Psychiatric Care for Eating Disorders

Eating disorders are serious medical and psychiatric illnesses that affect eating, thoughts about food, and often how a person sees their body. They include anorexia nervosa, bulimia nervosa, binge eating disorder, and avoidant/restrictive food intake disorder (ARFID). They can affect people of any age, gender, or body size, and often occur alongside anxiety, depression, or OCD.

How our physicians help

Our physicians evaluate the eating disorder alongside any anxiety, depression, trauma, or ADHD, and offer psychotherapy and medication where they help. Because eating disorders can be medically dangerous, we work closely with medical doctors, dietitians, and therapists. When someone needs a higher level of care, such as hospital, residential, or partial hospital treatment, we coordinate with that team; outpatient care does not replace it.

Signs of an eating disorder

Eating disorders are often hidden, and shame keeps many people quiet. In adults, early signs are often private, such as constant thoughts about food. In children and teens, family members usually notice first, often as mood changes around meals or slowed growth. Signs include:

• Thoughts about food or body shape that crowd out work, school, or friends
• Avoiding shared meals, or tension around eating
• Eating in secret, or feeling out of control with food and then ashamed
• Exercise that feels like a rule rather than a choice
• Often feeling dizzy, cold, or worn out, or periods that stop
• In children, growth that slows or a shrinking list of foods they will eat

How eating disorders are evaluated

Our physicians ask how eating and thoughts about food have changed and how daily life has been affected. We go at a manageable pace.

A medical check is part of care too. It usually includes vital signs, blood tests, and often a heart rhythm test, done with a primary care physician or pediatrician. Normal results do not rule out a problem.

Other causes to rule out include thyroid disease, diabetes, digestive conditions, and appetite changes from depression or medication.

Therapy, nutrition, and medication

Regular nourishment comes first, because therapy works better when the body and brain are fed. For children and teens with anorexia or bulimia, family-based treatment (FBT) is usually the first choice. Parents take the lead with meals for a time, then hand control back as health returns.

For adults and many teens, cognitive behavioral therapy (CBT) works on the thinking and habits that maintain the illness. For ARFID, a form called CBT-AR slowly builds comfort with more foods.

Medication has a smaller role. Certain antidepressants can reduce symptoms of bulimia and binge eating for some people, and your physician chooses carefully, since not all are safe with an eating disorder. No medication treats anorexia itself, though medicine may ease depression or anxiety alongside it. Recovery often takes many months or longer, with setbacks along the way.

How to help a loved one

Parents do not cause eating disorders, and no one chooses one. The illness can make a person deny there is a problem, so expect some anger when you bring it up, and keep the door open. With a child or teen, do not wait for them to agree before arranging an evaluation.

• Talk about changes in mood and energy, not food or body shape
• Skip comments on looks, even kind ones
• Keep talk of diets and body size away from the table

It is never too early to ask

You do not need to look ill or reach any certain point to deserve care. Reach out when worries about food or your body fill much of the day, or when a child's eating changes and does not bounce back.

For fainting, chest pain, a racing or uneven heartbeat, confusion, or refusal of all food or fluids, call 911. If you or someone close to you is thinking about suicide or self-harm, call or text 988 (the Suicide & Crisis Lifeline) or call 911. We are not an emergency service.

Find your doctor for eating disorders →