Treatment for Eating Disorders: Evidence-Based Approaches That Work
From Disordered Eating to Recovery: Treatment Approaches That Work
If you or someone you care about is struggling with disordered eating or an eating disorder, you might be wondering: What does treatment actually look like? How do I find help? What can I realistically expect from therapy? Will I ever have a normal relationship with food again?
These are important questions, and the answers can help you feel more prepared and hopeful as you consider treatment. The good news is that eating disorders are treatable conditions, and effective, evidence-based treatments exist. With proper support, most people can recover and develop healthier eating habits and a more peaceful relationship with food and their bodies.
This guide will walk you through what eating disorder treatment involves, which approaches work best for the most common eating disorders, and what you can expect as you move through the recovery process.
Understanding What Treatment Can Accomplish
The goals of eating disorder treatment typically include:
Normalizing eating behaviors: Establishing regular, balanced eating patterns and reducing or eliminating restrictive eating, binge eating, or purging behaviors.
Achieving medical stability: For those with anorexia nervosa, weight restoration is a critical component of treatment. For all eating disorders, addressing medical complications and nutritional deficiencies is essential for restoring physical health.
Addressing distorted beliefs: Challenging and changing unhelpful thoughts about body shape, weight, food intake, and self-worth that maintain the eating disorder.
Treating co-occurring conditions: Addressing depression, anxiety, obsessive-compulsive disorder, or other mental health conditions that often accompany eating disorders.
Improving quality of life: Helping you return to activities you've been avoiding, rebuild relationships, and rediscover meaning beyond food and weight concerns.
The Role of Psychotherapy in Eating Disorder Treatment
Psychotherapy is the mainstay of treatment for eating disorders. Different types of therapy have been studied extensively, and we now have strong evidence for which approaches work best for specific eating disorders.
Treatment for Anorexia Nervosa
For Children and Adolescents:
Family-Based Treatment (FBT) is the first-line treatment for young adults and adolescents with anorexia nervosa. This approach, delivered over 6 to 12 months, empowers parents to take an active role in supporting their child's weight restoration without blaming them for the illness.
FBT is associated with remission rates of 49% compared to 34% with individual treatment at 6- to 12-month follow-up. This makes it one of the most effective treatment options available for adolescent anorexia nervosa.
How FBT works:
Phase 1: Parents take charge of their child's eating and weight restoration, helping them overcome intense fear of gaining weight
Phase 2: Control over eating gradually returns to the adolescent as weight stabilizes
Phase 3: Focus shifts to broader adolescent development issues beyond eating
The therapy reframes anorexia nervosa as an illness that has taken over the young person, rather than a choice they're making. This reduces blame and mobilizes the family as a powerful resource for recovery.
For Adults:
For adults with anorexia nervosa, several types of psychotherapy can be effective, including cognitive behavioral therapy (CBT), psychodynamic therapy, and specialist supportive clinical management. Research shows that no single therapy has been proven superior to others for adults with anorexia nervosa, which means your treatment plan can be tailored to individual preferences and needs.
These therapies typically focus on:
Understanding the function the eating disorder serves in your life
Developing motivation for change and addressing ambivalence about weight gain
Addressing fears about gaining weight and eating
Building distress tolerance skills
Improving interpersonal relationships affected by eating disorder behaviors
Treatment for Bulimia Nervosa
Cognitive Behavioral Therapy (CBT) is the first-line treatment for bulimia nervosa in adults and is superior to other interventions. The odds of achieving abstinence from binge eating are more than 5 times greater with CBT compared to a waiting list.
What CBT for bulimia nervosa involves:
Psychoeducation: Learning about the binge-purge cycle and factors that maintain bulimia nervosa
Regular eating: Establishing a pattern of three meals plus planned snacks daily to reduce biological and psychological urges to binge
Behavioral experiments: Testing beliefs about eating, weight, and body shape
Problem-solving: Developing skills to manage triggers and high-risk situations
Relapse prevention: Creating a plan to maintain progress after treatment ends
CBT for bulimia nervosa is typically delivered in 16 to 20 sessions over 4 to 5 months as part of a comprehensive treatment plan.
For adolescents with bulimia nervosa: Family-based therapy is recommended as it helps parents support their teen's recovery.
Guided self-help: For some adults with bulimia nervosa, guided self-help using CBT principles can also be effective. This involves working through a structured self-help manual with periodic support from a mental health professional.
