Eating disorder therapy options: 10 types of treatment

Eating disorders are serious mental health conditions that are typically characterized by unhealthy patterns of eating and exercise. If you’re experiencing an eating disorder, know that you are not alone. According to the National Eating Disorders Association, “9% of the US population, or 28.8 million Americans will have an eating disorder in their lifetime.” 

Those living with an eating disorder often experience a negative body image and low self-esteem. Different types of therapy can be effective in managing and treating eating disorders, including cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), peer support groups, and more. A combination of these approaches may provide individuals with the most powerful recovery outcomes. In this article, we’ll explore a list of 10 eating disorder treatments and their potential benefits. 

*You can contact the National Alliance for Eating Disorders Helpline at 1 (866) 662-1235.

1. Cognitive behavioral therapy (CBT)

Cognitive behavioral therapy is one of the most recommended treatments for eating disorders, such as anorexia nervosa, bulimia, and binge eating disorder. A systematic review and meta-analysis on the efficacy of CBT for eating disorders found that CBT outperformed all other types of psychotherapies. CBT typically focuses on the maladaptive thought processes (negative or inaccurate thoughts and beliefs) that are behind maladaptive behaviors.  

The cognitive aspect of eating disorders tends to involve body image, self-esteem, and obsessive thoughts about weight and eating. The behavioral aspect typically includes the actions of binging, restricting, purging, body-checking, or self-harm. CBT aims to help people recognize the cognitions, or thoughts, behind their eating disorder behaviors and then shift their automatic thoughts to be healthier and more positive. By shifting their thoughts, individuals can often learn how to change their unwanted behaviors.

Cognitive behavioral therapy (CBT) techniques for eating disorders typically include:

• Cognitive restructuring: Recognizing and replacing unhealthy thoughts with more adaptive thoughts.
• Nutritional counseling: Education and guidance about nutrition, food planning, and physical health. 
• Coping strategies: Individuals can learn ways to cope with their triggers and manage their negative thoughts. 
• Homework: Eating disorder therapists may assign homework for their clients to complete in between sessions.
• Relapse prevention: Relapse prevention can be an important part of eating disorder recovery that CBT can aid with by teaching skills and providing emotional support. 
  

2. Dialectical behavior therapy (DBT)

Dialectical behavior therapy (DBT) was developed as a treatment for borderline personality disorder but has since been adapted to be used as a treatment for eating disorders, substance use disorders, and post-traumatic stress disorder.

DBT typically focuses on teaching clients how to accept themselves as they are while also working toward their goals and making positive behavioral changes. CBT and DBT both aim to help people manage strong emotions without relying on harmful coping mechanisms or destructive behaviors. A 2020 review of the efficacy of DBT for eating disorders found that DBT could be an effective treatment for binge eating disorder, bulimia, and possibly anorexia. However, more research still needs to be done. 

Dialectical behavior therapy (DBT) typically has five components:

• Skills training: DBT skills training often takes place in groups where participants are taught skills regarding emotional regulation, mindfulness, distress tolerance, and ways to maintain healthy interpersonal relationships. 
• Individual therapy: Working one-on-one with a talk therapist while going through DBT skills training can provide additional emotional support and guidance. 
• Coaching: Some DBT therapists offer telephone coaching, allowing their clients to reach out in between sessions for guidance on how to handle situations in real time using DBT skills. 
• Environment: Environment can play a large role in mental health; DBT may include management skills for structuring daily life in a way that supports healthy living. 
• Consultation team: A DBT consultation team typically consists of a group of mental health professionals, including counselors, therapists, skills training experts, and social workers, who work together for a collaborative treatment. 

3. Family-based treatment (FBT)

Family-based treatment (FBT) is an eating disorder therapy approach that includes the family in the treatment process. It is typically recommended for young adults and adolescents with anorexia nervosa or bulimia. FBT is a therapy model that also offers support to the caregivers of individuals living with an eating disorder. 

Family-based therapy typically applies principles from structural family therapy, behavior therapy, and narrative therapy to treat eating disorders. The framework of FBT is to empower a family to share a stronger connection and work toward goals together. FBT also tends to emphasize the importance of nutrition, and therapy sessions may include having a family meal with the therapist so they can observe the family’s dynamics. 

4. Interpersonal psychotherapy (IPT)

Interpersonal psychotherapy (IPT) is an approach that aims to help people develop the necessary skills for close interpersonal relationships. This can reduce their mental distress and allow them to build a strong support network. IPT may help individuals view their emotional reactions as social signals and then adapt their behavior accordingly to have more positive interpersonal connections. 

When utilized to treat eating disorders, IPT typically focuses on how interpersonal dynamics can affect people’s self-esteem and behavior. IPT often aims to improve self-esteem, address the isolation that can come from having an eating disorder, and teach skills for coping with triggers from interpersonal relationships that may lead to binges and other harmful behaviors.

IPT typically has two primary principles:

• Depression is a treatable medical illness that is not the individual’s fault. 
• Life circumstances play a role in mental health, and mood disturbances can be a natural reaction to triggering or stressful life events. 

5. Acceptance and commitment therapy (ACT)

Acceptance and commitment therapy (ACT) is a type of behavior therapy that aims to treat eating disorders by teaching individuals how to practice self-acceptance. ACT typically relies on various metaphors to shift an individual’s perspective and to help them accept their thoughts and feelings without judging them. It also tends to teach skills for preventing harmful coping mechanisms and behaviors, which may otherwise worsen the symptoms associated with eating disorders. 

