Is an eating disorder a symptom of a larger problem? What are eating disorders really about? Why is it not about the food? In this podcast episode, Dr. Cristina Castagnini discusses the bigger issues which underlie eating disorders.


  • An eating disorder is a symptom of a larger issue
  • “It is not about the food”
  • Possible reasons behind disordered eating

An eating disorder is a symptom of a larger issue

Disordered eating as a behavior is a symptom of a larger illness at hand and treating the eating disorder does not mean that the full issue has been healed.
What I’m hoping to do is bring awareness that simply changing behavior is not full recovery because the behavior is not the whole story, it’s just part of it. (Dr. Cristina Castagnini)
Even though changing eating disorder behaviors is a step in the direction of recovery, it is not full recovery itself.

“It is not about the food”

Eating disorders do not happen spontaneously. There may be underlying reasons that a person is struggling, and they may use food as a coping mechanism, which later develops into what the eating disorder becomes. It is easy to solely focus on healing the eating disorder without looking at what caused it; that is where the genuine healing takes place.

Possible reasons behind disordered eating

The need to assert control

The eating disorder gives a person a false sense of control over their life. Someone might not have the ability to make decisions for themselves in their home, and the eating disorder enables them to feel like they have control and autonomy.
Focusing on food and exercise can help someone to feel like they’re able to control something in their life if other areas in their life feel completely out of control. (Dr. Cristina Castagnini)

Purpose and Identity

An eating disorder can give someone a false sense of purpose and identity, especially if they feel very insecure, or only receive validation based on their outward appearance from their family and friends.
If someone starts to being known as “the healthy one”, “the gym rat”, this new identity is something they really don’t want to lose, so they want to maintain it because if they stopped it would mean losing their sense of purpose … and identity. (Dr. Cristina Castagnini)


An eating disorder can serve to communicate. Some people live in homes or spaces where they feel unsafe in speaking about their needs and wants, and they feel they will be judged, criticized, or misunderstood, and so the eating disorder becomes an expression of how the person is feeling internally.

Coping Mechanism

An eating disorder can be a coping mechanism. It distracts and numbs a person from having to deal with stressful or difficult things in their life.



I am a licensed Psychologist and Certified Eating Disorder Specialist. While I may have over 20 years of clinical experience, what I also have is the experience of having been a patient who had an eating disorder as well. One thing that I never had during all of my treatment was someone who could look me in the eye and honestly say to me "hey, I've been there. I understand". Going through treatment for an eating disorder is one of the hardest and scariest things to do. I remember being asked to do things that scared me. Things I now know ultimately helped me to get better. But, at the time, I had serious doubts and fears about it. If even one of my providers had been able to tell me "I know it's scary, but I had to go through that part too. Here's what will probably happen...." then perhaps I would not have gone in and out of treatment so many times. My own experience ultimately led me to specialize in treating eating disorders. I wanted to be the therapist I never had; the one who "got it". I will be giving you my perspective and information as an expert and clinician who has been treating patients for over 2 decades. But don't just take my word for it...keep listening to hear the truly informative insights and knowledge guest experts have to share. I am so happy you are here!


