Motivational responses to both body and food stimuli are relevant for eating disorders (EDs). Thin-ideal internalization, a socio-cognitive factor implicated in EDs, has been associated with approach responses toward thin bodies and avoidant responses to overweight bodies. Research examining reactions to food in EDs has been mixed, with some studies reporting enhanced approach and others observing avoidant responses to food. Thin-ideal internalization may help to explain these mixed findings, as individuals with eating pathology may experience food as a threat to internalized ideals of thinness, despite its inherently appetitive qualities. In the present study, physiological reflexes measuring aversive (startle blink reflex) and appetitive (postauricular reflex) responding as well as self-report ratings were recorded while 87 women with and without eating pathology viewed images of high- and low-calorie food. Greater global eating pathology, but not thin-ideal internalization, was associated with negative self-report valence ratings and lower craving ratings of high-calorie food. Thin-ideal internalization was related to more positive self-report ratings of low-calorie food, and low-calorie food ratings were related to eating pathology indirectly through thin-ideal internalization. Overall, thin-ideal internalization may represent a higher-order factor that influences conscious reactions to food.