What’s an Eating Disorder Therapist?

Therapy comes in many shapes and sizes. While some therapists treat anxiety and depression, others specialize in helping with more specific conditions.

Eating disorders affect 9 percent of the US population. They’re the second deadliest mental illnesses, after opioid addiction, and are most likely to affect women. They’re also becoming more and more common; for instance, they’ve skyrocketed among teens during the pandemic due to a confluence of factors at home, including too much time spent comparing themselves to social media.

The three most common eating disorders are anorexia, bulimia and binge-eating disorder. Patients with anorexia typically restrict food intake. People with binge-eating disorder typically consume food past the point of satiety, while patients with bulimia typically binge and then purge.

While everyone’s recovery plan looks different, at some point, patients in eating disorder recovery will need an eating disorder therapist.

Thankfully, there are specialists out there who can help get to the complex root causes of these conditions.

Where should you turn first for treatment if you’re struggling with an eating disorder?

Seeking help for an eating disorder can be incredibly difficult. At times, it may require some pressure or intervention from concerned friends or family members. Once someone has agreed to get help, their first point of contact will likely be a primary care doctor. They can help you determine next steps. 

Treatment isn’t a one-size-fits-all solution. For instance, if someone has experienced severe weight loss, they might have to be directly admitted into the hospital. But depending on the patient’s condition, there are a range of other treatment options, from residential treatment facilities to outpatient programs — or less structured self-driven recovery plans with individual practitioners.

Regardless of the format, comprehensive treatment requires a team of practitioners, typically a medical doctor, a dietitian and an eating disorder therapist. 

So, what’s an eating disorder therapist?

As Dr. Joann Hendelman, clinical director of the National Alliance for Eating Disorders, explains, “Eating disorder behavior is only the tip of the iceberg.”

While a dietitian might come up with a meal plan to help a patient improve their physical health, an eating disorder therapist works with a patient to address the root psychological causes behind their behaviors. Everything from low-self esteem to certain personality traits can cause an eating disorder to manifest. 

Most eating disorder therapists are trained in at least one of these therapeutic modalities:

• Enhanced cognitive behavioral therapy (CBT-E): This form of CBT is tailored to eating disorders. It uses a variety of strategies to identify and then modify or manage the thoughts and beliefs that contribute to an eating disorder. As opposed to regular CBT, CBT-E incorporates modules that address certain eating disorder-specific obstacles, like perfectionism and low self-esteem. Research shows that when a patient sticks with the program, CBT-E is an effective eating disorder treatment.
• Dialectical behavioral therapy (DBT): This approach helps patients manage difficult emotions by promoting skills like flexibility, emotional expression and mindfulness. Research is still emerging on the effectiveness of DBT in treating eating disorders, but initial evidence looks promising. 
• Cognitive remediation therapy (CRT): This anorexia-specific treatment approach aims to alter rigid thinking patterns through a variety of exercises. Early research shows it can be effective. 
• Interpersonal psychotherapy (IPT): This approach helps patients overcome bulimia and binge-eating disorder by reframing how they approach and cope in their interpersonal relationships. It has been shown to be an effective long-term treatment for these eating disorders. 

Like all therapists, eating disorder therapists also need to be incredibly patient, especially because eating disorders are often lifelong conditions that can be incredibly hard to kick to the curb. 

“Often, individuals experiencing eating disorders may not want treatment and will fight to keep their eating disorder,” Hendelman says. “They can be extremely impulsive. There will typically be many ups and downs in the course of the treatment.”

Where does an eating disorder therapist fit into a full treatment plan?

“Although many therapists may occasionally check in with other professionals working with their patients, when working with eating disorders, this is essential,” Hendelmen says. Without a tight-knit team to look out for them, a patient can find loopholes in treatment to “stay entrenched” in disordered behaviors. 

“An eating disorder is a complex, biopsychosocial illness,” Hendelmen adds, pointing to the fact that they’re often accompanied by comorbid psychological conditions, like depression or anxiety, as well as physiological consequences, like malnourishment or amenorrhea, the absence of a period.

An eating disorder therapist will also understand the importance of collaborating with a patient’s full treatment team, which generally includes a physician and a dietitian. Usually, the patient sees their therapist with the most frequency, often on a weekly basis. Depending on the severity of someone’s physical symptoms, several weeks or even months may elapse between appointments with doctors and dietitians. 

Regardless, all the providers keep in close contact, working together to make sure a patient stays on track. A patient’s therapist might touch base with their nutritionist to find out any important eating changes or goals, and their doctor will notify the rest of the team about any weight fluctuations or concerning labs.

What qualifications should I look for in an eating disorder therapist?

There aren’t specific requirements therapists need to meet to call themselves an “eating disorder therapist.” However, if you’re looking for a provider as a patient, there are a few things you can look out for. 

Most graduate programs don’t include extensive education on eating disorders, so to become an eating disorder therapist, practitioners must go through additional, eating disorder-specific training. The American Board of Clinical Social Work recommends a threefold approach to eating disorder training, involving didactic learning (i.e., school), supervised clinical practice and personal therapy. 

Only a handful of universities offer eating disorder certificates for master’s students (Lewis & Clark and Northern Illinois University, for example), but other organizations have stepped up to fill in the educational gaps. 

The Center for the Study of Anorexia and Bulimia offers a two year post-graduate training program in the treatment of eating disorders. Doctors, dietitians and therapists can also take a course through the International Association of Eating Disorder Professionals to become an IAEDP-certified eating disorder specialist (CEDS). Furthermore, the ANAD, NEDA, and the National Alliance for Eating Disorders all have helpful directories.