Online Therapy for Eating Disorders & Body Image

“Genetics load the gun, and the environment pulls the trigger.”

Eating disorders are complex illnesses that are not linked to any one specific factor. Although we continue to learn more through research, the etiology (what causes a disease to develop) of eating disorders is not entirely understood.
What we can say is that eating disorders are biopsychosocial conditions. This means they have at least three contributing factors.

biological: your genetic predispositions, neurobiological mechanisms, physiological factors, and physical illnesses.
psychological: your personality temperament and thoughts, feelings, and behaviors.
and
social: the environment you grew up in, socioeconomic status, support you have, family dynamics.

We are aware of some specific risk factors that can exacerbate the development of eating disorders:

• Overly rigid, authoritarian family dynamics

• Overly permissive parenting styles

• Objectification of women

• Sports that emphasize weight or appearance (ie. gymnastics, dance, swimming, diving, ice skating, rowing, wrestling)

• Social media, comparison, and the perpetuation of thin ideal

• Low self esteem

• Anxiety or obsessive-compulsive features

• Impulsivity

• Bullying

• Perfectionistic personality styles

• Childhood sexual abuse

• Sexual trauma

• Emotional abuse, neglect, and abandonment

• Scary experiences (ie. choking, vomiting)

• Sensory Issues
  

This is a complicated question! The primary difference between the three boils down to two factors:

• Whether or not you use compensatory behaviors (like vomiting, exercising, laxatives).

• Whether or not you are considered “underweight.”
  (problematic! Read more about why BMI is bullshit)
  In all three disorders, there can be an element of restricting, binge eating, and purging. Sounds confusing, right?
  
  Because:
  When we think about anorexia, society thinks “very underweight.”
  When we think about bulimia, society thinks “throwing up.”
  When we think about binge eating, society thinks “eating a lot all at once.”
  
  But the reality is that in anorexia, there are two sub-types: restrictive type, or binge/purge type. Both types are considered “underweight.”
  
  In bulimia, there is binge eating and purging, but the person is not considered “underweight.”
  
  In binge eating, the person is not considered “underweight” and there is no purging (or other compensatory behaviors)

Use The Comprehensive Guide to Finding a Qualified Eating Disorder Therapist

Look for a therapist that:

• Lists 5–10 core specialties (not 15+)

• Has "Eating Disorders" in their top three specialties

• Holds a CEDS or have explicit training in eating disorders

• Has at least 2–5 years of ED experience

• Understands your co-occurring concerns (trauma, anxiety, etc.)

• Offers multiple levels of clinical depth (not just food behavior)

• Is transparent, curious, and never makes promises that feel too good to be true

How to Use the ED-Friendly Directories

Use the National Alliance for Eating Disorders search tool: www.findedhelp.com

or

Visit iaedp.com and use their Find a Provider tool. You can search by location and look specifically for clinicians with the CEDS credential. This is one of the most reliable directories for finding vetted, experienced eating disorder professionals.

Finding an eating disorder therapist near you is more than ticking off boxes. It’s about finding someone who makes you feel safe, seen, and capable of change. The process may take time, and that’s okay. You’re allowed to ask questions, to advocate for yourself, and to wait until it feels right.

Absolutely. Working with an eating disorder therapist can transform your recovery. An eating disorder therapist is a mental health professional trained to help individuals heal from disordered eating, body image distress, and the complex emotional experiences underneath.

Therapy explores not just what you do with food, but why you do it: what roles food, control, punishment, or avoidance play in your life.

Eating disorder therapists create a safe, compassionate, authentic, and validating spaces to explore fear, shame, identity, and trauma.

They don't just aim for "behavior change," they help you reconnect with your body, reclaim your voice, and begin to trust yourself again.

I like to say that we “help you find your glow again.”

Many eating disorder therapists are aligned with Health at Every Size® (HAES®) and use approaches that see the whole you - not just a diagnosis.

Recovery length varies widely and is challenging to study. There is no current consensus on what “recovery” means and there are there dozens of factors that influence it.

Some factors that impact how long it takes to recover:

• Adherence to treatment protocol

• Type of eating disorder

• Length of illness

• Symptom severity

• Medical complications

• Age

• Level of motivation

• Co-occurring issues/diagnoses (trauma, personality disorders, depression, anxiety, suicidality, self-harm, etc)

• Family support

• Family dynamics

• Current environment

• Neurobiological Underpinnings

• Genetics

• Therapeutic relationship

• Hope
  

Mild - moderate eating disorders (have not been active for very long, without co-occurring conditions, with those adherent to treatment recommendations) can often benefit from guided self-help (like a workbook) or from manualized treatment (with a single modality like Cognitive Behavioral therapy, Dialectical Behavior Therapist, or Family Based Treatment). Manualized treatments often have a session-by-session protocol and conclude within a set timeframe.

CBT-E:
~20 sessions (~20 weeks) for non-underweight individuals.
~40 sessions (~40 weeks / 9–10 months) if underweight or medically unstable.

FBT (for adolescents):
~ 15–20 sessions (completed over 6–12 months).

Moderate - severe eating disorders (ex. ED has been around for over a few years, there are co-occurring conditions, lower motivation, less support, more severe symptoms, older age, etc) can take anywhere between 3 - 5+ years of intensive work. This often involves utilizing multiple therapeutic modalities to address symptoms and underlying factors, may require higher levels of care, is simultaneously managing crises as they arise, etc.

Important: Many people start to feel better within a few months — but that’s different from being fully recovered. EDs often involve deeply rooted patterns, and rushing can trigger relapse.

Meta-analyses of all eating disorders determined the average length of recovery was 9.1 years (SD = 6.1 years, with a range of 1 year to 35 years.

That means:

• We do not use weight as a proxy for health.

