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“Eating disorders aren’t really about eating” corrects one error but introduces a bigger one.

Restriction and bingeing generate psychological changes that can look like pre-existing traits.

Evidence does not support solving the “deeper” problem first and expecting eating to follow.

The patient is very knowledgeable about her condition and various treatment approaches. Among all the ‘facts’ she can rattle off, she says, “My therapist told me that eating disorders aren’t about eating.”

I have heard this phrase repeated so frequently about anorexia, bulimia, and other eating disorders; even among some professionals, it has achieved the status of clinical common sense: Eating disorders are not really about eating.

Admittedly, it sounds insightful. The danger is that it is also only partly true and, as in many other areas of life, half-true knowledge can sometimes be more dangerous than a false belief.

The aim of this statement is to correct a critical misconception: Eating disorders are not actually about making poor food choices or a lack of willpower. Empirical research and clinical observations show that people who suffer from these conditions typically have solid nutritional knowledge and strong willpower; they cannot simply decide to eat normally. Their struggles involve fear, perfectionism, self-perception, self-evaluation, self-regulation, emotion regulation, reward, habit, interpersonal experience, biological vulnerability, and, for some, trauma.

Anyone who has sat with a patient in the grip of one of these conditions knows that the food is never only food. But from there we tend to make a second mistake, and it is the more consequential one: We move from saying that an eating disorder is not only about eating to saying that eating is merely the surface expression of some deeper psychological problem. The food becomes a symptom screen. Underneath, we assume, hides the real disorder: trauma, low........

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