My name is Leeor Gal and I’m a licensed marriage and family therapist. At my therapy practice in Philadelphia, I often see how deeply anxiety intertwines with disordered eating behaviors. For many individuals, especially those struggling with eating disorders, the relationship with food is not just about nutrition it’s about control, safety, and emotional regulation. In collaboration with eating disorder dietitians, we often explore how the roots of disordered eating are less about food itself and more about the psychological and physiological need to manage overwhelming emotions, especially anxiety.

The Brain on Anxiety and Control

Anxiety activates the brain’s amygdala, which is responsible for detecting threats and triggering the fight-or-flight response. When this system is chronically activated, as it often is in individuals with high anxiety, the prefrontal cortex (responsible for rational decision-making and emotional regulation) becomes less active. This creates a neurobiological environment in which fear-based behaviors like restricting, bingeing, or purging may feel like necessary coping mechanisms.

Eating disorders can provide a false sense of control in a world that feels unpredictable. For example, restricting food intake may help someone feel powerful, disciplined, or “in control” in an environment where they otherwise feel powerless. Conversely, binge eating may offer temporary emotional relief or numbness from anxiety, though it is usually followed by shame or guilt that perpetuates the cycle.

Regaining Safety and Flexibility

Recovery is not about losing control, it’s about redefining control as inner safety, trust in oneself, and the ability to tolerate uncertainty. Healing must address both the behaviors and the underlying emotional landscape.

Here are key components of healing from this dual lens:

1. Nervous System Regulation

Therapies that help calm the nervous system, like somatic experiencing, EMDR, polyvagal-informed therapy, and mindfulness-based practices can reduce chronic anxiety and help individuals feel safer in their bodies.

2. Cognitive and Emotional Work

Through therapy, clients can identify the core fears driving their need for control and develop new ways to cope with anxiety. This may include:

• Challenging perfectionistic thinking
  
• Increasing distress tolerance
  
• Exploring family dynamics and attachment wounds
  
• Building a more compassionate inner voice
  

3. Nutrition Therapy

From the dietitian’s perspective, consistent and adequate nourishment helps stabilize blood sugar, reduce irritability, and support brain function, making emotional regulation and therapy work more effective.

4. Building Trust in the Body

Recovery includes reconnecting to hunger and fullness cues, practicing intuitive eating, and gradually releasing rigid food rules. This can feel frightening at first, especially when anxiety is high, but with the right support, individuals can learn to trust their bodies again.

5. Developing New Forms of “Control”

Rather than eliminating control, recovery invites clients to shift toward healthy control, such as:

• Setting boundaries
• Changing your relationship with control
• Choosing who to spend time with
• Managing their environment to support recovery
  Creating routines that foster emotional and physical well-being

Stepping Stone in Shifting Your Relationship With Control:

• Short term: Shifting towards healthy control 
• Long term: Ultimately getting comfortable with the things that are outside of our control so that we are no longer relying on a sense of control.

Final Thoughts

Healing from an eating disorder is not just about viewing food differently, it’s also about the emotion around it. It’s about finding new ways to manage anxiety, release the grip of perfectionism, and step into a more connected, embodied way of living.

As therapists our job is to help clients feel safe enough to let go of the old strategies that no longer serve them. Together, we can create a path toward lasting healing- one that honors both the mind and the body.

If you’re looking for a therapist in Philadelphia, reach out for a free consultation!