Treatment for Binge Eating Disorder
Both therapist-delivered and self-guided CBT are effective for binge eating disorder, one of the most common eating disorders. Interpersonal psychotherapy may also help reduce binge eating episodes.
CBT for binge eating disorder focuses on:
Breaking the restrict-binge cycle by establishing regular eating patterns
Identifying and managing emotional triggers for binge eating
Developing alternative coping strategies for difficult emotions beyond food intake
Challenging beliefs about food, eating, weight, and body image
Building a life with meaning beyond food intake and body weight
Interpersonal psychotherapy takes a different approach, focusing on improving relationships and communication patterns rather than directly addressing eating behaviors. The theory is that improving interpersonal functioning will reduce emotional distress that drives binge eating.
Treatment for ARFID
Avoidant restrictive food intake disorder (ARFID), also called restrictive food intake disorder, involves avoidance of food due to lack of interest, sensory characteristics, or concern about consequences of eating. Unlike anorexia nervosa, ARFID does not involve body image concerns or fear of gaining weight.
Treatment for ARFID involves an individualized treatment plan and may include several specialists including therapists, dietitians, and medical providers. The approach depends on the specific reasons for food avoidance and may involve exposure therapy to feared foods, sensory integration work, or addressing anxiety about eating.
In our work at the Baltimore Therapy Group, we've seen how transformative evidence-based treatment can be. We regularly work with clients who come in feeling hopeless, convinced their eating disorder defines them and they'll never be free of it. Through structured therapy—whether that's CBT for bulimia nervosa or binge eating disorder, or helping families implement family-based treatment—we watch people reclaim their lives. Recovery doesn't mean you'll never think about food again, but it does mean food and weight stop controlling your decisions.
Nutritional Counseling: A Critical Component
While psychotherapy addresses the psychological and behavioral aspects of eating disorders, nutritional counseling with a registered dietitian is an essential part of comprehensive treatment. A dietitian who specializes in eating disorders can:
For Anorexia Nervosa:
Develop a meal plan that gradually increases caloric intake to support weight restoration and address intense fear of weight gain
Monitor the refeeding process to prevent serious complications
Help challenge food rules and fears about certain foods
Guide the transition from structured meal plans to more intuitive eating patterns
For Bulimia Nervosa and Binge Eating Disorder:
Establish regular eating patterns to reduce urges to binge
Work through food fears and rigid food rules
Help distinguish physical hunger from emotional hunger
Support development of flexible, balanced healthy eating habits
For All Eating Disorders:
Provide accurate nutrition education to counter myths and misinformation
Help develop practical meal planning and food preparation skills to improve eating habits
Address nutritional deficiencies and physical health concerns
Support the development of healthy eating habits that can be maintained long-term
Nutritional counseling is not about following a restrictive diet to lose weight—it's about healing your relationship with food and nourishing your body adequately.
Medication: When Is It Helpful?
Medications can be helpful as part of a comprehensive treatment plan, though they should not be used alone without psychotherapy.
Medications for Specific Eating Disorders
Anorexia Nervosa: No medications are FDA-approved specifically for anorexia nervosa. However, medications may be used to treat co-occurring mental health conditions like depression or anxiety that often accompany eating disorders.
Bulimia Nervosa: Fluoxetine (Prozac) at 60 mg per day is FDA-approved and has been shown to substantially decrease binge eating and purging behaviors. This is a higher dose than typically used for depression.
Binge Eating Disorder: Lisdexamfetamine (Vyvanse) is the only FDA-approved medication for binge eating disorder. Antidepressant medications may also help, though they may have lower acceptability due to side effects.
Important Safety Note: Bupropion (Wellbutrin) is contraindicated in anorexia nervosa and bulimia nervosa due to increased seizure risk. Always inform prescribers about eating disorder symptoms.
Treating Co-Occurring Conditions
Many people with eating disorders also struggle with other mental health conditions like depression, anxiety, obsessive-compulsive disorder, or substance use disorders. Treating these co-occurring mental health conditions with appropriate medications can support overall recovery and improve mental health.
From a clinical perspective, we approach medication as one tool in a comprehensive treatment plan, never as a standalone solution. When medications are appropriate—like fluoxetine for bulimia nervosa or treatment for co-occurring depression—they can make therapy more effective by reducing symptoms enough that you can engage fully in the psychological work. But the core of recovery happens through psychotherapy and nutritional rehabilitation, where you learn new ways of relating to food, your body, and yourself.