The following are some techniques that are typically used in acceptance and commitment therapy (ACT):

• Acceptance: Eating disorders can often be a result of an individual trying to cope with strong emotions and avoid unpleasant internal feelings or thoughts. ACT typically teaches individuals how to accept their full range of emotions without dwelling on the unhelpful or negative ones. 
• Defusion: When someone believes that their negative thoughts are true, this is called cognitive fusion. ACT aims to “defuse” irrational or negative thoughts, such as thoughts of low self-worth, and replace them with healthier thought processes. 
• Mindfulness: Mindfulness refers to the practice of staying present in the moment and being aware of one’s thoughts, feelings, and sensations. ACT teaches mindfulness skills that can be beneficial for eating disorder recovery. 
• Detachment: Clients are often taught how to detach themselves from their beliefs of negative self-worth and see themselves from a more objective point of view. They are then encouraged to develop healthier beliefs about themselves.
• Clarity: This portion of ACT treatment for eating disorders tends to focus on gaining clarity about what the client’s values are and who they want to be as a person. Some people’s sense of identity can be deeply impacted by their eating disorder, which is why it can be important to identify what they want their identity to be beyond their disorder. 
• Action: ACT is a behavioral therapy that is typically action-focused and encourages individuals to take steps toward reaching their goals through behavioral changes. The goal is typically to help them reconnect with daily life, interpersonal relationships, and activities to live a more fulfilling life. 

6. Psychodynamic therapy (PDT)

Psychodynamic therapy (PDT) is a form of talk therapy that typically focuses on how early childhood memories and past experiences can shape our beliefs and behaviors. PDT is based on the idea that patients can gain insight into their current mindset and behaviors by looking at how their beliefs were formed in childhood. 

Attachment insecurities can sometimes lead to eating disorder symptoms. Research suggests that psychodynamic therapy can treat eating disorders by addressing attachment states of mind and defensive functioning. A therapist who practices PDT often considers interpersonal relationships and social aspects during treatment. 

7. Group therapy

Peer support groups can be an effective option for supporting eating disorder recovery. Group therapy is often recommended in addition to individual talk therapy. Meeting others with similar experiences may help people understand themselves on a deeper level.

Experiencing an eating disorder can make people feel isolated. With group sessions, patients can be reminded that they are not alone. Connecting with peers can help individuals living with eating disorders improve their self-esteem, be more accountable, and gain emotional support. 

Eating disorder support groups may provide education, fun group activities, and discussions led by mental health professionals. A few of the different types of support groups for eating disorder treatment include CBT groups, DBT groups, family therapy groups, expressive arts therapy groups, and problem-solving groups. 

8. Nutritional counseling

Nutritional deficiencies and dehydration can have serious impacts on physical health, so nutritional counseling is often a part of the eating disorder recovery process. During nutritional counseling, a health professional typically helps their clients explore their relationship with food and learn actionable skills, such as meal planning.

Nutritional counseling is typically tailored to fit the needs of the individual and focuses on treating both the mind and the body. Correcting misinformation about diet and nutrition and shifting the client’s beliefs about food intake or body image are often at the forefront of the nutritional counseling approach. Nutritional coaches often help people with eating disorders create healthy food plans and set achievable goals for recovery. 

9. Medical management

Some individuals living with an eating disorder require medical oversight in a residential treatment program to test for vitamin and mineral deficiencies, hormone imbalances, loss of bone density, and low or high blood pressure. Medical interventions for eating disorders may also include pharmaceuticals such as antidepressants. Medications can help manage symptoms of comorbid mental illnesses, such as anxiety and depression, which often exist alongside eating disorders. It’s recommended that you consult a doctor before deciding to start a new medication.

10. Online therapy for eating disorder treatment

Individuals experiencing an eating disorder may require in-person treatment, including medical management, to treat their condition, but others may find healing through talk therapy alone. In these instances, online therapy can be a more convenient option for finding support. Platforms such as BetterHelp offer mental health care to individuals from the comfort of their own homes. Through video chats, phone calls, or in-app messaging, individuals can receive treatment for their eating disorders without barriers like travel and physical limitations. 

The effectiveness of online therapy for eating disorders

A 2021 study on the effectiveness of internet-delivered cognitive behavioral therapy for eating disorders found that patients had long-term benefits from attending online therapy sessions. Online CBT benefited their self-esteem, body image, social functioning, and quality of life, and these benefits were still present at six-month and one-year follow-ups. CBT is an approach to treatment that focuses on the connection between a person’s thoughts and behaviors. By identifying unhelpful or negative thought patterns, individuals can often learn how to think more positively and thereby shift their behaviors. 

Takeaway

Those living with an eating disorder may find healing through several therapeutic approaches. Cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), group therapy, and other treatments could be effective options for managing and treating the symptoms of various kinds of eating disorders. It may take one or more of these therapies to aid in full recovery. For example, CBT may be combined with group therapy and medical care, which may help address physical complications related to an eating disorder. 

For those who might benefit from talk therapy alone, online therapy could provide a convenient way to receive mental health support. With online therapy, you can be matched with a licensed therapist who has experience treating eating disorders. Take the first step toward healing and reach out to BetterHelp today.