Partly because eating disorders are so complex, knowing where to go for treatment and how to access it can feel overwhelming. Patients with eating disorders may receive treatment in a variety of settings including an outpatient clinic, a hospital setting, or something in between. Knowing more about the aspects of treatment—including goals, treatment providers, settings for treatment, components of treatment, and payment and compliance issues—can help you feel a bit more ready to take your first step on the road ahead.
What Are the Settings in Which Eating Disorder Treatment Occurs?
Because insurance providers frequently dictate what level of treatment they are willing to financially cover, you may not have much of a say over which setting you are treated in (unless you are willing and able to pay for treatment out of pocket). It is common to start with a lower level of treatment and progress to higher levels of care as needed. Additionally, if you do receive more intensive treatment, you will likely be gradually stepped down to progressively lower levels of care as treatment progresses and you improve. This is typically decided by members of the treatment team in conjunction with insurance providers. The different levels from least to most intensive include:
Outpatient treatment typically entails individual, one-hour sessions once or twice a week with each individual provider. Intensive outpatient treatment (IOP) can be two to three sessions a week, a few hours each time, while you live at home and possibly work or attend school. Partial hospitalization programs (PHP) are usually held five days a week for six to 11 hours per day, allowing you to sleep at home. Residential treatment centers (RTC) provide 24-hour care for those who are medically stable but require supervision. Medical hospitalizations provide 24-hour care for those who require medical supervision.
Who Is on an Eating Disorder Treatment Team?
Because eating disorders are mental illnesses, a central member of the treatment team is usually a psychotherapist who may be a psychologist, psychiatrist, social worker, or other licensed counselor. The team will often include a medical doctor, such as a primary care physician or pediatrician, a registered dietitian, and a psychiatrist. A team approach allows for the various aspects of the eating disorder to be managed. Collaboration amongst team members is critical. If you are not in a treatment center, you may have to play a role in assembling your team. It is a good idea to ensure your providers have experience with eating disorders. Sometimes providers will have recommendations for other team members with whom they like to collaborate, which can help you build your team.
Goals of Treatment
The goals of treatment, according to the Academy for Eating Disorders’ Medical Care Standards Committee (2016), include:
Nutritional rehabilitation Weight restoration (where appropriate) Medical stabilization and prevention of serious medical complications Cessation of binge eating and/or purging behaviors Elimination of disordered eating or ritualistic eating behaviors Improved body image Restoration of meal patterns that promote health Reestablishment of social engagement
Nutritional Therapy
One of the first tasks of recovery is repairing lost weight and health, and normalizing food intake and behaviors. Nutritional therapy is commonly conducted by a registered dietitian. A dietitian typically assesses your nutritional status, medical needs, and food preferences. He or she also helps to collaboratively develop a meal plan that provides needed nutrition, as well as exposure to feared foods with the goal of increasing flexibility.
Medical Treatment
Medical treatment for patients with eating disorders is best handled by a medical doctor with specific training in the treatment of eating disorders, so potential medical issues related to disordered eating behaviors can be successfully managed. The Academy for Eating Disorders’ Critical Points for Early Recognition and Medical Risk Management in the Care of Individuals with Eating Disorders provides guidelines for medical professionals. Medical treatment commonly includes:
Monitoring of vitals Laboratory tests and weight tracking Additional testing to assess heart function and bone density Management of physical symptoms ranging from gastrointestinal distress to heart problems
Psychological Treatments for Eating Disorders
The best-studied treatment for eating disorders is cognitive-behavioral therapy (CBT). It has proven effective for adults with bulimia nervosa, binge eating disorder, other specified feeding and eating disorder, and anorexia nervosa. It is also sometimes used for older adolescents. In cognitive behavioral therapy, the initial focus is on addressing symptoms and on behavioral change. Elements of CBT treatment commonly include:
Self-monitoring such as keeping a food diary Meal planning Establishing regular eating Disrupting dangerous behaviors such as dieting, binge eating, and compensatory behaviors Addressing the over-evaluation of shape and weight Challenging dietary rules Addressing body image Exposure to forbidden foods Relapse prevention