Understanding Different Treatment Settings
Treatment can occur in various settings depending on the severity of the eating disorder and your medical and psychological needs:
Outpatient Treatment
What it involves: Regular therapy sessions (typically weekly) while living at home and maintaining daily routines.
Best for: People who are medically stable, those with adequate support at home, individuals who can maintain safety between sessions, or early-stage disordered eating.
Typical schedule: One to two therapy sessions per week, plus periodic appointments with a dietitian and medical provider for proper medical care.
Intensive Outpatient Program (IOP)
What it involves: More frequent sessions with meal support, typically 2 to 3 hours per day, several days per week.
Best for: People who need more support than weekly therapy provides, those stepping down from higher levels of care, or individuals who need structure around meals but can maintain safety at home.
Partial Hospitalization Program (PHP) / Day Treatment
What it involves: Full-day programming (typically 6 to 8 hours) with comprehensive treatment including multiple therapy sessions, supervised meals and snacks, and medical monitoring.
Best for: People who need significant support but can be safe overnight at home, those requiring intensive meal support, or individuals stepping down from residential or inpatient care.
Residential Treatment
What it involves: 24-hour care in a specialized facility with a structured treatment plan including therapy, meal support, medical monitoring, and skill-building activities.
Best for: People who need round-the-clock support to interrupt eating disorder behaviors, those who haven't improved with less intensive treatment, or individuals who need to be removed from triggering environments.
Inpatient Hospitalization
What it involves: Medical hospitalization for severe medical complications or psychiatric emergencies related to life-threatening eating disorders.
Best for: Medical instability (severe malnutrition, dangerous vital signs, serious electrolyte imbalances), acute suicidal thoughts or self-harm behaviors, severe psychiatric symptoms, or failure to improve with less intensive treatment despite good engagement.
Most people don't need the highest level of care. Your treatment team will help determine the appropriate setting for your treatment plan based on your specific needs, and you may move between levels as your condition changes.
What to Expect During the Recovery Process
Recovery from an eating disorder is a process, not an event. Understanding what to expect can help you stay committed even when it feels difficult.
Early Treatment: The First Few Weeks
What's happening: Assessment and treatment plan development, beginning to challenge eating disorder behaviors, learning about your specific eating disorder, and starting to establish regular eating patterns.
What it feels like: Often very uncomfortable as you're asked to do things that feel anxiety-provoking, like eating certain foods or reducing compensatory behaviors. Ambivalence about recovery is normal—part of you wants to get better while another part wants to hold onto the eating disorder.
What helps: Remembering that discomfort is temporary and expected, using support from your treatment team, being honest about struggles rather than hiding them, and focusing on small, achievable steps.
Middle Treatment: Building Skills and Momentum
What's happening: Practicing new eating behaviors and coping strategies, challenging distorted thoughts about food and body image, addressing underlying issues that contributed to the eating disorder, and developing a life with meaning beyond the eating disorder.
What it feels like: Continued challenges but also glimpses of progress. Moments of "I can do this" alternating with "This is too hard." Noticing small improvements in physical and mental health, mood, and relationships.
What helps: Tracking progress beyond the scale (energy levels, mood, social engagement), building a support network beyond your treatment team, and practicing skills consistently.
Later Treatment: Maintaining Progress
What's happening: Solidifying new habits and skills, developing relapse prevention strategies, addressing what life will look like after structured treatment ends, and graduating to less intensive care or completing treatment.
What it feels like: More confidence in managing challenges, less mental energy consumed by food and body concerns, occasional setbacks or rough days but with better ability to cope.
What helps: Having a relapse prevention plan in place, maintaining some level of ongoing support (therapy, support groups), and recognizing that recovery is not linear.
One pattern we consistently see in our Baltimore practice is that clients who struggle most in early treatment often become the strongest advocates for recovery later. The intense discomfort you feel when first challenging eating disorder behaviors doesn't last forever. As you practice new skills, what once felt impossible becomes manageable. We encourage clients to measure progress not just by symptoms but by reclaimed experiences—eating with friends, traveling without anxiety, pursuing goals beyond food and weight.
How Long Does Treatment Take?
This is one of the most common questions, and the honest answer is: it varies significantly.
