How To Treat Eating Disorders

Eating disorders can affect anyone—regardless of age, gender, race, body weight, or any other identifier. The wide variety of eating disorders and eating patterns can make their treatment complex, but with proactive intervention, the support of compassionate professionals, and effective treatment, recovery is possible. 

Depending on the type of eating disorder, treatment plans can vary significantly. To break down the treatment process, we’ll briefly discuss the most common types of eating disorders, followed by information on how to seek treatment for a specific eating disorder diagnosis. 

Eating disorder recovery

Five classifications

Eating disorders are a mental illness characterized by unhealthy attitudes and behaviors related to food. Eating disorders may impact the mental and physical health of someone experiencing an eating disorder. Eating disorders may create a life-threatening medical emergency if not treated. The  American Psychiatric Association outlines the following common eating disorders and their symptoms, based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).

Anorexia nervosa, often shortened to just anorexia, is an eating disorder characterized by extreme weight loss and resistance to maintaining healthy body weight. Some of the primary symptoms for people with this eating disorder include:

• Distorted body image
• Caloric restriction
• Compulsive rigid, and excessive exercise regimes to lose weight
• Dramatic weight loss 
• Dressing in layers to hide weight loss and/or stay warm

Bulimia nervosa, often shortened to bulimia, is an eating disorder characterized by a cycle of “binging”—eating large amounts of food—followed by “purging,” typically through self-induced vomiting or use of laxatives, to prevent weight gain. Purging behaviors may cause additional health risks such as dehydration or irregular heartbeat. Other common symptoms of this eating disorder include:

• Evidence of food binging, such as empty containers or wrappers in a living space
• Frequent trips to the bathroom after meals
• Calluses on the backs of hands and knuckles from forced vomiting
• Excessive consumption of water or other zero-calorie beverages, as well as mouthwash, mints, and gum
• Dental problems

3. Binge eating disorder (BED) 

Like bulimia, binge eating disorder leads people to consume large quantities of food in short periods of time. However, these binges are not typically followed by purges; instead, people with binge eating disorder typically report a feeling of loss of control, shame, distress, and/or guilt after their binges. Other common symptoms of binge eating disorder include:

• Secret and recurring binge eating episodes to avoid gaining weight
• Feelings of disgust, depression, or guilt after overeating
• A tendency to steal or hoard food in strange places
• Evidence of binge eating that may cause a person to gain weight or experience high blood pressure
• Lifestyle schedules or rituals to make time for binges

4. Other specified feeding and eating disorders (OSFED)

Previously known as Eating Disorder Not Otherwise Specified (EDNOS), OSFED is considered a “catch-all” diagnosis for people whose symptoms do not meet the diagnostic criteria for anorexia or bulimia, but who still present with eating disorder behaviors and related symptoms. Symptoms of this eating disorder are varied but may include:

• Dieting or restrictive eating behaviors
• Evidence of binge eating and/or purging
• Poor self-esteem related to body image

ARFID is a new diagnosis in the DSM-5. While the eating disorder behaviors for ARFID are similar to anorexia, ARFID does not usually involve any distress about body shape or size. People with ARFID often have poor nutrition and don’t consume enough calories to sustain proper development and daily functioning. Common symptoms of this type of eating disorder may include:

• Dramatic weight loss
• Picky eating that progressively worsens
• Intense fear of choking or vomiting

While these represent some of the most common eating disorder diagnoses, eating disorders can take many forms, and some people experience multiple eating disorders throughout their lifetime. Other eating-related diagnoses include rumination syndrome and unspecified feeding or eating disorder (UFED), which may require more specialized treatments. As always, consult with your physician for an accurate and personalized diagnosis for an eating disorder. A mental health disorder, including eating disorders, should never be self-diagnosed.

Co-occurring mental health conditions

According to the National Eating Disorder Association, many eating disorders also co-occur with other mental health conditions or psychiatric disorders including obsessive-compulsive disorder, depression, and anxiety. As the National Eating Disorders Association explains, these disorders may influence eating behaviors and enhance the severity of an eating disorder. 

Options for treatment

Eating disorders are serious and can be life-threatening, but they’re also treatable with comprehensive treatment plans. 

In order to treat eating disorders, mental health professionals recommend a combination of the following interventions to manage the symptoms of an eating disorder. Depending on your specific eating disorder diagnosis and personal needs, the exact treatment and treatment team may vary. If you’re wondering how to treat eating disorders when there are underlying health conditions present, you might speak with a doctor, who may review your medical history before developing a treatment plan. Certain eating disorders may be best treated with a tailored approach that takes into account your medical history.

