How to find the right eating disorder treatment plan for you
- Most eating disorder treatment plans include therapy and nutrition counseling.
- Some people recovering from an eating disorder may also take medication to help treat any preexisting mental health disorders.
- Treatment programs like inpatient, residential, and outpatient are also available.
- This article was medically reviewed by Mayra Mendez, PhD, LMFT, a psychotherapist and program coordinator for intellectual and developmental disabilities and mental health services at Providence Saint John's Child and Family Development Center.
- Visit Insider's Health Reference library for more advice.
Deciding to seek treatment for an eating disorder is a brave first step on the path to recovery. But knowing where and how to get help can seem daunting, especially since no two eating disorders are exactly the same. Here is what you need to know about finding the right treatment plan for you.
Where to start
If you think you may have an eating disorder, it may be helpful to reach out to a trusted family member or loved one for additional support, especially if you're a young adult.
However, some may choose to seek help on their own. "Individuals with eating disorders often combat a great deal of shame and guilt. For some individuals, the process of reaching out to a loved one could be extremely anxiety-inducing,'' says Leela R. Magavi, MD, psychiatrist and regional medical director for Community Psychiatry.
To properly treat an eating disorder, you'll eventually require a team which may include a therapist, medical doctor, and a registered dietitian, says Gabrielle Kahn, MS, a registered dietitian at Methodd Nutrition located in Long Island, New York.
If you already have a relationship with a professional in one of these fields, you may choose for them to be your first point of contact when discussing an eating disorder. "Reaching out to a specialist could lead to the prompt initiation of therapy and even pharmacotherapy, which could decrease hospitalizations and save lives," says Magavi. They can either advise you on treatment or point you to another recommended professional.
If you don't have a relationship with a healthcare professional in these fields, try looking for someone with eating disorder patient experience. This person can be a therapist, nutritionist or primary care doctor, depending on who is available in your area. While not a deal-breaker, look for a therapist or registered dietician with "CED" in their title. This title is a certification from the International Association of Eating Disorders Professionals and confirms they specialize in the field.
Treatment options for eating disorders such as anorexia nervosa, bulimia nervosa, and binge eating may vary depending on a patient's medical history, current state of health, and budget. Treatment needs to be as tailored as possible, and no plan is set in stone. Instead, a treatment plan will adapt and change as a patient makes progress, faces various challenges, and works towards new goals.
Find a therapist
Therapy is a critical component of eating disorder treatment, as it is first and foremost a mental health condition. Additionally, many people with eating disorders also have other mental health conditions such as anxiety, depression, and post-traumatic stress disorder (PTSD).
"Eating disorders are rarely just about food and weight, which is why they are not treated with only medical and nutritional interventions," says Hailey Shafir, a licensed clinical mental health counselor and licensed clinical addiction specialist. "Emotional eating is a core component of both bulimia and binge eating. Restricting and purging, found in bulimia and anorexia, also tend to be driven by guilt, anxiety, or low self-esteem."
A person may choose to see a therapist for just the duration of their eating disorder treatment or continue afterwards to prevent a relapse. The following are the most effective types of therapy for eating disorders:
Cognitive Behavioral Therapy (CBT)
Cognitive behavioral therapy is a type of talk therapy focused on the idea that harmful thinking and behavior patterns can be changed through understanding their cause and implementing healthy coping skills.
"It helps individuals reframe their thinking and perception of their body and food. It also teaches them to employ specific skills to alleviate distressing urges to restrict, binge, purge or excessively exercise," says Magavi.
The positive effects of CBT on patients with eating disorders has been continually proven. In a 2017 systematic review published by the American Psychological Association, researchers examined 79 trials and found that therapist-led CBT is more effective than other psychotherapies in treating bulimia nervosa and binge eating disorder.
Cognitive Remediation Therapy (CRT)
Cognitive remediation therapy is a rehabilitative therapy designed to improve neurological functioning such as memory and attention disorders.
According to a 2013 report published in Psychotherapy and Psychosomatics, eating disorder patients may experience deficits in brain functioning, causing neurological issues.
Those who received CRT on top of their usual eating disorder treatment showed significant improvement at the end of their treatment and at a follow-up than those who did not participate in CRT with their usual treatment.
Dialectical Behavioral Therapy (DBT)
Dialectical behavioral therapy was designed for individuals prone to extreme reactions, such as self-destructive behavior. DBT has been found to help those with an eating disorder identify triggers, control negative thoughts, and practice mindful eating.
The four main pillars of DBT are:
- Mindfulness. Working to gain an awareness of and participation with the world around you.
- Interpersonal effectiveness. Learning how to say no and asking for what you need.
- Distress tolerance. Developing coping mechanisms and practicing how to deal with crisis more effectively.
- Emotion regulation. Going through the process of labelling emotions and becoming aware of the barriers in place to reach them.
Family-Based Therapy (FBT)
Family-based therapy is a technique often used for treating eating disorder patients, either on its own or in combination with individualized treatment. FBT involves group therapy sessions with a patient and their family, whether that's parents, siblings, children, or significant others.
"Family-based treatment is especially helpful for children and adolescents," says Shafir. "This form of treatment involves the whole family and empowers parents to help their children engage in and maintain healthy eating."