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[CHRISTINA CASTAGNINI] Behind The Bite podcast is part of a network of podcasts that are good for the world. Check out podcasts like the Full of Shift podcast, After the First Marriage podcast and Eating Recovery Academy over at Welcome to Behind The Bite podcast. This podcast is about the real life struggles women face with food, body image and weight. We're here to help you inspire and create better healthier lives. Welcome. Hello and welcome to Behind The Bite podcast. I'm your host, Dr. Christina Castagnini. Today at wants to discuss eating disorders. Now that may sound like an obvious statement, I mean, simply because this podcast is about eating disorders, but when I say that, I really mean just that. What are they really all about? There's so much confusion out there about what they really are and what they're not. So I sometimes hear people say eating disorders really are just about someone wanting to lose weight or look better or they are just about someone who is chronically dieting or always exercising. Or for instance, I'll have someone in my practice who was discharged from a higher level of care, like an intensive outpatient program and they or their loved one will think that they're no longer needing treatment or they no longer have an eating disorder or they're in full recovery because they've been able to follow their meal plan and they've been told by their medical providers that their weight restored and they're medically stable and so they believe it's time to stop treatment. I want to discuss this because it's important. So if you've listened to any of my previous podcast, I've said some of this before, an eating disorder is not really the problem. It is a symptom of the problem. There are underlying reasons for why someone engages in the behaviors with food or exercise that they do. So just because someone stops the behaviors, like I just mentioned, if they're able to follow a meal plan for instance, and they're no longer restricting or bingeing, for instance, that does not mean that the eating disorder, the actual illness itself is fully gone. Yes, this is a great step and every step towards recovery is important and it needs to be applauded for sure. So please don't take what I'm saying is anything to sound like I'm in any way, discounting or thing, any progress someone makes toward recovery is not awesome. But what I'm hoping to do is bring awareness that simply changing behavior is not full recovery because the behavior is not the whole story. It's just part of it. The eating disorder is not just about the food or the exercise or the numbers on the scale. That is just what we see on the surface. So when those things change, when those things on the surface seem like they're "fixed," and someone is no longer engaging in the eating disorder behaviors, it can be really confusing to understand why isn't someone at that point fully recovered. I mean, I get it. It would seem like someone who was once bingeing and purging several times a week, who is no longer doing that for weeks or even months. You know, it seemed like they'd no longer need treatment. Likewise, if you knew someone who had been severely restricting their food intake and also exercising compulsively for hours every day, if you saw them going out to restaurants and you saw them able to eat without restriction and they were no longer compulsively exercising for months, it would, of course, seem like their eating disorder was no longer an issue for them. Why wouldn't you think that? Why wouldn't they even think that? Well, because underneath the behaviors, there's often a lot more that needs to be addressed. That's why. The eating disorder behaviors did not just start for no reason. There are often underlying reasons for the eating disorder. It serves a purpose like helping someone distract, escape or numb from their uncomfortable, painful feelings or problems. It helps them cope. So it's really not about the food or the exercise. Even when someone with an eating disorder is not engaging in the behaviors, their mind is occupied most of the day with eating disorder thoughts, thoughts about what they want to eat, just eat, can't eat, but want to eat, thoughts about their body, weight, exercise, feelings of guilt, shame, or remorse about what they just say or anxiety about how they're going to fit in their exercise, exercises that they didn't already. They're constantly negotiating in their mind things like what they're allowed to eat or earned eating based on what they eat earlier that day, or want to eat later that day. I could go on and on about all the things that occupy someone's mind in the day that are eating disorder that only serve to distract them from other things that they would otherwise have space in their head to think about. So if you're struggling with this, ask yourself, if you were not thinking about all this all day long, what would you be thinking about or focusing on instead? You might not know. Well, I so often hear people say to me, "I'm so tired of thinking about this all day long. I just want it to stop. I just want to stop thinking about food and dieting and my weight and be free of it." But the interesting thing is that so often as painful and difficult, all of those thoughts are to have and every day for some reason, ultimately for some reason, they are still somehow considered, at least on some level, much less painful or scary than whatever thoughts or issues they might otherwise be having. Ultimately, whatever someone is avoiding or distracting from what their eating disorder that needs to be addressed. So what are some reasons why someone might have an eating disorder and why just because someone has on the surface changed their behaviors and even considered medically stable and weight restored, why are they not fully recovered? So one reason might be the eating disorder serves as a sense of control. So focusing on food and exercise can help someone to feel like they're able to control something in their life when other areas of their life feel completely out of control. So perhaps they feel overwhelmed with responsibilities or demands that either they placed on