Nutritional counseling is usually a key part of eating disorder recovery. Registered dieticians and nutritionists have slightly different educational and licensing requirements, but both professionals can educate their clients about nutrition, and diet, and help to improve eating habits. During eating disorder recovery, these professionals may help people with eating disorders eliminate self-defeating behaviors and reframe adequate nutrition as a form of self-care while providing meal planning that meets an individual’s needs. A registered dietician may even create a personalized menu and grocery shopping list to ensure that clients are getting the nutrition that they need to support their physical and mental health during their eating disorder treatment.

2. Eating disorder medications

In addition to their eating disorder diagnosis, some people experience depression, anxiety, substance use, and other mental health conditions at the same time. Depending on a physician’s advice, antidepressants and/or other medications may become a part of their treatment plan. 

If you are struggling with substance use, contact the SAMHSA National Helpline at (800) 662-4357 to receive support and resources. Support is available 24/7.

An eating disorder therapist cannot prescribe psychiatric medication, regardless of the eating disorder diagnosis. Only a licensed physician or psychiatrist has the training and credentials to prescribe medication. Although medications undergo clinical trials, it may be helpful to tell your doctor about any other medications you take to avoid medical complications. You can also ask them if they have any patient medication guides before taking new medications.

3. Medical treatment

Some people with eating disorders may need more immediate medical attention and proper medical care to restore a healthy weight and adequate nutrition. Medical treatment for eating disorders is generally divided into five levels of care:

• Inpatient care at a hospital or treatment center, which means a person stays in a hospital 24/7 for their treatment. Inpatient programs are usually reserved for people whose eating disorders put them at higher risk of serious illness or death.
• Residential treatment centers, which are also 24/7 programs. A residential treatment program may ensure that people with eating disorders are medically stable before they are admitted, as they typically spend an extended period of time at the eating disorder treatment center—sometimes 30 days or more.
• Partial hospitalization, also called day treatment. This option generally provides treatment for 6-10 hours per day, five or six days per week.
• Intensive outpatient care and medical monitoring, which generally offers eating disorder treatment for three to four hours per day, three to five days per week. This level of care is suitable for people with less medically severe cases who want to continue their work, schooling, and/or other obligations while in recovery.
• Outpatient care. Patients can see medical providers for weekly or monthly sessions in the provider’s outpatient offices. Healthcare professionals may advise you on foods you can enjoy and strategies to maintain your normal weight.

For any person with an eating disorder, a licensed physician will likely perform a thorough physical and mental exam, including blood tests, to determine whether inpatient eating disorder treatment is necessary. Recommendations may vary depending on the person’s age, lifestyle, and immediate physical needs, so it’s advisable to consult a doctor before solidifying decisions about medical care for your eating disorder. 

For many people with eating disorders, talk therapy can be a crucial part of their long-term treatment and recovery. A licensed mental health professional can offer compassionate advice as well as evidence-based strategies for recovery that take your family history, individual factors, and social factors into account. Some research suggests that cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT) can especially benefit people with bulimia and binge eating disorder, and can also help those with anorexia and other eating disorders.

Cognitive behavioral approaches aim to help people identify the connections between their thoughts, feelings, and behaviors to overcome unhealthy thinking patterns and actions. Cognitive behavioral therapy is also frequently used in the treatment of a variety of other mental disorders. IPT is a time-limited treatment that tends to have a specific end date in mind. It often focuses on the interpersonal and social contexts that influence a person’s eating disorder symptoms and overall mental health. 

Beyond individual talk therapy, family therapy can often be effective for treating eating disorders and improving long-term treatment outcomes, especially for children and adolescents. It can be important for other individuals in the family to learn about eating disorders and typical treatment goals so that they can aid in recovery.

Cognitive behavioral therapy

CBT aims to help people experiencing eating disorders to identify the connections between their thoughts, feelings, and behaviors to overcome unhealthy thinking patterns and actions. IPT is a time-limited treatment that tends to have a specific end date in mind. It often focuses on the interpersonal and social contexts that influence a person’s eating disorder symptoms and overall mental health. 

Beyond individual talk therapy, family therapy can often be effective for treating eating disorders and improving long-term treatment outcomes, especially for children and adolescents.

While some people prefer to begin their eating disorder recovery journey through a primary care provider or in-person therapy, others find that online therapy is a more available starting point. Digital platforms like BetterHelp make it easy to connect with a licensed therapist. Within 48 hours, you can be matched with a licensed therapist with experience helping people overcome eating disorders. All BetterHelp therapists have at least 1,000 hours of hands-on professional experience, and you can always change therapists until you find someone who is a good fit for you. Family may have concerns that are best addressed altogether, family-based therapy may be appropriate in some situations and sessions may also occur online.  

A growing body of research suggests that online therapy can be effective in the treatment of eating disorders and other mental health conditions. A 2019 review of 23 studies concluded that online therapy effectively improved symptoms, primarily among people with bulimia and binge eating disorder, as well as co-occurring depression and anxiety.