Eating disorders such as anorexia, bulimia, binge eating disorder and ARFID are serious, treatable psychiatric conditions. Outpatient treatment combines medical monitoring, specialized psychotherapy (CBT-E, family-based treatment for adolescents), nutritional support, and medication where evidence supports it: fluoxetine for bulimia and lisdexamfetamine for binge eating disorder. Early treatment significantly improves recovery.
Stedfast Psychiatry provides outpatient psychiatric care for eating disorders: diagnosis, medical and psychiatric monitoring, medication where it helps, and coordination with therapists, dietitians and higher levels of care when needed. We treat the depression, anxiety and OCD that so often accompany eating disorders, and we treat the person rather than the number on a scale.
Symptoms of eating disorders
- Restricting food intake, skipping meals or rigid food rules
- Intense fear of gaining weight or distorted body image
- Eating large amounts in a short time with a sense of losing control
- Vomiting, laxative or diuretic use, or excessive exercise to compensate
- Eating in secret, hiding food or shame about eating
- Preoccupation with calories, weight and body shape
- Significant weight loss, weight fluctuations or weight gain
- Dizziness, fainting, feeling cold, hair loss or missed periods
- Dental erosion, swollen cheeks or calluses on the knuckles
- Withdrawal from meals with others and social activities
Causes and risk factors
Eating disorders arise from an interaction between genetic vulnerability (heritability is 50 to 80 percent for anorexia and bulimia), temperament (perfectionism, anxiety, harm avoidance or impulsivity), and environment. Dieting is the most common trigger, and for a genetically vulnerable person, the physiological effects of restriction can lock in the illness. Weight-based teasing, athletic or aesthetic pressure, trauma, and cultural emphasis on thinness contribute. Starvation itself changes the brain, intensifying obsessionality and anxiety and making the disorder self-perpetuating. Binge eating is strongly linked to restriction, emotional dysregulation, ADHD and depression. Eating disorders are not a choice, a phase or a diet gone wrong.
Lifetime prevalence of eating disorders in US adults is about 0.6 percent for anorexia, 0.3 percent for bulimia and 2.8 percent for binge eating disorder, with binge eating disorder the most common.
Source: NIMH, National Comorbidity Survey Replication
Anorexia nervosa has one of the highest mortality rates of any psychiatric disorder, with a standardized mortality ratio of about 5.
Source: Arcelus et al., Archives of General Psychiatry, 2011 meta-analysis
Among adolescents, 2.7 percent have an eating disorder, and more than half of those with an eating disorder have at least one other psychiatric condition.
Source: NIMH
Family-based treatment leads to full remission in roughly 40 to 50 percent of adolescents with anorexia nervosa at the end of treatment, about twice the rate of individual therapy in trials.
Source: Lock et al., Archives of General Psychiatry, 2010
How we diagnose it at Stedfast Psychiatry
Our evaluation includes a detailed history of eating, weight, exercise and compensatory behaviors, body image, and the course of symptoms over time, using screening tools such as the SCOFF questionnaire and the Eating Disorder Examination Questionnaire (EDE-Q). We assess medical stability: weight and vital signs including orthostatic blood pressure and heart rate, and labs including a metabolic panel (particularly potassium, phosphorus and magnesium), complete blood count, thyroid function and an EKG when purging, rapid weight loss or low heart rate are present. We screen for depression, anxiety, OCD, PTSD, ADHD, substance use and suicidality, which are present in the majority of cases. We determine the appropriate level of care: outpatient, intensive outpatient, partial hospitalization, residential or inpatient medical stabilization, and we refer when a higher level is needed.
Treatment options
Medication management
Medication is an adjunct to therapy and nutritional rehabilitation, not a replacement, and its role differs by disorder. For bulimia nervosa, fluoxetine at 60 mg is FDA-approved and reduces binge and purge frequency; other SSRIs are also used. For binge eating disorder, lisdexamfetamine (Vyvanse) is FDA-approved for moderate to severe cases and reduces binge days; SSRIs and topiramate are alternatives. For anorexia nervosa, no medication reliably restores weight, and antidepressants work poorly in a starved brain; low-dose olanzapine has modest evidence for weight gain and obsessional thinking, and SSRIs are used once weight is restored to treat depression and anxiety and prevent relapse. For ARFID, treatment is behavioral, with medication for anxiety when it is a barrier. We avoid bupropion in patients who purge or restrict because of seizure risk, and we monitor electrolytes, heart rate and EKG as indicated.
