What to Expect from Outpatient Eating Disorder Treatment

What to Expect from Outpatient Eating Disorder Treatment

Eating Disorder Awareness Week 2025 kicks off on February 24th. While advocacy and education have begun to increase visibility and support of eating disorders, there is still a lack of awareness about how eating disorders are treated. In fact, according to the National Institute of Mental Health, less than 50% of people with a diagnosable eating disorder actually receive treatment for it. This is likely due to the stigma and uncertainty around seeking help for these diagnoses. As a result, many individuals who do eventually seek treatment have to attend residential or partial hospitalization programs due to the severity of their symptoms and malnutrition. However, when eating disorders are recognized and addressed early on, many people can be successful in outpatient treatment. 

Signs that You or a Loved One May Benefit from Treatment

Due to how engrained diet culture is in our society, it can be difficult to recognize the symptoms of an eating disorder. However, early detection of eating disorders increases the likelihood of positive outcomes. It is important to note that eating disorders are not one size fits all and they look different for each individual, but here are some common warning signs and symptoms to look out for:

• Unexplained weight loss
• Refusal to eat around others
• Preoccupation with weight or food
• Excessive calorie counting
• Mood swings and isolation
• Mealtime rituals (ex: cutting food into small pieces, eating strange food combinations, eating extremely slowly or quickly)
• Obsession with body size/shape
• Hair loss
• Dental problems

Components of Outpatient Eating Disorder Treatment

When attending outpatient treatment for an eating disorder, there are typically multiple professionals involved. Unlike some other mental health conditions, there can be a large medical component to eating disorders due to how the symptoms affect your body. Because of this, it is often recommended to work with a trained dietician in conjunction with therapy. In addition, informing one’s doctor of their eating disorder is beneficial in some cases.

Therapy

When seeking therapy for an eating disorder, it is crucial to ensure that your clinician is someone who specializes in disordered eating due to the complexity of these diagnoses. There are many different types of therapy that can be beneficial in the treatment of eating disorders, and your therapist will likely use a combination of interventions to address your symptoms. 

Cognitive Behavioral Therapy (CBT) tends to be the most commonly utilized therapeutic modality in the treatment of eating disorders. CBT aims to identify and challenge negative or unhelpful patterns of thinking and behaving that contribute to and maintain eating disorders. This treatment approach addresses cognitive distortions related to body image and food and assists the client in developing a more neutral or positive relationship to their weight and eating. This is a crucial part of treatment as changing these thought patterns is necessary in order to identify and break the rigid rules that result from diet culture such as the need to eat under a certain amount of calories per day or the fear of eating foods labeled as ‘unhealthy’.

Another component in CBT is Exposure Response Prevention (ERP). ERP plays a pivotal role in eating disorder treatment as it directly focuses on the behaviors that one engages in due to their eating disorder. ERP allows the client to gradually challenge their eating disorder rules and fears and confront triggering situations. Exposures look different depending on the person and their specific diagnosis, but common examples of exposures in eating disorder treatment include eating a fear food, eating at a restaurant or in front of others, or wearing clothes that trigger body image concerns. There is an additional type of exposure called mirror work that aims to increase one’s acceptance of and comfortability in their body as it is. The key to ERP is to engage in these exposures without performing compulsive behaviors such as purging, excessive exercise, or restriction afterwards. 

Acceptance and Commitment Therapy (ACT) is also commonly used to treat eating disorders. ACT helps clients to accept and tolerate the discomfort that comes with eating disorders and their treatment. One of the main interventions of ACT is cognitive defusion, which allows individuals to change the relationship that they have with their thoughts. For example, one may have negative thoughts about their body and a resulting urge to restrict food. Cognitive defusion teaches us to acknowledge that thought without acting on it and let the thought pass. ACT also has a significant focus on values, which is helpful because many folks find that their eating disorder pushes them away from their values. This modality encourages individuals to set treatment goals that bring them closer to aligning with their values.

Many therapists will also incorporate Dialectical Behavioral Therapy (DBT) into their treatment of eating disorders. DBT focuses on mindfulness, distress tolerance, and emotional regulation; which are all key components of treatment. Having an eating disorder and getting treatment for it often entail many uncomfortable situations. The skills learned through DBT teach clients how to cope with that discomfort and resulting negative emotions. There is a type of DBT called Radically Open DBT (RO-DBT) which is also used in eating disorders. This modality focuses on the rigidness and excessive self-control that is often seen in individuals with eating disorders. 

A final intervention that is frequently seen in eating disorder treatment is Family-Based Treatment (FBT). FBT is often used in the treatment of children and adolescents as it gets family members closely involved in treatment and teaches parents or other loved ones how to best support the client at home. FBT is shown to be highly effective in helping children with anorexia or bulimia quickly achieve weight restoration and minimizes the physical effects of eating disorders.

Working with a Dietitian

Therapists will typically refer their clients with an eating disorder to work with a dietician and vice versa. Ideally, the therapist and dietician will collaborate to ensure that their client is receiving the best holistic care possible. When looking for a dietician, it is important to ensure that they are weight inclusive and practice from a Health at Every Size (HAES) standpoint as this tells you that they are anti-diet and will help you achieve ideal nutrition without promoting any restriction or other eating disorder behaviors. 

Typically, dietitians will create a personalized meal plan for clients as they begin eating disorder recovery, which works towards maintaining proper food intake. Dieticians will also provide education on nutrition, meal components, and the dangers of under eating. Additionally, dietitians are skilled in helping clients implement coping strategies while challenging their eating disorder. Working with a dietician is a crucial part of finding peace with food and your body while feeling empowered to change disordered eating behaviors. 

Support from Medical Providers

Because eating disorders can have a significant negative impact on one’s health, therapists and dietitians will sometimes recommend a trip to your primary care doctor as you begin treatment. It is important to disclose disordered eating to a provider during this visit so that they can run the proper tests and exams. The purpose of this visit is to ensure that the client is nutritionally stable and appropriate for outpatient care. If there are serious concerns with labs or vitals, it may be a sign that someone would benefit from a higher level of care. If this is the case, your treatment team will work with you in figuring out the next best steps. 

Beginning Treatment

If you feel that it is time for yourself or your child to begin treatment for an eating disorder, we are here to help at Serengeti Wellness. We are always happy to schedule a consultation call or intake session with you to discuss your goals and answer any additional questions you may have about therapy. For dietician services, we highly recommend our friends at Doherty Nutrition.