In a 2012 study published in the International Journal of Eating Disorders, adolescents with eating disorders who underwent FBT saw significant sustained improvement six to 12 months out of treatment. The post treatment benefits from FBT show better long-term outcomes than individual therapy alone.
A 2014 study published in JAMA Psychiatry studied 164 patients aged 12 to 18 with anorexia nervosa who attended one of two forms of FBT. One therapy taught parents how to help their child eat a proper diet, while the other focused on improving family dynamics. Both options were equally effective in treating eating disorders, except for patients with severe obsessive-compulsive disorder (OCD), who found the latter treatment more beneficial.
Interpersonal Psychotherapy (IPT)
Interpersonal psychotherapy focuses on treating mood disorders by improving interpersonal relationships and social functioning. In fact, a 2012 report published in Clinical Psychology and Psychotherapy found IPT is effective for treating binge eating disorder.
In the study, IPT patients had higher self-esteem and lower rates of relapse after a two-year follow up, when compared to those who underwent behavioral weight loss treatment (BWL). ITP can also be used for bulimia nervosa but is not recommended for the treatment of anorexia nervosa.
Get nutrition counseling
Working with a registered dietician is critical for recovering from an eating disorder. "Nutrition counseling is so important because it is needed to help restore or stabilize the patient's weight, improve any nutrition related deficiencies, re-establish blood sugar levels, and help the patient improve their relationship with food and their body," says Kahn.
A registered dietician will also work with you to create a regular meal plan encompassing all food groups. People with eating disorders often develop a fear of specific foods or food groups, which a dietician can help them overcome.
Each eating disorder brings distinct challenges around food, says Kahn. Therefore, treatments can vary based on the patient's condition:
Nutrition education for anorexia
For anorexia nervosa, education will center on reducing food restrictions, creating regular mealtimes, increasing calorie intake, and understanding hunger cues. Once a person's weight is restored, and their eating is improving, the focus will shift to maintaining these habits, trusting their body through intuitive eating, and letting go of any rules they've built around food like not eating past a certain time or avoiding specific food groups.
Nutrition education for bulimia
A patient with bulimia nervosa will work with a registered dietician to stabilize their weight, create structured eating plans across food groups, and remediate nutritional intake deficiencies. After that, the process is similar to anorexia nervosa with a focus on intuitive eating and removing the idea that some foods are good and others are bad.
Nutrition education for binge eating
As for binge eating disorder, an emphasis is placed on creating structured eating patterns throughout the day to deter bingeing episodes. Intuitive eating, learning how to understand hunger and fullness signs, and changing any negative views of food are also important here.
Read more about how to stop binge eating through mindfulness and nutrition counseling.
Consider trying medications
For eating disorder patients with a mental health condition like anxiety or depression, prescription medication may be helpful for managing the condition and benefiting from treatment.
Medication options typically include:
- Antidepressants
- Mood stabilizers
- Anti-anxiety medications
- Atypical antipsychotics
"I have had patients who have not recovered whatsoever from their eating disorder even with extensive support from a multidisciplinary team, but once they initiate medication, they are able to engage in therapy and utilize coping skills," says Magavi.
Check out treatment programs
There are three distinct treatment programs a person with an eating disorder may enter: outpatient, inpatient, and residential. These treatment programs are designed to create a structured environment in which eating disorder patients can receive help. The three programs vary in terms of intensity, with admission based on an individual patient's health and needs.
Outpatient
Outpatient care involves regular counseling sessions, meetings with your doctor, and working with a nutritionist, all while implementing recommendations themselves at home. A person who is making progress and voluntarily working to improve can stay in an outpatient program.
Unless someone has gotten to the point of a dangerous or life-threatening situation, outpatient care is typically the first option — a less restrictive method for treatment.
"Typically, inpatient or residential care is only recommended in cases where outpatient care has been unsuccessful, or when there are secondary medical or mental health issues placing a person at risk," says Shafir.
Residential
Residential care is best for patients who are not seeing significant progress from outpatient care and are not experiencing life-threatening complications requiring hospitalization.
This form of treatment involves checking into a 24/7 facility often with around the clock surveillance, meals provided, nutrition counseling, and group, individual, and family therapy. A person may stay between two weeks and a year, depending on their progress and ability to afford the program.
Inpatient
Inpatient care is when a person requires hospitalization. This treatment usually includes 24-hour supervision, locked bathrooms to prevent purging, medical interventions like hydration through IV, nutrition counseling, and group, individual, and family therapy.
"If a patient I evaluate has experienced ongoing weight loss despite continued treatment or is less than 75% body weight, I recommend acute hospitalization," says Magavi. Other signs that you may require inpatient care include:
- Changes in blood pressure, heart rate, and temperature
- Regurgitating blood
- Thoughts or actions of self-harm
A person will generally continue inpatient care for up to a few weeks, depending on their health.
Takeaways
When approaching treatment for an eating disorder, start by reaching out to a qualified medical professional and exploring different treatment options to determine which one works best for you.
"It is important to recognize that treatment can be challenging for someone with eating disorders, but it leads to the greatest and healthiest outcome," says Kahn. "It is never too late to get help, and you can recover and create a healthy relationship with food and your body."