• We affirm all bodies — all sizes, all shapes, all lived experiences.

• We do not push weight loss as a treatment goal.

• We challenge the internalized and systemic weight stigma that often fuels eating disorder behaviors.

Our goal is not to “fix” your body — it's to help you heal your relationship with it. We work with clients in thin bodies, fat bodies, disabled bodies, queer bodies, neurodivergent bodies, and bodies that have felt at war with themselves for years.

Eating disorders do not discriminate — and neither do we.

HAES (Health at Every Size®) was developed to promote respectful, inclusive, and weight-neutral healthcare in response to our society’s focus on diet culture and the harm from weight stigma. There are five core principles:

1. Weight Inclusivity.

In our society, weight bias runs rampant. Being “thin” is idealized, being “fat” is pathologized. So often, clients go to the doctor for something like fatigue, a general check-up, depression, or anxiety and are told that their weight is responsible for their symptoms without any further assessment done.
Weight inclusivity means that there is no “ideal” body size or weight and that health CANNOT be determined by weight alone.

2. Health Enhancement

Health is complex and influenced by a multitude of factors beyond just behavior – like income, access, trauma, and discrimination. HAES supports health policies that equalize access to information and services.

3. Respectful Care

We need to acknowledge and work to end weight bias. People in larger bodies deserve the same exact quality of care as those in smaller ones. There should not be assumptions or blame tied to weight. Clients should not fear being shamed by their doctors due to their weight or worry that assumptions will be made about their lifestyle choices.

4. Eating for Well-being

HAES encourages intuitive eating and rebuilding trust with your body instead of restricting your caloric intake or dieting. It promotes having a flexible relationship with food that is based on your satiety levels, nutritional needs, hunger, and pleasure

5. Life-Enhancing Movement

Exercise should not be something that is done to achieve a desired look, be monotonous, dreaded, or boring.  HAES aims to support physical activity that allows people of all sizes and abilities to enjoy movement.

Disordered eating and eating disorders overlap quite a bit, but the main difference is that disordered eating does not meet full diagnostic criteria for an eating disorder.

Disordered eating may include symptoms of restricting, dieting, emotional, compulsive, or mindless eating, or other inflexible ways of relating to food. Other examples may include:

• fad diets

• compensating (“oh I had so much at dinner last night, I’ll skip breakfast”)

• cleanses

• misuse of supplements or protein shakes

• use of diet pills or steroids

• eliminating food group(s)

• pushing yourself to exercise when you aren’t feeling well.

You might have an eating disorder if:

• You spend a lot of time worrying about your weight or shape.

• You feel out of control when you eat.

• You feel uncomfortable eating around others due to shame or guilt.

• You push yourself to exercise when you don’t feel well.

• You eat to deal with emotions or sensations (ie. when you’re angry, overwhelmed, stressed, lonely, bored, tired, in pain.)

• You feel the need to “make up” for eating by exercising, fasting, skipping meals, using laxatives, vomiting, etc.

• You find yourself using fad-diets, misusing supplements or using steroids, cleanses, etc.

• You have food rules (ie. you can’t eat after 8 pm, have to eat slowly, drink a certain amount of water, eat standing up, spit out food after chewing it, can’t have sweets, etc).

There are multiple levels of care available to treat eating disorders, however, depending on the severity of your eating disorder, you may need to start treatment at a hospital. The level of care you need for treatment is primarily determined by:

• Medical status (e.g., vitals, labs, BMI, menstrual function)

• Psychiatric stability (e.g., suicidality, self-harm, co-occurring disorders)

• Behavioral severity (e.g., binge/purge frequency, food refusal, compensatory behavior use)

• Support system (e.g., family ability to supervise, meal support)

• Motivation for treatment
  

Levels of care and when you need each:

Outpatient: Outpatient therapy typically occurs 1-2x per week for an hour at a time. You may meet with a treatment team (a therapist, dietitian, medical doctor, psychiatrist) to ensure that you are healthy.
To work at an outpatient level of care, you need to be safe.
This means:

• You are more or less weight-stable (or demonstrating consistent progress)

• You are medically stable (ie. vital signs are normal and organs are functioning appropriately) and lab values are normal (ex. sodium, potassium, magnesium, etc) and do not indicate a need for medical intervention.

• You are not an imminent danger to yourself or others (ie. you are not actively suicidal or homicidal)

Intensive Outpatient Program (IOP): a treatment program that meets approximately 3-5x per week for a few hours at a time and involves a meal. You may need IOP if:

• You are struggling to regulate your symptoms with outpatient therapy alone.

• You do not need around the clock medical monitoring but may be developing some health concerns.

• You may not have the support you need at home.

Partial Hospitalization Program (PHP): a treatment program that meets 5-7x per week for the entire day. You may need PHP if:

• You have moderate - severe eating disorder symptoms that you cannot regulate without consistent, daily structure.

• You may have medical concerns that require monitoring - but not continuously.

Residential Treatment (RES):
a 24/7 treatment program that you live at. These programs typically are anywhere between 30 - 120 days long (though they can certainly be longer) and are designed to completely interrupt symptom use and medically stabilize you. You may need residential treatment if:

• You are medically or psychiatrically unstable.

• You have acute symptoms that cannot be managed at home (you use compensatory behaviors that undo progress made at a lower level of care)

Inpatient Treatment (IP):
An acute, hospital-based treatment program that is designed to stabilize imminent, life-threatening medical/psychiatric issues. You may need inpatient treatment if:

• You are severely dehydrated, have electrolye imbalances, cardiac complications, refeeding syndrome, require medical intervention to support digestion (ie. J-tube, NG-tube), etc.

• Are actively suicidal or homicidal (have a plan and intend to harm yourself or others).