Types Of Eating Disorders Counseling

Eating disorders are complex mental health conditions that are typically characterized by persistent and severe disturbances in eating behaviors. They are often accompanied by distressing thoughts and emotions and can be serious conditions affecting multiple aspects of a person’s life. 

Early intervention and treatment can be crucial to recovery, and multiple treatment approaches may be beneficial. Below are various types of eating disorders counseling that may be a part of a comprehensive treatment plan.

Inpatient or outpatient medical care

Eating disorders can be treated in a variety of settings. Many cases can be managed in an outpatient setting, which means the person lives at home and visits their doctors and counselors as needed. Some people may need to visit a treatment center multiple times a week for several hours at a time, while others may be able to go about their regular activities and check in with their team a few times a week. Outpatient programs may be an effective option for people who are medically stable and have the support they need to manage their own care.

Eating disorders can have significant effects on someone’s physical or mental health, and sometimes these problems must be addressed urgently. Hospitalization may be necessary to correct problems like electrolyte imbalances, abnormal heart rhythms, or low body temperatures or if someone is experiencing suicidal thoughts or experiencing a co-occurring drug or alcohol addiction. 

Nutrition counseling

Nutrition counseling is often a crucial part of recovering from an eating disorder. Specially trained dieticians, often with a specialized certification from the International Association of Eating Disorder Professionals, often help people in recovery learn about food and their bodies. During this counseling, a registered dietitian typically offers emotional support while educating individuals about nutrition, eating disorders, meal planning, and nutritional needs. This education can also include teaching about metabolism, hunger cues, and how to better understand the human body’s needs.

Cognitive-behavioral therapy (CBT)

Psychotherapy is often an important part of recovery for people with eating disorders. One therapy approach that may be effective is CBT or, more specifically, enhanced cognitive behavioral therapy (CBT-E). CBT-E may help people with eating disorders learn how to address the thoughts and behaviors contributing to their eating disorder, overcome a distorted body image, and re-establish a regular eating pattern. 

This form of psychotherapy can be extensive, lasting anywhere from six months to a year. Sessions may occur multiple times a week in the beginning, then weekly, then every other week. Every case is different, but CBT-E sessions for eating disorders may involve weekly weigh-ins, structured eating plans, and keeping food diaries.

CBT-E often has four stages: 

Stage 1

Stage 1 typically focuses on understanding the specific challenges a person faces in regard to food and eating. This stage may help the therapist determine the specific problems the person faces and how best to help them meet their treatment goals. In this stage, the person typically works to establish healthy eating patterns, so they may keep a diary of everything they eat as well as their thoughts and feelings.

Stage 2

This stage tends to be transitional, focusing on reviewing the progress made in stage 1 and planning for the rest of recovery, including anything that the person in treatment wants to learn. The therapist may help the person identify any barriers that may impede progress and decide what to focus on in the next stage of treatment.

Stage 3

In stage 3, treatment typically focuses on things that may be continuing to contribute to unhealthy eating behaviors and attitudes toward food. These factors can be unique to everyone, but they can include handling day-to-day stress, working through negative thoughts about appearance, and addressing challenges with low self-esteem and other interpersonal problems that may act as barriers to recovery. Individuals in therapy may learn to prioritize areas of life other than food and dieting,

Stage 4

By this stage, the person generally only has sessions every other week that focus on the future and how to continue to apply the skills they have learned so they can continue to make progress. In stage 4, the person typically works with their therapist to learn how to deal with setbacks, phase out daily food logs and weights, and address any concerns they have about treatment coming to an end.

Interpersonal therapy (IPT)

Research has found that interpersonal therapy can also be effective at treating some eating disorders, specifically bulimia nervosa and binge eating disorder. This type of therapy typically centers on the idea that interpersonal difficulties affect some features of eating disorders, that problematic relationships directly relate to a person’s current mood, and that improving mood can lead to improved relationships. 

Relationship problems can be common in people with eating disorders, which can lead to isolation from the support and normalizing behaviors of friends, family, and peers, which allows eating disorder symptoms to “persist unchallenged.” Addressing these relationship concerns may help someone recover from eating disorder symptoms. 

Dialectical behavioral therapy (DBT)

DBT was developed as a way to treat borderline personality disorder (BPD) but has been adapted to treating disorders as researchers believe that eating disorder symptoms may serve as a way to regulate emotions. DBT typically treats these symptoms by focusing on learning emotional regulation and a balanced approach to eating. 

In DBT, people with eating disorders often learn mindfulness and emotional regulation through both individual and group sessions. They typically learn to apply these skills to a variety of behaviors, such as substance use, binge eating, purging, and food restriction. People in this treatment can have coaching calls with their therapist between sessions if needed, and they often have homework to complete, such as keeping a diary to monitor symptoms and track progress.

Family-based therapy (FBT)

Family-based therapy can be an effective treatment for some eating disorders in children and adolescents, particularly anorexia nervosa. In fact, some consider FBT to be the treatment of choice for adolescents with anorexia who are able to participate in outpatient treatment.

For anorexia, FBT typically has three phases. The first is typically to restore the person’s physical health, the process of which is managed by the patient’s parents. FBT allows young people with anorexia to recover in their homes with the support of their families instead of having to go to a residential treatment program. A person with anorexia typically has a difficult time making decisions about food and eating, so these decisions are initially given to the parents to control. Parents usually decide what and how much their children eat and when they eat, and they monitor food intake while limiting or eliminating physical activity. 

When the adolescent is experiencing a steady increase in body weight and eating without resistance, the focus typically shifts to slowly giving responsibility for their food and eating choices back to them. This shift usually happens gradually to prevent backsliding, and parents still have some oversight. For example, adolescents may serve themselves portions of the meals the parents prepared, but parents can still add food to their plates if they feel it is not enough. 

Once this transition is complete and the adolescent is responsible for their own food choices, the therapist works with the family to ensure everything is back on track. The therapist typically also helps the family plan for future challenges the adolescent may face to prevent them from reverting to previous disordered eating behaviors.

Effectiveness of treatment for eating disorders

Eating disorders can be challenging to treat. The success of various types of therapy can depend on the type of eating disorder and its severity. Recovery and remission rates vary; one review found that 42% of participants had full remission.

Anorexia nervosa

Research has found that while 75% of people with anorexia make a partial recovery, only 21% recover completely. This study found that, of these, 94% maintained their recovery two years later, but those who made only a partial recovery were more susceptible to relapse.

Bulimia nervosa

Studies have found that between 40% and 60% of people with bulimia recover, but less than 40% achieve full recovery and about 30% relapse.

Binge eating disorder

Research shows that both CBT and IPT are effective at treating binge eating disorder, with one study finding that 64.4% of patients experienced a full recovery after treatment and 80% were in long-term remission. 

Online therapy for binge eating disorder and other disorders

For those who may feel hesitant to participate in traditional in-person therapy, online therapy can be a flexible and convenient option. With an online therapy platform, you can work with a licensed mental health professional from the comfort of your home or anywhere you have a reliable internet connection. Sessions can take place via audio, video, live chat, or a combination of these methods. Most people are matched with a therapist within 48 hours, so you can get started with treatment right away. 

How effective is online therapy for eating disorders?

Research has found that online therapy can be an effective treatment for eating disorders (ED). One study found that “short-term clinical outcomes with virtual and in-person ED therapies are comparable.” The study highlighted the potential for online treatment to overcome barriers to specialized treatments, such as geographical distance.