Psychotherapy
Specialized psychotherapy is the core of eating disorder treatment. Enhanced cognitive behavioral therapy (CBT-E) is the leading treatment for bulimia, binge eating disorder and adult anorexia, addressing the over-evaluation of shape and weight, dietary rules, and the binge-purge cycle over 20 to 40 sessions. Family-based treatment (FBT, the Maudsley approach) is the first-line treatment for adolescents with anorexia and bulimia, empowering parents to restore nutrition at home. Dialectical behavior therapy helps when emotional dysregulation drives binge eating. We provide psychiatric care alongside these therapies, coordinate with your therapist and a registered dietitian experienced in eating disorders, and refer to specialized programs when outpatient care is not enough.
What to expect
The first visit is a 60-minute evaluation, in person or by video, with vital signs and labs arranged if needed. We discuss what level of care fits your medical and psychiatric situation honestly. If outpatient care is appropriate, you leave with a plan that includes psychiatric follow-up, therapy and dietitian referrals, medication if indicated, and a monitoring schedule. Follow-ups are every two to four weeks at first, with weight and vital signs checked in person when medically necessary. Telehealth is available across Florida and South Carolina for follow-up and for patients who are medically stable.
When to seek help
Seek help as soon as eating, weight or body image are taking over your thoughts or changing your behavior; waiting for it to get 'bad enough' is the most common mistake, and early treatment doubles the chance of full recovery. Seek urgent medical care for fainting, chest pain, a heart rate below 50, blood in vomit, confusion or inability to keep fluids down. If you are having thoughts of suicide, call or text 988. The NEDA Helpline and ANAD provide additional support. If someone's life is in immediate danger, call 911.
The eating disorders
Anorexia nervosa comes in a restricting type and a binge-purge type and is defined by low weight for age and height, fear of weight gain and body image disturbance; atypical anorexia has the same features at a normal or higher weight and carries the same medical risks. Bulimia nervosa involves binges with compensation at least weekly for three months, usually at normal weight. Binge eating disorder involves at least weekly binges with loss of control, distress, and no regular compensation, and it affects about three percent of adults, more than anorexia and bulimia combined. ARFID involves restricted intake due to sensory sensitivity, fear of choking or vomiting, or low interest in food, leading to weight loss or nutritional deficiency without body image concerns, and is common in children and in people with autism or anxiety. Other specified feeding or eating disorder (OSFED) covers clinically significant presentations that do not fit a single category, and it is the most common diagnosis of all.
Medical complications
Restriction and purging affect every organ system. Low heart rate, low blood pressure and arrhythmias cause sudden death in anorexia. Vomiting and laxative use drop potassium, which also causes arrhythmias, and erode tooth enamel. Bone density loss begins within months of amenorrhea and may be permanent. Refeeding after severe restriction must be medically supervised to avoid refeeding syndrome. Binge eating is associated with diabetes, hypertension and reflux. Part of our role is to track these risks and know when outpatient care is no longer safe.
Co-occurring conditions
Most people with eating disorders have at least one other psychiatric condition. Anxiety disorders and OCD often precede anorexia; depression is nearly universal during illness and may lift with nutrition; ADHD is common in binge eating and bulimia, and treating it often reduces bingeing; PTSD is linked to bulimia and binge eating; substance use affects about a quarter of patients; and borderline personality traits are common in the binge-purge presentations. Treating these alongside the eating disorder, with attention to sequencing (nutrition first, then trauma work, for example), improves outcomes.
Supporting recovery
Regular eating (three meals and two to three snacks, no more than three to four hours apart) is the single most important behavioral change in every eating disorder, because it breaks the restriction that drives bingeing and the starvation that drives obsession. Removing scales and body checking, unfollowing diet and fitness content, and eating with others support this. For families, avoiding food and body commentary, staying calm at meals, and seeking their own support through FEAST or NEDA resources help.
