A complicated relationship with food is rarely just about food. In this episode of the Her Health™ Podcast, Lauren Marsh, psychotherapist and eating disorder specialist with a focus on OCD, perfectionism, and anxiety, opened up a conversation that went far deeper than the plate.
From the difference between disordered eating and a clinical eating disorder, to the role of anxiety, perfectionism, childhood experiences, and burnout, Lauren brought honesty and depth to one of the most taboo and misunderstood areas of women’s mental health.
Rapid Fire: What Affects Your Relationship with Food, Rated
We asked Lauren to rate common factors from zero to 10 based on their effect on a person’s relationship with food:
- Social media – 7/10: It breeds comparison – and comparison is a significant driver of disordered thinking around food and body image.
- Perfectionism – 10/10: The single biggest risk factor for eating disorders.
- OCD – 8–9/10: A major risk factor and frequent co-occurring condition alongside eating disorders.
- Childhood experiences – 10/10: They shape how we interact with people – and with food.
- Genetics – 8/10: Eating disorders are heavily genetically loaded. Environment still matters, but the biological vulnerability is real.
- Nutritional deficiencies – 5–6/10: Not a driver of eating disorders, but important to address in recovery.
- Burnout – 8/10: Burnout changes the way we think – and thinking drives behaviour.
- Anxiety – 10/10: Anxiety is the umbrella under which eating disorders, OCD, and perfectionism all sit.
Disordered Eating vs an Eating Disorder – What’s the Difference?
Lauren opened with a distinction that many people may not have considered: disordered eating and eating disorders aren’t the same thing – though one can become the other.
Disordered eating is common. Many people move through periods of complicated thinking or behaviour around food without it fundamentally changing who they are or shrinking their world. An eating disorder, by contrast, is a recognised mental health illness. It consumes a person’s life. It changes how they think, how they function, and who they are.
She was clear that eating disorders don’t have a look. Anorexia, for example, is commonly associated with being visibly underweight – but atypical anorexia exists, and a person in a larger body can experience the same restriction, the same food noise, the same hyperfocus, the same loss of executive functioning. Eating disorders don’t discriminate.
She also addressed GLP-1 medications directly. From a clinical perspective, she explained, they mimic restriction – which makes them a serious concern for anyone with an underlying tendency toward restraint or restriction. For a population already vulnerable to eating disorders, easier restriction isn’t a neutral tool.
Anxiety – The Umbrella Over Everything
Lauren described anxiety as the brain searching for certainty and safety. When it can’t find it, it develops coping mechanisms – and those coping mechanisms can take the form of perfectionism, eating disorders, or OCD.
The smoke detector analogy she used was memorable: an anxious brain fires off a fire alarm when all that is happening is the making of toast. There is no pause between trigger and response. No gap in which a choice can be made. The anxiety is total.
She was also clear that anxiety isn’t always irrational. Sometimes it is deliberately structured. The problem is that the structure is designed to make the person fail – a meal plan so rigid that any deviation becomes a catastrophe, a moment that confirms what the anxious brain has always believed.
Perfectionism – Healthy Ambition vs Clinical Perfectionism
The difference between healthy ambition and clinical perfectionism, Lauren explained, comes down to function.
Healthy ambition doesn’t shrink a person’s life. It doesn’t define their sense of self. Getting 90% on an exam with healthy ambition means celebrating 90%. Getting 90% with clinical perfectionism means fixating on the missing 10% and feeling like a failure.
She was clear that the function of clinical perfectionism is pathological – it keeps people sick. And it rarely appears in isolation. Almost every eating disorder she sees comes with co-occurring OCD or another related condition. They are rarely standalone.
OCD – The Compulsion That Keeps People Stuck
With OCD, Lauren explained, there were two components: the obsession and the compulsion. The compulsion is the behaviour done to relieve the distress of the obsession – and it is those maintaining behaviours that keep people locked in the cycle.
She used a vivid analogy: someone flapping their arms to keep dragons away. They feel compelled to do it. And because they keep doing it, they never prove to themselves that the dragons aren’t real. Stopping the compulsion is the only way to disprove the belief – but stopping feels impossible when the belief is that something terrible will happen if you do.
Childhood Experiences – Where the Patterns Begin
Lauren spoke about how eating disorders generally start early, often without obvious symptoms. The relationship with food develops in the context of family dynamics, attachment styles, and the messages received about food, body, and worth.
Food used as reward or punishment, needing to earn food, or the sense that eating is something to perform in order to deserve – these aren’t always conscious messages. But somewhere, she explained, the disordered thought towards food takes root.
She was equally clear that environment can protect against genetic loading. A child predisposed to an eating disorder, raised in a home where their voice is heard, their opinions matter, and food isn’t given moral weight, may never express that tendency at all.
Therapy – What Actually Helps
Lauren outlined three evidence-based approaches she uses in her practice:
Cognitive Behavioural Therapy (CBT) is the gold standard for anxiety-related disorders. She explained that it examines the relationship between thoughts, feelings, and behaviours – and specifically targets the maintaining cycles that keep people stuck. Disproving the disordered belief is the mechanism. The brain, she noted, is often smarter than people expect – once it can disprove an anxious belief, it lets go of the behaviour, and the peripheral behaviours disintegrate on their own.
