Eating disorder therapy includes a multidisciplinary treatment team approach with professionals such as primary care providers, therapists, dentists, psychiatrists, and dieticians.1, 2 Treatment can happen at the inpatient or outpatient level, and therapy can occur at individual, family, or group modalities.(FN2) Severity of symptoms, insurance coverage, diagnosis, age, gender, and need for privacy may impact the type of therapy you seek.2
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Importance of Therapy in Treating Eating Disorders
Therapy is important for treating eating disorders because it addresses the root causes of why the individual developed an eating disorder. Individuals with eating disorders often struggle with impulsivity, obsessive-compulsiveness, and perfectionism, all of which can be addressed in therapy.1 Additionally, eating disorders have a high morbidity with childhood sexual abuse, which is also best addressed with some form of trauma therapy.1
Types of Eating Disorder Therapy
Psychotherapy for eating disorders can be focused on changing thoughts around food, increasing life skills, or improving relationships. Treating eating disorders in therapy can include different approaches that might work better for different diagnoses. However, there are some approaches to eating disorder therapy that are useful for all diagnoses. Regardless of the type, early intervention increases the chances of recovery and lowers the risks of relapse.1
Effective types of eating disorder therapy include:
Cognitive Behavioral Therapy
CBT for eating disorders (CBT-e) is somewhat the best therapy for eating disorders because it is transdiagnostic, meaning that it is used for the treatment of all eating disorder diagnoses.5 Although it has long been the gold standard treatment for bulimia nervosa, the new enhanced version of CBT is adaptive to other eating disorders such as anorexia nervosa and eating disorders not otherwise specified.5 CBT-e has also been adapted for work with younger populations, and research is ongoing in this area.5
CBT-e addresses underlying distorted beliefs, which are common in all eating disorders. This is what makes the therapy able to treat all diagnoses. For example, people with eating disorders often overvalue their shape and weight, leading to patterns of restricting, binging, or other compensatory behaviors.5 CBT-e focuses on addressing underlying issues with perfectionism, relationships, and self-esteem.5
Here is some additional information about CBT for eating disorders:
- Length of treatment: For individuals who are underweight, 40 sessions are generally completed over 40 weeks.5 For individuals who are weight-stable, 20 sessions over 20 weeks is advised.5 More sessions are generally required for anorexia nervosa compared to bulimia nervosa or binge eating disorder.1
- Ideal for: CBT-e can be helpful for all eating disorders.5 It is often the first line of treatment recommended for binge eating and bulimia nervosa.1, 5 Research is ongoing around adaptations for younger populations.5
- Individual or group setting: CBT-e is designed to be delivered on an individual basis for adults in any outpatient setting.5 Research is ongoing around adaptations for inpatient and day program settings.5
Dialectical Behavior Therapy
DBT for eating disorders is focused on teaching individuals core life skills in four distinct areas: mindfulness, interpersonal effectiveness, emotion regulation, and distress tolerance.6 Although originally developed for work with individuals diagnosed with borderline personality disorder, DBT has grown in research evidence for the treatment of anorexia nervosa, bulimia nervosa, and binge eating disorder.6
Different adaptations of DBT may be more appropriate for certain diagnoses. Radically-open DBT (RO-DBT) is appropriate for individuals with anorexia nervosa who have not responded to CBT-e and have moments of emotional overcontrol that affect treatment.6 Standard DBT may be appropriate for individuals with bulimia or binge eating disorder when CBT-e has not been effective and lack of emotion regulation is affecting treatment.6
Here is some additional information about DBT for eating disorders:
- Length of treatment: Treatment can range from 20 weeks to 6 months, with the average length of treatment around 21.7 weeks.6 Treatment length largely depends on the program, severity of eating disorder symptoms, and individual needs of a person.
- Ideal for: DBT is generally used for bulimia nervosa and binge eating disorder treatment in adults.1 Research is ongoing around adaptations for adolescents.
- Individual or group setting: DBT is typically conducted with a combination of individual and group therapy. Individual therapy allows for more focused attention on the person, while group therapy allows them to learn and practice the core skills with others.
Family-Based Treatment
Family-based treatment (FBT), a type of family therapy, is an effective eating disorder therapy for adolescents with anorexia nervosa or binge eating disorder.1, 3 FBT also has emerged as an eating disorder therapy for adults who have bulimia nervosa or ARFID.1 When used with adolescents, the main goal of FBT is to recover adolescents through the support of their parents and sometimes other family members.7
FBT involves parents in the treatment process by giving them the autonomy to make most decisions about their child’s food and eating patterns.7 The idea is that this temporary shift in power will help keep the child out of higher levels of care while also building a healthy dependence and bond.7 Siblings are generally also given supportive roles in treatment.7 Other stages of treatment include family meals and the eventual return of autonomy back to the child.7
Here is some additional information about family-based treatment for eating disorders:
- Length of treatment: FBT can take anywhere from 6 to 12 months as an eating disorder therapy. FBT also depends on how quickly patients progress from one stage to the next.