Prognosis
Recovery is realistic. With treatment, roughly half of people with anorexia or bulimia recover fully and most of the rest improve substantially; binge eating disorder has even higher response rates to CBT-E and medication. Early treatment, especially in adolescents, is the strongest predictor of full recovery, and illness duration is the strongest predictor of a chronic course. The years of life lost to untreated eating disorders are largely preventable with timely care.
Frequently asked questions
Can I have an eating disorder if I am not underweight?
Yes. Most people with eating disorders are at a normal or higher weight. Bulimia, binge eating disorder, and atypical anorexia (all the features of anorexia without a low weight, often after rapid loss from a higher starting point) can be medically dangerous at any size. Weight is one data point in the evaluation, not the diagnosis. If food and body image are controlling your life, that is enough reason to be evaluated.
What medications help with binge eating?
Lisdexamfetamine (Vyvanse) is FDA-approved for moderate to severe binge eating disorder in adults and reduces binge days substantially in trials. SSRIs reduce binge frequency and help the depression and anxiety that often accompany it. Topiramate is an alternative with evidence but more side effects. Medication works best alongside CBT-E, which addresses the restriction and emotional triggers that drive bingeing. We do not use medication as a weight-loss tool.
Is there a medication for anorexia?
Not a reliable one. No medication restores weight or treats the core of anorexia, and antidepressants work poorly while the brain is undernourished. Low-dose olanzapine has modest evidence for weight gain and reducing obsessional thinking. Nutritional rehabilitation and specialized therapy (family-based treatment for adolescents, CBT-E for adults) are the treatment. Once weight is restored, SSRIs help treat depression and anxiety and may reduce relapse.
Can eating disorders be treated outpatient, or do I need a program?
It depends on medical stability and the severity of symptoms. Outpatient care with a psychiatric provider, therapist and dietitian is appropriate for many people who are medically stable and able to make progress at home. Intensive outpatient, partial hospitalization and residential programs are for those who cannot interrupt the behaviors with weekly visits, and inpatient medical care is for unstable vital signs or electrolytes. We assess this honestly at the first visit and help you move between levels as needed.
Can eating disorders be treated by telehealth?
Partly. Psychiatric follow-up, therapy and dietitian visits work by video, and we serve patients across Florida and South Carolina, which helps when specialized providers are far away. Medical monitoring (weight, orthostatic vital signs, labs, EKG) requires in-person visits or coordination with your primary care provider, and we build that into the plan from the start. Patients who are medically unstable need in-person or hospital care, and we will say so plainly.
Is eating disorder treatment covered by insurance?
Psychiatric visits, psychotherapy and labs are covered by most major insurance plans and Medicare as medical and mental health care. Dietitian visits are covered by many plans for eating disorders. Residential and partial hospitalization programs require authorization, which varies. Our self-pay rate for a new evaluation is $185. Vyvanse for binge eating disorder usually requires prior authorization, which we handle.
How do I help my teenager with an eating disorder?
Act early and do not wait for them to want help; eating disorders impair the judgment needed to seek it. Family-based treatment, in which parents take charge of meals and nutrition with professional guidance, is the most effective treatment for adolescents with anorexia and bulimia. Avoid comments about weight, shape or food choices, keep meals structured, and get a medical evaluation promptly. Our child and adolescent providers evaluate teens and coordinate FBT.
Do men get eating disorders?
Yes. About one in three people with an eating disorder is male, and men are less likely to be diagnosed because the illness often looks different: a drive for muscularity, compulsive exercise, rigid 'clean eating,' or binge eating. Athletes in weight-class and endurance sports are at higher risk. The treatments are the same, and we see men and boys at all of our offices.
Where to get treatment for eating disorders
Evaluation and treatment for eating disorders is available at every Stedfast Psychiatry office and by video across Florida and South Carolina.
Related conditions
If you are thinking about harming yourself, call or text 988 now, or go to the nearest emergency room. This page is educational and does not replace an evaluation. Clinical content reviewed by Dr. David Husted, board-certified psychiatrist.