Dialectical Behaviour Therapy (DBT) brings mindfulness into the picture. Lauren explained that it is particularly suited to people who experience intense emotions and struggle to tolerate distress. Tools like breathing techniques, affirmations, and grounding practices give people a way to navigate high-anxiety moments without the behaviour escalating. The butterfly hug she described – crossing both hands over the shoulders and gently pressing the fingertips against the body – is one practical example of a sensory grounding technique used in the moment.
Focal Psychodynamic Therapy looks backwards. Not always, she was careful to say – sometimes scratching old wounds made people more vulnerable, not less. But roughly half the time, going back to understand where the pattern began in childhood is essential to breaking it.
Nutrition as Therapy – The RAVES Model
Lauren studied clinical nutrition alongside psychotherapy and brought both to her practice. She described the framework she uses as the RAVES model: Regularity, Adequacy, Variability, and Experimental Spontaneity.
Is the person eating regular meals? Are those meals actually adequate? Is there variability, or is eating extremely narrow and controlled? And can the person be spontaneous – accept an invitation to dinner without restriction beforehand – without it becoming a crisis?
She also addressed orthorexia directly: the hyperfocus on clean eating that social media normalises and amplifies. A restricted range of foods, however nutritious, will produce deficiencies. Variability isn’t optional for health.
Her broader point was important: food is just food. Removing the morality from eating – the idea that eating a certain way makes someone good or successful – is a fundamental part of the work.
Burnout and Food – A Connection Worth Understanding
Burnout, Lauren explained, isn’t the dramatic collapse most people imagine. It is still meeting all of life’s demands – just at the expense of everything else. Tiredness, inability to be present, saying yes when the answer was no.
Using a pie chart analogy, she described what happens when one area of life consumes the vast majority of available energy. When something goes wrong in that dominant area, there is almost nothing left to hold the person up. Burnout is the result of that sustained imbalance.
An unfed brain, she was direct about this, is an anxious brain. Going hours without food compromises thinking, emotional regulation, and executive functioning. For people already in a pattern of restriction or restraint, burnout makes everything harder and disordered behaviour more entrenched.
Supplements and Restriction – Why They Matter in Recovery
Lauren was straightforward about where supplements fit into her clinical work: for clients who have been restricting, restraining, purging, or over-exercising, nutritional insufficiency is almost certain.
Supplements aren’t a substitute for food – but during the process of refeeding or regulating intake, they can help ensure that the nutrients a restricted diet can’t provide are still reaching the body. For clients whose eating remains very narrow while psychological work is underway, supplementation gives her some confidence that foundational nutritional needs are still being met. Read more on nutrient deficiency here.
Food, Restriction and Children – Why What We Take Away Matters
Lauren spoke candidly about what restriction communicates to children – even when the intention is purely about health. She described being at a birthday party where all the children were eating cake except one.
A child’s brain doesn’t process restriction as a health decision – it processes it as exclusion. Restricting certain foods doesn’t necessarily neutralise desire for them, Lauren explained. It amplifies it. What is withheld becomes significant.
“When we restrict, what they are seeing is: that’s really yummy and I have to do something in order to get it. That’s where the disconnect between food is food – and food is something more – starts to creep in.”
Her approach, both clinically and at home, is to remove the hierarchy from food entirely. When nothing is forbidden, nothing becomes charged. Eating intentionally is important here.
Community Questions Answered
What do I do if my child starts speaking negatively about their body?
Lauren’s recommendation was to be curious, not corrective. Asking why, exploring where the thought came from, keeping the conversation open. Telling a child their concern was “rubbish” shuts the door. Curiosity keeps it open – and allows a parent to influence the thought rather than inadvertently reinforcing it by shutting it down. Living by example matters too. Children notice what adults say about their own bodies.
How do I know when being health-conscious has become unhealthy?
When it starts to shrink your life. When thinking about food and eating overtakes thoughts that used to belong elsewhere. When the meal plan becomes the organising principle of your day, your social life, your sense of self. That, she said, was the line.
What do I do if I recognise disordered eating in someone I love?
Reach out for help rather than trying to navigate it alone. There is a way to talk about food that isn’t triggering for someone in a disordered pattern – and there is a way that is. About 20% of Lauren’s practice is working with families on exactly this: how to hold the conversation, what to say, what not to say, and how to support someone without inadvertently making things worse.
How do I know if I’m hungry or just bored, stressed, or emotional?
Lauren explained that emotional hunger and physiological hunger feel different in the body. Emotional hunger tends to live higher – in the chest, the throat, the head. True physiological hunger is more physical, more stomach-based. The question she asks her clients is simply: where are you experiencing this? That pause alone is often useful.
One Tip Everyone Can Start Today
“An unfed brain is an anxious brain. Regulate the basic processes so that your brain can allow you to be flexible in thought and express all the different emotions of your personality.”
A complicated relationship with food is rarely just about food – and as Lauren Marsh reminded us on this episode, the path forward almost always begins with understanding what is driving the behaviour, not just the behaviour itself. Whether it is anxiety, perfectionism, childhood experience, or burnout, the root matters. And help is always available.
If you or someone you know is struggling with disordered eating or an eating disorder, the South African Depression and Anxiety Group offers support and referrals, or the Alliance for Eating Disorders Awareness also provides international resources.
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This content is for informational purposes only and does not constitute medical advice. Always consult with your healthcare provider or a qualified mental health professional if you are concerned about your relationship with food or mental health. This unregistered medicine has not been evaluated by SAHPRA for its quality, safety or intended use. If symptoms persist, consult your healthcare provider.