Factors that influence treatment length:
Severity and duration of the eating disorder
Type of eating disorder (anorexia nervosa often requires longer treatment than bulimia nervosa or binge eating disorder)
Presence of co-occurring mental health conditions
Level of support in your environment
How quickly you can engage in treatment
Typical timelines:
Outpatient CBT for bulimia nervosa or binge eating disorder: 16 to 20 sessions over 4 to 5 months
Family-based treatment for anorexia nervosa: 6 to 12 months
Outpatient treatment for anorexia nervosa in adults: Often 6 months to 2+ years
Higher levels of care: Weeks to months, followed by step-down to outpatient care
Important to know: Many people don't improve with the first treatment approach, and this is normal—it doesn't mean you won't get better. Treatment may require trying different approaches to find what works best for you.
Finding the Right Treatment Provider
Not all mental health professionals have specialized training in eating disorders, so it's important to find an eating disorder specialist with specific expertise.
Questions to ask potential providers:
What training and experience do you have treating eating disorders?
What treatment approach do you use, and what's the evidence for it?
Do you work with a team (dietitian, medical provider)?
How do you involve family members in treatment (if relevant)?
How do you measure progress?
Where to find specialized providers:
Ask your primary care provider for referrals to eating disorder specialists
Contact national eating disorder organizations for treatment provider directories
Check with your insurance company for coverage (in-network or out-of-network)
Look for therapists who explicitly list eating disorders as a specialty area
At the Baltimore Therapy Group, our therapists have specialized training in evidence-based treatments for eating disorders and disordered eating. We work collaboratively with medical providers and dietitians to provide comprehensive care. If you're in the Baltimore, Towson, or surrounding areas and ready to seek treatment, schedule an appointment to discuss how we can help.
What If Treatment Feels Too Hard?
It's completely normal to feel overwhelmed, ambivalent, or resistant during eating disorder treatment. Here's what to remember:
Discomfort is part of the process: If treatment felt easy and comfortable, you probably wouldn't need it. The anxiety you feel when challenging eating disorder behaviors is expected—it means you're doing the work.
Ambivalence doesn't mean failure: Most people feel torn between wanting to recover and wanting to hold onto their eating disorder. This is normal and something to explore with your therapist.
Progress isn't linear: You'll have good days and difficult days. Setbacks don't erase progress—they're opportunities to practice new skills.
You can ask for help: If something in your treatment plan isn't working, talk to your treatment team. Sometimes adjustments can make treatment more effective.
The difficulty is temporary: As you practice new eating behaviors and build skills, what feels impossible now will become easier.
Supporting a Loved One in Treatment
If someone you care about is in treatment for an eating disorder, your support matters—but it's also important to support them in helpful ways:
Do:
Educate yourself about common eating disorders and treatment
Ask how you can be most helpful rather than assuming
Celebrate non-weight-related progress (e.g., eating with the family, trying a feared food)
Be patient with the process—recovery takes time
Trust the treatment team's expertise
Don't:
Comment on weight, appearance, or food intake (even positive comments can be triggering)
Try to control their eating or monitor their behaviors (unless you're implementing family-based treatment with professional guidance)
Express frustration if they struggle or have setbacks
Expect them to "just eat" or "get over it"
Consider seeking your own support through family therapy or support groups for families of people with eating disorders.
Moving Toward Recovery
Recovery from an eating disorder or disordered eating is possible. While the path isn't always linear and may require persistence, effective treatments exist, and most people who engage in proper treatment can develop healthier eating habits and significantly improve their quality of life and well-being.
Recovery doesn't mean:
Never thinking about food or your body again
Eating perfectly all the time
Always feeling confident about your appearance
Never experiencing distress about body image
Recovery does mean:
Food and weight concerns no longer control your life
You can eat flexibly in response to hunger and fullness
You can participate in social activities without anxiety
You have effective ways to cope with difficult emotions
Your physical and mental health have improved
You can pursue goals and relationships beyond the eating disorder
If you're struggling with disordered eating or an eating disorder, seeking treatment is a courageous step. You don't have to face this alone, and you deserve support in building a healthier relationship with food and your body.
Disclaimer: This article is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or qualified mental health provider with any questions you may have regarding a mental health condition. If you are in crisis or experiencing thoughts of self-harm, please call 988 (Suicide and Crisis Lifeline) or go to your nearest emergency room.