Eating disorder treatment: Know your options

Finding the right type of eating disorder treatment depends on the disorder and its symptoms. It usually includes a mix of specific types of talk therapy, also known as psychotherapy, as well as medical monitoring and sometimes nutrition education or medicines.

Eating disorder treatment also involves taking care of other medical problems that an eating disorder causes or makes worse. These problems can be serious or even life-threatening if they go without being treated for too long. If an eating disorder doesn't get better with standard treatment or causes health problems, a stay in a hospital or another type of inpatient program may be needed.

A proven approach to eating disorder treatment can help people eliminate symptoms, return to a healthy weight, and maintain their physical and mental health.

Where to start

Whether you start by seeing your primary healthcare professional or a mental health professional, you'll likely benefit from a referral to a team of professionals who specialize in eating disorder treatment. Members of your treatment team may include:

• A mental health professional, such as a psychologist or therapist for talk therapy. It's important to choose a mental health professional with specialized training in eating disorder care, as this isn't something all therapists have.
• A registered dietitian to educate about nutrition and meal planning.
• Medical specialists to treat health problems due to your eating disorder.
• Your parents or other family members. For young people still living at home, parents should be involved in treatment and may supervise meals.

Managing an eating disorder can be a long-term challenge. You may need to continue to see members of your treatment team regularly until your eating disorder symptoms have been completely addressed.

Setting up a treatment plan

You and your treatment team figure out what your needs are and come up with goals and guidelines. Your treatment team works with you to:

• Create a treatment plan. This includes figuring out what evidence-based treatment you will use to address your eating disorder and what your treatment goals are. It also makes it clear what to do if you can't stay with your plan.
• Treat physical complications. Your treatment team monitors and takes care of any health and medical issues due to your eating disorder.
• Find resources. Your treatment team can help you figure out what resources are in your area to help you meet your goals.
• Work to find affordable treatment options. Hospital stays and outpatient programs for treating eating disorders can be expensive. Insurance may not cover all the costs related to your care. Talk with your treatment team about financial issues and any concerns. Don't avoid treatment due to cost. Some programs have scholarships or sliding scale programs that may help offset some of these costs.

Talk therapy

Talk therapy, also known as psychotherapy, is the most important part of eating disorder treatment. It involves regularly seeing a psychologist or another mental health professional with specialized training in eating disorder care.

Therapy may last from a few months to years. It can help you:

• Make your eating patterns better and help you reach a healthy weight.
• Replace habits that aren't healthy with healthy ones.
• Create problem-solving skills.
• Find healthy ways to cope with stress.
• Make your relationships better.
• Make your mood better.

Treatment may involve one of several types of proven eating disorder treatments, such as:

• Enhanced cognitive behavioral therapy (CBT-e). This type of talk therapy can be helpful for bulimia nervosa or binge-eating disorder. It focuses on behaviors, thoughts and feelings related to your eating disorder. After helping you gain healthy eating behaviors, it helps you learn to recognize and change distorted thoughts that lead to eating disorder behaviors. It has not been shown to be effective for anorexia nervosa.
• Family-based treatment. During this therapy, family members learn to help you regain healthy eating patterns and reach a healthy weight until you can do it on your own. This type of therapy can be especially useful for parents learning how to help a teen with an eating disorder.
• Dialectical behavioral therapy. This type of therapy has been proven to help binge eating or some symptoms of bulimia. It's a mix of group and individual therapy that helps you develop skills to manage distress, control emotions and have healthy relationships. Often this therapy involves phone coaching when you need more support in the moment.

Your psychologist or another mental health professional may ask you to do homework. This could include keeping a food journal to review in therapy sessions and figuring out what causes you to binge, purge or use other eating behaviors that aren't healthy.

Nutrition education

Registered dietitians and other professionals who take part in your treatment can help you learn more about your eating disorder and create a plan to regain and maintain healthy eating habits. It's important to seek treatment from someone who has specialized training in eating disorders because this training is not standard for dietitians. Goals of nutrition education may be to:

• Work toward a healthy weight.
• Learn how nutrition affects your body, including knowing how your eating disorder causes nutrition issues and physical problems.
• Practice meal planning.
• Set regular eating patterns — generally, three meals a day with regular snacks.
• Take steps not to diet or binge.
• Correct health problems due to poor nutrition.

Medicines

Medicines can't cure an eating disorder. They're most effective when combined with talk therapy. Antidepressants are the most common medicines used to treat eating disorders that involve binge eating behaviors. Taking an antidepressant may be helpful if you have bulimia or binge-eating disorder. These medicines have not been shown to be effective for people who are underweight.

You also may need to take medicines, vitamins or supplements for physical health problems that your eating disorder causes.

A hospital stay

A hospital stay may be needed if you have serious physical or mental health problems or if you can't eat or gain weight. Severe or life-threatening physical health problems that occur with eating disorders can be a medical emergency.

In many cases, the most important goal of a hospital stay is to stabilize short-term medical symptoms by starting to improve eating and weight. Most of this work takes place in the outpatient setting.

Hospital day treatment programs

Day treatment programs are structured. Generally, you need to attend for multiple hours a day, several days a week. Day treatment can include medical care, as well as group, individual and family therapy. It also can include structured eating sessions and nutrition education.

Residential treatment

With residential treatment, you live at an eating disorder treatment facility for a time. A residential treatment program may be needed if you need long-term care for your eating disorder or you've been in the hospital several times, but your mental or physical health hasn't gotten better.

Ongoing treatment for health problems

Eating disorders can cause serious health problems related to poor nutrition, bingeing, purging and other factors. Which health problems eating disorders cause depends on the type of eating disorder and how severe it is. In many cases, the problems an eating disorder cause require ongoing treatment and monitoring.

Health problems linked to eating disorders may include:

• Electrolyte imbalances, which can affect how well your muscles, heart and nerves work.
• Heart problems and high blood pressure.
• Digestive problems.
• Lack of nutrients.
• Dental cavities and wearing away of the surface of your teeth from vomiting a lot, such as with bulimia.
• Not having a menstrual period and having problems getting pregnant and with pregnancy.
• Low bone density, also known as osteoporosis, due to irregular or no menstrual period or long-term poor nutrition, such as with anorexia.
• Stunted growth due to poor nutrition, such as with anorexia.
• Mental health conditions such as depression, anxiety, obsessive-compulsive disorder or substance misuse.

Take an active role

You are the most important member of your treatment team. For treatment to work, you need to take part in your treatment, as do your family members and other loved ones. Your treatment team can help you learn more about eating disorders and tell you where to find more information and support.

There's a lot of bad information about eating disorders on the web. Follow your treatment team's advice and get their input on which websites you can trust to learn more about your eating disorder. Examples of websites you can trust include the Academy for Eating Disorders (AED), National Eating Disorders Association (NEDA) and Families Empowered and Supporting Treatment of Eating Disorders (F.E.A.S.T.).