themselves or other people place on them, or perhaps they feel they're unable to make any decisions in their life and they have a lot of other people putting rules and constraints on them. So I'll give an example. If there's a young teenager who lives in a really strict household where they have a lot of rules and they're unable to go out with their friends and they have a lot of expectations placed on them to get straight A's and do well in school and maybe they're the oldest and they have to take care of their younger siblings while the parents are at work, this kind of person could possibly feel like the only thing they can control in their life is what they eat and how much they exercise. So the eating disorder can serve as a sense of control for them. And it sort of can also give someone a sense of purpose and identity. So when someone is insecure and struggling with who they are, if they start to focus on food and exercise, that structure and focus on reaching goals can feel really good. It can bring them a sense of purpose. They're striving to achieve something. And then really, if they start to see results from what they're doing, this can be even more validating, especially if others start to take notice. So if someone starts to become known for being "the healthy one" or the gym one, this new identity is something they really don't want to lose. So they want to maintain it because if they stopped, it would mean losing their sense of purpose and they will lose their identity. So engaging in behaviors, listen, it's not a true identity. Feeling this overwhelming compulsion and need to engage in these behaviors, it starts to become something else. They start to get anxious and the anxiety takes over if they don't engage in these behaviors. It's like they have to do them or else they feel like they have no purpose. They have no structure in their life. And this becomes all that matters. All of this becomes more important above everything and everyone else in their life and it just simply starts to take over everything. Another purpose that eating disorder behaviors or eating disorders concern is it serves as a way to communicate. So often people who have eating disorders feel like it's unsafe to speak their opinions, their needs, or their feelings. They fear they'll be judged, criticized, or even misunderstood if they talk. So they say nothing. I often find people who have eating disorders, they're not assertive. They stay quiet and they suffer in silence. The eating disorder signals, or it's really just one way for them to communicate to others, just how much pain and suffering is going on inside. You know, I'll share something. I recall one very distinct moment when I just thought to myself, okay, I'm just going to stop eating or drinking anything until I'm so emaciated that someone will finally ask me what's wrong. Maybe someone will finally get it, or at least ask because in that giddy awful moment, I didn't feel like I could say anything. On the outside it looked fine so I thought, no, one's going to get it. If I said something was wrong, I really believed I would be dismissed and told to stop complaining or told I was just being overly dramatic or overly emotional and even told something like, "So many people have it," and forced to shut up. But I thought, "Maybe if I was so sick looking, then it would finally be taken seriously that maybe somebody would finally pay attention to me and listen to me. Maybe I would finally be the one that had it worse and I would be taken seriously that I needed help." But really how sad that I felt then that the only way I would be listened to was if I looked physically like I was hurting, even though I was really emotionally hurting? So another purpose that an eating disorder can serve is that, and I mentioned this before it numbs or distracts you from painful emotions, thoughts or issues going on in your life. I think it needs to be mentioned again, because this is something that's very common. So for instance, if someone is bingeing, when they're bingeing, they're not feeling anything. They're really engaged in the binge. They're numb, they're distracted. But even before they engage in the binge, they may be thinking about the binge all day long. They may be looking forward to it for hours, thinking about what they're going to have at their binge, maybe planning it. And even the process of maybe going to buy the binge food takes up time and effort and energy and occupies their mind. And it serves as a great distractor from all sorts of other things and then after they may beat themselves up feeling guilty and have all sorts of these horrible thoughts about, it's horrible, what did you do? I'll never do this again, just really awful self-critical thoughts. And all of this is just serving to further occupy their mind and distract them even more. So those are other reasons why immune disorders exists. I want to mention the eating disorder complex. There's not one thing we can just point to about why someone has one. I'm discussing all of this today, because I do hear so often, like I said, people thinking that eating disorders are fully treated and someone is in recovery once they stop the behaviors and they're told they're medically stable. There's just so much more to consider as I've mentioned here, but the road to recovery is not linear. It's not a straight line. And for any of you out there who are in treatment right now or in recovery right now, just hang in there. Each and every step you're taking is courageous and definitely worth it. Like I know firsthand, it's not easy, but I also know firsthand that recovery is possible and you can achieve full recovery. So anything I said in here today that sounds confusing, or you want to ask more questions about please DM me and email me with any comments, any questions. I'm always here listening. Thanks guys. This podcast is designed to provide accurate and authoritative information in regards to the subject matter covered. It is given with the understanding that neither the host, the publisher or the guests are rendering legal, accounting, clinical, or any other professional information. If you want a professional, you should find one.