- Ideal for: FBT is the most recommended treatment for children and adolescents with anorexia nervosa and binge eating disorder.1, 3 However, FBT can also be adapted for use with individuals who have bulimia nervosa or ARFID.1
- Individual or group setting: FBT is used with individuals who are medically stable enough for outpatient eating disorder therapy.7 FBT is typically conducted in an individual family setting.
Interpersonal Psychotherapy
Interpersonal psychotherapy (IPT) focuses on treating the interpersonal difficulties that individuals with eating disorders experience.8 IPT has evidence of being an alternative to CBT-e for the treatment of binge eating disorder and bulimia nervosa.8 IPT is an effective treatment for eating disorders because it directly addresses interpersonal difficulties that develop as a result of the eating disorder, such as social withdrawal and low self-esteem.8
IPT breaks down interpersonal problems to address the areas of grief, role disputes, role transitions, and interpersonal deficits.8 Since IPT focuses more on lasting interpersonal changes, patients are responsible for upholding social and occupational obligations during treatment.8
Here is some additional information about interpersonal therapy for eating disorders:
- Length of treatment: IPT as eating disorder therapy generally occurs across 16-20 50-minute treatment sessions over 4-5 months.8 There are three phases of treatment for IPT.8
- Ideal for: IPT is generally recommended for individuals struggling with binge eating disorder or bulimia nervosa.8 The therapy is not recommended for anorexia nervosa, as research evidence has not been documented.8
- Individual or group setting: IPT for eating disorder therapy can be conducted in either individual or group format. The group format allows individuals to practice the skills learned to resolve interpersonal difficulties in individual therapy.
Emotion-Focused Family Therapy
Emotion-focused family therapy (EFFT) is a type of eating disorder therapy that is a transdiagnostic approach involving whole-family healing. Through emotion-focused family therapy, parents learn to serve as emotion coaches for their child.9 Parents are taught to provide a safe and validating environment for children to process painful emotions, ultimately removing the need to use eating-disordered behaviors to cope.10
The two main goals of EFFT are to help parents learn to interrupt symptoms and how to support recovery, as well as to support parents in becoming emotion coaches.10 EFFT has gathered evidence supporting positive parental self-esteem building and decreasing self-blame.9 EFFT supports the positive building of emotion regulation skills necessary to prevent relapse.10
Here is some additional information about emotion-focused family therapy for eating disorders:
- Length of treatment: EFFT is generally an eating disorder therapy that takes 8 weeks. The length of treatment can be expanded or shortened based on individual needs.
- Ideal for: EFFT is recommended for children and adolescents as a family-based treatment when other approaches have not been beneficial. Since EFFT is considered transdiagnostic, it can be used for a variety of eating disorders.
- Individual or group setting: EFFT is typically conducted either with the whole family or solely with the parents or caregivers. Sometimes, there is a mix of these sessions.
Online Vs. In-Person Eating Disorder Therapy
It may be more beneficial for certain individuals to seek in-person versus online care for disordered eating, depending on the severity of symptoms. Most programs and therapists will ask screening questions when you contact them about beginning treatment. It is important to be honest about symptoms during this screening so that professionals can provide you with the most accurate recommendations for treatment.
Online therapy is contraindicated for individuals whose eating disorder symptoms are severe enough to warrant the need for in-person monitoring. Some individuals may need to gain weight to receive medical clearance for lower levels of care. Other individuals may need weight, vitals, or simply checks for physical signs of continued eating disorder behaviors. Eating meals together is sometimes a helpful experiential therapy for disordered eating, which may be best done in person rather than online.
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Individual Vs. Group Eating Disorder Therapy
Eating disorders therapy on an individual level includes more privacy and more focused monitoring than is available at a group level. Individual therapy may be more appropriate for someone who is in crisis or still working on addressing specific traumas or phobias that may prevent them from healthy group participation. Sometimes, individual eating disorder therapy can help prepare someone for group therapy work.
Some research supports evidence that group therapy for eating disorders is as effective as individual psychotherapy.3 Benefits of group therapy include practicing social skills, gaining social support, practicing eating meals around others, addressing social anxieties, practicing accountability, and learning to tolerate others’ perspectives. Group therapy for eating disorders could include psychoeducation, process, or therapy-driven groups.
Combining Individual and Group Therapy
In many cases, combining individual and group therapy may be beneficial. For example, treatment programs often have a psychoeducation group, art therapy group, family therapy, and nutrition or meal group, in addition to individual therapy. Through each of these individual and group treatments, patients can learn important aspects of recovery and practice learned coping skills for eating disorders, such as meal planning, mindful eating, processing body image, or fostering mindfulness skills.
The goal is to help someone understand how to use their recovery skills flexibly. When someone can practice how to cope under varied circumstances, they are more likely to experience confidence and success in recovery after treatment.
