crisis doesn't necessarily mean someone is fully recovered.

Knowing What to Do Isn't the Same as Being Able to Do It

People with longstanding eating disorders often know an extraordinary amount about eating disorder treatment.

You may already know what a meal plan looks like. You may recognize your eating disorder thoughts. You may understand your triggers. You may even be able to identify exactly what your therapist or dietitian would tell you to do.

And still struggle to do it.

That isn't necessarily a knowledge problem.

Therapy may need to explore what happens between knowing and doing.

What does the eating disorder protect you from? What feels frightening about changing? What happens when you experience uncertainty or loss of control? What other coping strategies are available—and do they actually work for you?

These questions often require more than repeating information you already understand.

Ambivalence Is Part of the Conversation

Not everyone entering eating disorder treatment feels completely ready to recover.

Sometimes people desperately want their life to change while simultaneously feeling terrified of giving up the eating disorder.

Both can be true.

Rather than pretending that ambivalence doesn't exist, effective therapy can make room to understand it.

For some individuals, particularly those with longstanding or complex eating disorders, treatment may involve collaborative conversations about motivation, autonomy, risk, quality of life, and harm reduction while continuing to monitor safety.

You May Need More Specialized Care

If you've been in therapy but continue to struggle significantly with eating disorder symptoms, it may be worth considering whether your current treatment matches the complexity of what you're experiencing.

Eating disorders can overlap with OCD, anxiety, trauma, ADHD, mood disorders, neurodivergence, medical conditions, and other concerns. Treatment may need to account for those interactions rather than treating each issue as though it exists separately.

It can also be important to reassess whether outpatient therapy remains the appropriate level of care. Sometimes continued difficulty is a sign that additional structure or medical and nutritional support is needed.

Struggling Again Doesn't Erase Your Progress

Returning symptoms don't mean you're back at the beginning.

Recovery often involves learning what happens when treatment meets real life: relationships, work, school, travel, stress, grief, changing bodies, illness, independence, and uncertainty.

Sometimes the next stage isn't about starting over.

It's about understanding what still isn't working and developing a treatment approach that fits where you are now.

Specialized Eating Disorder Treatment in Westport, Connecticut

Dr. Joy Zelikovsky provides specialized outpatient eating disorder treatment at Shoreline Eating Disorder Center in Westport, Connecticut, as well as telehealth for appropriate clients.

Treatment is individualized and may be particularly helpful for individuals with complex or longstanding eating disorders, co-occurring concerns, previous treatment experiences, or ambivalence about recovery.

A complimentary 15-minute consultation is available to discuss whether treatment may be a good fit.

This article is for educational purposes and is not a substitute for individualized medical, nutritional, or mental health care.

Eating Disorders in Larger Bodies: Why Serious Symptoms Are Often Missed

One of the most persistent myths about eating disorders is that you can tell whether someone has one simply by looking at their body.

You can't.

Eating disorders occur across the weight spectrum. People in larger bodies can experience significant restriction, binge eating, purging, compulsive exercise, nutritional deficiencies, and serious medical complications. Yet their symptoms are often recognized later—or overlooked entirely.

In some cases, the very behaviors that would cause concern in a thinner person are praised when they occur in someone living in a larger body.

An Eating Disorder Doesn't Have a “Look”

Popular images of eating disorders have historically focused on extremely thin individuals, particularly young white women with anorexia nervosa.

That stereotype leaves many people wondering whether their own experience is serious enough to count.

A person may be restricting significantly, losing weight rapidly, experiencing intense fear surrounding food or weight, or becoming increasingly rigid about eating and exercise without ever appearing stereotypically underweight.

One example is atypical anorexia nervosa. Individuals with atypical anorexia can experience the restrictive behaviors, fear of weight gain, and significant psychological distress associated with anorexia while not meeting the low-weight criterion for anorexia nervosa.

The word atypical can unfortunately make the disorder sound unusual or less severe.

Neither assumption is necessarily true.

Weight Loss Can Hide an Eating Disorder in Plain Sight

Imagine two people begin skipping meals, dramatically restricting what they eat, exercising despite exhaustion, and becoming increasingly preoccupied with food.

One loses weight from an already smaller body.

The other loses weight from a larger body.

The first person may quickly receive expressions of concern.

The second may receive compliments.

Friends may ask what they're doing. Healthcare professionals may congratulate them. They may be told to “keep it up.”

Nobody asks what it is costing them.

That difference matters because social reinforcement can make it much harder for someone to recognize that their relationship with food has become dangerous or distressing.

Medical Risk Isn't Determined by Appearance

Eating disorders affect much more than someone's weight.

Restriction, purging, dehydration, binge eating, and other eating disorder behaviors can affect cardiovascular functioning, electrolytes, gastrointestinal functioning, hormones, cognition, energy, bone health, and other body systems.

Someone's appearance cannot tell us whether they are medically stable.

That is why appropriate eating disorder care often involves collaboration among therapists, physicians, registered dietitians, psychiatrists, and other professionals.

Weight Bias Can Follow People Into Healthcare

People in larger bodies sometimes encounter a particularly confusing situation in treatment.

One provider recognizes an eating disorder and encourages adequate nourishment and reduced eating disorder behaviors.

Another focuses primarily on weight loss.

The patient is left trying to reconcile two seemingly incompatible messages.

For someone already struggling with food, weight, and body image, this can reinforce eating disorder thoughts and make trusting treatment more difficult.

A weight-inclusive approach does not mean ignoring health.

It means evaluating health comprehensively rather than assuming body size alone tells us what someone should eat, how healthy they are, or whether an eating disorder is serious.

“I'm Not Sick Enough”

Many people with eating disorders struggle with the belief that they aren't sick enough to deserve help.

For people living in larger bodies, that belief can be especially powerful.

You may compare yourself to people you met in treatment, images you've seen online, or cultural stereotypes of eating disorders and conclude that your symptoms aren't severe enough.

You may even have had eating disorder behaviors praised as “healthy.”

But eating disorders are not competitions.

You do not have to reach a particular weight, appearance, or level of medical crisis before your relationship with food deserves attention.

Treatment Should See the Whole Person

Effective eating disorder treatment considers much more than a number on a scale.

It looks at eating behaviors, thoughts, emotions, medical functioning, nutritional status, relationships, culture, identity, quality of life, and the function an eating disorder may serve.

For many people in larger bodies, treatment may also involve addressing years of weight stigma—including experiences within healthcare—that have influenced how they understand their bodies and whether they believe they deserve care.

Your body does not have to look a certain way for an eating disorder to be real.

And you do not have to wait until someone else decides you look sick enough to ask for help.

Weight-Inclusive Eating Disorder Treatment in Westport, Connecticut

Dr. Joy Zelikovsky provides specialized, weight-inclusive eating disorder treatment at Shoreline Eating Disorder Center in Westport, Connecticut.

Treatment is available for adolescents and adults with eating disorders and disordered eating, including individuals whose symptoms have previously been overlooked or minimized because of their body size.

In-person and telehealth treatment are available for appropriate clients. A complimentary 15-minute consultation is available to discuss your needs and whether treatment may be a good fit.

This article is for educational purposes and does not provide medical advice or determine medical stability. Eating disorders can cause serious medical complications, and individuals experiencing concerning symptoms should seek appropriate medical evaluation.