Psychodynamic Therapy (PDT)

Psychodynamic therapy is grounded in the idea that unresolved emotions and early relational experiences shape how we relate to ourselves and others in adulthood. For individuals with eating disorders, food and body image often become symbolic ways of managing feelings such as shame, guilt, fear, anger, or inadequacy. Restricting, binging, purging, or obsessing over physical appearance may serve as attempts to gain control, soothe distress, or communicate unmet emotional needs.

In this therapy, the goal is not only to stop harmful behaviors but to understand their emotional function. By bringing unconscious patterns to awareness, patients can begin to separate their core identity from their eating disorder and learn to express emotions in healthier, more direct ways. This process creates a foundation for lasting emotional and behavioral change.

Psychodynamic therapy typically takes place in one-on-one sessions between the therapist and client. Sessions encourage open, reflective discussion, allowing the person to speak freely about thoughts, memories, dreams, and feelings without judgment. The therapist listens for recurring patterns, emotional themes, or contradictions that point to unresolved inner conflicts.

One of the central elements of psychodynamic work is the therapeutic relationship itself. The interactions between the client and therapist often mirror the client’s past relationships, revealing how they relate to others and to themselves. For example, someone who constantly strives for approval from others may unconsciously seek that same validation from the therapist. Recognizing these dynamics in real time helps the client gain insight into how early relationships have shaped their current struggles with self-worth and body image.

The therapist also helps the individual identify defense mechanisms—psychological strategies the mind uses to avoid emotional pain. Common defenses in eating disorders may include denial (“I’m fine, I don’t have a problem”), projection (“People are judging my body”), or intellectualization (focusing on nutrition facts instead of feelings). Over time, the person learns to face emotions rather than avoid them through food or other forms of self-control.

Sessions may be scheduled weekly or more frequently, depending on symptom severity and treatment goals. While psychodynamic therapy is often considered longer-term, many modern approaches, known as time-limited psychodynamic therapy, are structured to produce meaningful progress within several months.

Eating disorders are rarely just about food or weight. They are emotional expressions of inner conflict—manifestations of self-criticism, insecurity, and unresolved trauma. Psychodynamic therapy provides a safe space to explore those underlying feelings. By examining how early experiences—such as parental expectations, emotional neglect, criticism, or societal pressures—shaped a person’s sense of self, therapy helps untangle the emotional roots of the disorder.

For example, a client who learned as a child that love must be earned through perfection may internalize the belief that thinness equals worthiness. Another might have experienced emotional chaos in their family and learned to use food restriction as a form of control. In both cases, the eating disorder becomes a coping strategy for deeper emotional pain. Psychodynamic therapy seeks to heal those internal wounds so the need for disordered behaviors naturally decreases.

As clients begin to understand themselves more fully, they often report feeling more self-accepting, confident, and emotionally balanced. Their relationship with food and their body starts to shift from one of control and punishment to one of awareness and compassion. This growing emotional insight lays the groundwork for sustained recovery, as individuals are less likely to relapse when they understand the emotional triggers behind their symptoms.

Research supports the effectiveness of psychodynamic therapy in treating eating disorders, particularly anorexia nervosa and bulimia nervosa. Studies have shown that it can lead to long-term improvement in both emotional functioning and eating behaviors. While progress may occur gradually, psychodynamic therapy addresses the roots of the disorder rather than only its visible symptoms, often resulting in deeper, more enduring recovery.

Success is measured not only by weight restoration or symptom reduction but also by improved emotional regulation, healthier relationships, and a more stable sense of identity. Many individuals who complete psychodynamic treatment describe feeling more authentic and connected to themselves, no longer defined by the rigid patterns of their disorder.

This approach can be particularly valuable for those who have tried more structured or behaviorally focused therapies without achieving lasting relief. By helping individuals make sense of the emotional meaning behind their behaviors, psychodynamic therapy allows them to replace destructive coping mechanisms with genuine self-understanding and emotional resilience.