Navigating Referrals & Insurance for Eating Disorder Therapy
Your first step for eating disorder therapy will require you to confide in some sort of professional about your symptoms. You could first contact your primary care doctor, therapist, or even an administrative member at an eating disorder program to discuss symptoms or schedule an initial evaluation. If you are attending any sort of inpatient or outpatient program, you may need prior approval from insurance.
Referral Process for Eating Disorder Therapy
If you are seeking therapy at the outpatient level, you will not require a referral for treatment. Treatment such as inpatient or partial hospitalization will require a diagnosis and referral for the potential of insurance coverage. The referral process can be tricky, although having a plan and willingness to advocate for your needs can help you make it through.
The typical pathway for eating disorder treatment involving a program occurs through a therapist, doctor, or treatment team. It is highly recommended to sign a release of information so that your treating professionals can confer with one another regarding the best options for treatment and continued recovery.
Insurance Coverage for Eating Disorder Therapy
Finding a treatment option that is in-network is highly recommended because it will offer you the most financial coverage from your insurance. Otherwise, you may be left to foot the bill for your eating disorder therapy. A common reason insurance coverage can be denied is if the treatment is deemed “not medically necessary.” This is why an accurate diagnosis and evaluation by a therapist, psychiatrist, or doctor can be helpful for insurance coverage.
Even individual versus group therapy coverage can vary based on your insurance benefits. Some insurances may also require certain service codes to cover individual or group therapy appointments. Even if you have an out-of-network appointment, you can ask for a super-bill to submit to your insurance for possible partial or full reimbursement of sessions.
Here are some examples of questions to ask your insurance provider about eating disorder therapy:
- Do I have mental health benefits?
- Does my plan cover partial hospitalization, residential services, etc.?
- What are my in-network and out-of-network benefits?
- Do I have a deductible to meet? If so, what is it?
- Is my provider or treatment center in-network? Do I need a pre-authorization to see them?
Financial Assistance & Sliding Scale Options for Eating Disorder Therapy
Finding financial assistance for eating disorder therapy can be difficult due to the specialization of the field. However, it is not impossible. Some options you might look into would include outpatient providers who offer sliding scale fees, community health centers, or sometimes medical schools that have interns.
There are also scholarship resources, such as Eating Disorder Recovery Support or Project Heal. Remember that even if a provider says they cannot offer services, you can ask if they have any referrals to advocate for your needs around eating disorders therapy.
How to Choose the Type of Eating Disorder Therapy
Choosing the right eating disorder therapy is a highly personal decision. Educating yourself on options through seeking a professional evaluation can help you combine medical knowledge with your own personal needs to make the best decision for treatment. When you hear the recommended level of care, it is important to trust a professional’s decision and follow through with the level of treatment suggested.
You still have options about what type of treatment or therapy you desire, even if you follow through with the recommended level of care. You can choose a treatment program that uses the types of eating disorder therapy you are most drawn to. It is not uncommon to ask questions about treatment, and some places may allow you to visit on-site prior to becoming a patient.
Role of Support Groups Alongside Eating Disorder Therapy
Support groups can complement primary eating disorder therapy by providing additional relational support to the person. Support groups have been found to foster self-esteem, reduce hospital stays, increase treatment engagement, and help support the hope for recovery.12 Particularly for groups that have members of mixed statuses of recovery, there is a lot of opportunity for beneficial mentoring relationships.12
Complementary Eating Disorder Therapies
Complementary therapies, such as biofeedback, acupuncture, and yoga, are often used in conjunction with mainstream eating disorder therapies. These approaches can offer a holistic approach to eating disorder treatment and generally support mind-body connection. Research on the effectiveness of complementary therapies is mixed, but the general consensus is that it should only be used as an additional therapy and not the primary course of treatment.11
Adjunctive eating disorder therapies include:
- Yoga
- Virtual reality exposure therapy
- Biofeedback
- Neurofeedback
- Massage
- Bright light therapy
- Acupuncture
How to Find an Eating Disorder Therapist
Professional support is recommended at the first sign of struggles around eating, as eating disorder symptoms can progress rapidly and have devastating physical consequences. It is important to understand that some therapists are not trained to work with eating disorders and may refer you to someone with more experience. Therapists and counselors are also trained to assess higher levels of care needs, such as in-patient or out-patient treatment programs. You may be referred for this type of care if outpatient therapy is not ethical based on your symptoms.
You can use an online therapist directory or online therapy platform to explore counseling options for therapists specializing in eating disorders. Eating disorder therapists often offer therapies such as DBT, CBT, or family-based treatments. Sometimes, online psychiatrist options may be warranted for medication management.
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Additional Resources
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Eating Disorder Treatment
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Eating Disorders: Types, Treatments & How To Get Help
If you or a loved one are dealing with an eating disorder, know you’re not alone. Treatment can significantly help improve thought patterns and symptoms that can contribute to eating disorders, and having a robust care team can be an effective prevention strategy long-term.
Eating Disorder Therapy Infographics