What’s Behind the Eating Disorder?

One of the keys to successful treatment, is finding out what’s behind the eating disorder.

what's behind the eating disorder

Intensive Short Term Dynamic Psychotherapy (ISTDP), a therapy based on attachment theory and psychodynamic principles, is an ideal way to do exactly that. Developed by Dr Habib Davanloo, the efficacy of ISTDP is now supported by extensive research.

What Does Attachment have to do with it?

To find out what’s behind the eating disorder (or other physical, emotional, or interpersonal difficulties), in order to treat it, ISTDP focuses on the emotional impacts of broken and disrupted attachments in the individual’s life.

“Attachment” describes the connection or relationship between infants/children and their caregivers. When this relationship goes well, the child develops healthy and functional ways of relating to themselves and their world.

However, childhood lasts a long time! The attachment relationship faces many obstacles, and it doesn’t necessarily mean that parents have done a “bad” job. Although attachment can be negatively impacted by things as extreme as abuse and neglect, it can also be affected by run-of-the-mill occurrences such as childhood illness and divorce.

The relationship with the primary caregiver is so important to the child’s survival, that they will typically avoid and block emotions that threaten this attachment, even if doing so leads to conflicted feelings such as love/anger/sadness/etc. For example, in the case of divorce, the child can feel both love and anger for the parent who left them behind, and even guilt at feeling that anger! Because they want the parent to come back so badly, they might block or hide parts of their anger, hoping that will entice them to return (if they are “good enough”).

The real impact doesn’t hit until years later, because our early attachment relationships form the template we use for all our important relationships in life. So yes, in a way we really do react to others, as if we were reacting to our parents! When later relationships and events stir up the feelings we have blocked, anxiety and defenses can be activated.

Some defenses are normal, healthy and good for us. Many are not. When the not-so-great defenses are unknown to the person, the result is often ruined relationships, psychological symptoms, and even physical problems. Many people who struggle with anxiety, depression, eating disorders, substance abuse, interpersonal problems, self sabotage,and a myriad of complex (and sometimes unexplainable) physical ailments are actually suffering as a result of this emotional blockage – often without even realising what is going on, deep down inside.

Finding out What’s Behind the Eating Disorder with ISTDP

ISTDP begins with helping the individual to identify and recognise these unconscious processes, and helping them overcome their emotional blocks or whatever is behind the eating disorder. It is important to highlight these processes in real time – which often means using recent examples, or the therapy relationship itself. You may not think you feel anything toward your therapist, but as you work together to get through to your blocked emotions, you will be surprised at what gets stirred up … and your therapist is counting on it!

When these blocked feelings are experienced (termed a “breakthrough”), tension and defenses decrease significantly. This allows for a healing process in which old avoided feelings can be worked through. Often just one breakthrough can lead to major symptom improvement, though often a series is required to bring about big behavioural change. At the end of successful therapy, the anxiety and defenses are no longer there, allowing the individual’s life and relationships to go smoothly – as they were always meant to.

What Else is ISTDP Used For?

In addition to being useful in the treatment of eating disorders, ISTDP can be helpful for everything from relatively small and acute difficulties, to those with long-standing, chronic issues, impacting multiple areas and relationships in their lives. It is especially useful for people diagnosed with eating disorders, personality disorders, or as “treatment resistant”, because ISTDP goes beyond the surface of the problem, and deals with the underlying causes.

If you, or someone you know is struggling with disordered eating, difficult relationships or other issues, contact me today to discuss whether Intensive Short Term Dynamic Psychotherapy may be for you.

Tiegan Holtham psychologist treating eating disordersAuthor: Tiegan Holtham, B Sc (Hons), M Psych (Clinical), MAPS.

Tiegan Holtham is a Clinical Psychology Registrar, based at M1 Psychology Loganholme. Working from a strengths-based framework, Tiegan assists children, adolescents, adults and families with difficulties such as anger, anxiety, jealousy, self-criticism, perfectionism, body image and eating disorders.


  • Abbass, A. (2002). Intensive short-term dynamic psychotherapy in a private psychiatric office: clinical and cost effectiveness. American journal of psychotherapy, 56(2), 225.
  • Abbass, A. (2015). Reaching Through Resistance: Advanced Psychotherapy Techniques.