While CBT is the best treatment for adults, the therapeutic approach that shows the best evidence for the treatment of adolescents with both anorexia nervosa and bulimia nervosa is family-based treatment (FBT). Preliminary research and case studies also indicate that FBT is an acceptable approach for young adults. Family-based treatment is a manualized therapy that is administered in weekly sessions by a psychotherapist who meets with the entire family. Parents are empowered to play an active role in the treatment. The adolescent remains in the home and parents provide meal support to help normalize eating behaviors. In addition to CBT and FBT, the other forms of psychotherapy that have proven successful (but are less well-studied) in the treatment of eating disorders include the following:
Interpersonal therapy (IPT) for bulimia nervosa and binge eating disorder Dialectical behavior therapy (DBT) for bulimia nervosa and binge eating disorder Acceptance and commitment therapy (ACT) for anorexia nervosa, bulimia nervosa, and binge eating disorder Integrative cognitive-affective therapy (ICAT) for bulimia nervosa Cognitive remediation therapy (CRT) for anorexia nervosa Special supportive clinical management (SSCM) for chronic anorexia nervosa Mindfulness-based eating awareness training (MB-EAT) for binge eating disorder Self-help/guided self-help (based on CBT) for bulimia nervosa and binge eating disorder
This list, while not exhaustive, does demonstrate that there are a number of psychotherapeutic approaches that have been employed and investigated for the treatment of eating disorders.
Psychiatric Medication
Eating disorders may be the mental health disorders that are offered the least helped by psychiatric medications.
No medication has been shown to be particularly successful in clinical trials for anorexia nervosa. Antidepressants, such as the SSRIs and the anticonvulsant Topiramate, have shown to provide some help in reducing binging and purging in patients with bulimia nervosa. Antidepressants—primarily selective serotonin reuptake inhibitors (SSRIs), the ADHD medication Vyvanse, and Topirimate—have been shown to be helpful for the treatment of binge eating disorder.
A psychiatrist (or sometimes a general medical doctor) makes decisions about the prescription of psychiatric medication on a case by case basis. Usually, medications are used in conjunction with psychotherapy.
How to Find Treatment
Finding treatment for yourself or a loved on can feel overwhelming. One good place to start is with your general medical provider, internist, or pediatrician. Let them know your concerns and ask for referrals. The National Eating Disorders Association has a confidential, toll-free helpline. You can call and speak to a trained volunteer who can offer support and make referrals. The number is 800-931-2237.
Paying for Treatment
Treatment for eating disorders can be expensive, but is often covered by medical insurance. Calling your insurance provider and asking about coverage is a recommended step. Keep in mind, however, that insurance companies sometimes deny coverage for eating disorders. Hence, you may need to advocate on your or your loved one’s behalf, especially for the higher levels of care. If you do not have insurance, options are more limited. Several treatment centers and organizations such as Project Heal provide assistance to some. Unfortunately, all too often community mental health centers and public health insurance programs fail to provide treatment and coverage for eating disorders.
What If My Loved One Refuses Treatment?
It is not uncommon for patients with eating disorders to not believe that they have an eating disorder and to refuse treatment. Please do not let this deter you. If you are the parent of an adolescent (or young adult who is financially dependent), you should seek treatment on their behalf even if they do not want it. Eating disorders can have very serious consequences and are best treated when addressed early in the illness. Family-based treatment offers families the chance to seek recovery on a child’s behalf. If your loved one is an adult, this can be more complicated. Privacy laws and patients’ rights make it challenging to force an adult into treatment. However, please do not give up on your loved one. Many individuals with eating disorders have recovered because others wanted recovery for them. You may be able to stage an intervention or, in extreme circumstances, obtain a conservatorship or guardianship. Regardless, a great first step is to get more educated. Familiarize yourself with the information in these pages and you will go a long way in helping your loved one.
What About Relapses?
Unfortunately, relapses are not uncommon. They can be discouraging, but they do not mean that you’ve failed or that you won’t fully recover. They are a normal part of the recovery process and allow you to fine-tune your recovery skills.
A Word From Verywell
Starting treatment can be difficult and scary for all those involved. Recovery itself can have its ups and downs, and can be quite challenging. It may be helpful to keep focused on the end goal, which is a life free from your eating disorder.
