Does My Child (or do I) Have an Eating Disorder? Signs Not to Ignore
Understanding Eating Disorders: Types, Warning Signs, and What to Expect in Outpatient Treatment
Eating disorders are serious mental health conditions that affect a person’s relationship with food, body image, and self-worth. They are not a choice, a phase, or simply about dieting. They are complex illnesses influenced by biological, psychological, and social factors—and they are treatable [1,2].
If you or someone you love is struggling, understanding the different types of eating disorders and knowing when to seek help is an important first step.
Types of Eating Disorders
1. Anorexia Nervosa
Anorexia nervosa is characterized by[1,3]:
Restriction of food intake
Intense fear of weight gain
Distorted body image
Persistent behaviors that interfere with weight gain
There are two primary subtypes:
Restricting type (primarily food restriction)
Binge-eating/purging type (restriction with episodes of bingeing or purging)
Individuals may appear underweight, but not always. Atypical anorexia can involve significant restriction and medical risk even when a person’s weight is within or above the typical range [1,4]. Medical complications can affect the heart, brain, hormones, digestion, and bone health [1,5].
2. Bulimia Nervosa
Bulimia nervosa involves [1,3]:
Recurrent episodes of binge eating
Feeling out of control during binges
Compensatory behaviors (vomiting, laxatives, excessive exercise, fasting)
Significant shame and secrecy
Unlike anorexia, individuals with bulimia are often within a typical weight range, making the disorder harder to detect [3].
3. Binge Eating Disorder (BED)
Binge Eating Disorder includes [3,6]:
Recurrent binge eating episodes
Eating rapidly or past fullness
Eating when not physically hungry
Intense guilt, shame, or distress afterward
No regular compensatory behaviors
BED is one of the most common eating disorders and affects people of all body sizes [6,7].
4. ARFID (Avoidant/Restrictive Food Intake Disorder)
Avoidant/Restrictive Food Intake Disorder, or ARFID, is not driven by body image concerns. Instead, it may involve [1,8]:
Extreme picky eating
Sensory sensitivity to textures or smells
Fear of choking or vomiting
Lack of interest in food
ARFID can lead to nutritional deficiencies, weight changes, poor growth in children, reliance on supplements, and difficulty eating socially [1,8].
5. OSFED (Other Specified Feeding or Eating Disorder)
Other Specified Feeding or Eating Disorder, or OSFED, includes clinically significant eating disorder symptoms that do not meet full criteria for the above diagnoses [1,9].
This category is just as serious and deserves treatment. Research shows OSFED can involve significant psychological distress, physical health impairment, and eating disorder symptoms comparable to full-threshold diagnoses [9,10].
Signs It’s Time to Seek Help
It’s important to seek support early. Eating disorders tend to become more entrenched over time, and earlier recognition can improve access to effective care [1,11].
Emotional Signs
Preoccupation with food, weight, or body shape
Anxiety around meals
Guilt or shame after eating
Irritability or depression
Social withdrawal
Behavioral Signs
Skipping meals or eating very small portions
Frequent dieting or rigid food rules
Eating in secret
Frequent bathroom trips after meals
Compulsive exercise
Avoiding eating in front of others
Physical Signs
Rapid weight changes
Fatigue or dizziness
Hair thinning
Irregular or absent periods
Gastrointestinal complaints
Feeling cold frequently
If eating behaviors are interfering with daily life, relationships, work, or school, that is enough reason to reach out [1,12].
What to Expect with Outpatient Eating Disorder Treatment
Outpatient treatment is appropriate when a person is medically stable and does not require hospitalization. It allows individuals to remain at home while receiving structured therapeutic support [1,13].
Here’s what treatment typically includes:
1. Comprehensive Assessment
Your first appointments will focus on:
Eating patterns and behaviors
Medical history
Mental health history
Family dynamics
Current functioning
Medical monitoring, such as labs, weight checks, and vital signs, may be coordinated with a primary care provider [1,13].
2. Evidence-Based Therapy
Treatment is not one-size-fits-all. The approach depends on age, diagnosis, medical stability, and family involvement [1,13].
Common outpatient approaches include, but are not limited to:
Family-Based Treatment (FBT): Often first-line for adolescents with anorexia and supported for adolescent bulimia. Parents take an active role in supporting nutritional restoration and interrupting eating disorder behaviors [13,14].
Enhanced Cognitive Behavioral Therapy for Eating Disorders (CBT-E): A structured, evidence-based approach used across a range of eating disorder presentations, especially for older adolescents and adults [15].
DBT: Helpful when emotional regulation, self-harm, or impulsivity are major factors.
Trauma-informed therapy: Used when PTSD, medical trauma, or other trauma is part of the clinical picture.Exposure-based work: May help with feared foods, body image distress, food avoidance, or anxiety around eating [16].
3. Nutritional Support
Many outpatient teams include a registered dietitian specializing in eating disorders. Nutrition therapy focuses on:
Restoring adequate intake
Challenging food fears
Normalizing eating patterns
Reconnecting with hunger and fullness cues
The goal is flexibility — not perfection.
4. Medical Monitoring
Eating disorders can impact nearly every body system [1,5]. Ongoing medical care may include:
Weight monitoring, when clinically indicated
Lab work
Heart rate and blood pressure checks
Electrolyte monitoring
Bone density monitoring, if needed
Coordination with primary care, pediatrics, adolescent medicine, or other specialists
Normal labs do not always rule out a serious eating disorder, so symptoms, growth history, weight changes, vital signs, and behavior patterns all matter [1].
5. Gradual Recovery Process
Recovery is not linear. Common experiences include:
Fear of weight restoration
Increased anxiety at first
Emotional waves as nutrition stabilizes
Gradual reduction in eating disorder behaviors
Over time, most clients experience:
Improved mood and concentration
Increased energy
Less preoccupation with food
Greater freedom in social settings
When a Higher Level of Care (HLOC) Is Needed
Outpatient care may not be sufficient if:
There is medical instability
Rapid weight loss continues
Severe suicidal thoughts are present
Behaviors are escalating despite treatment
In these cases, higher levels of care, such as IOP, PHP, residential treatment, or inpatient hospitalization, may be recommended temporarily [1,13].
Recovery Is Possible
Eating disorders thrive in secrecy and shame. Recovery begins with connection, compassion, and evidence-based care.
Early intervention can improve outcomes. If you’re wondering whether it’s “serious enough” to seek help, that question alone is worth exploring with a professional [11,12].
You don’t have to wait until things get worse.
Healing your relationship with food and your body is possible — and you deserve support along the way. Here at Ezer Psychotherapy, PLLC we are here to help and support you on your journey.
If you think you or your loved one may have an eating disorder, reach out as soon as possible and schedule a Diagnostic Evaluation today.
References
Hornberger LL, Lane MA, Committee on Adolescence. Identification and management of eating disorders in children and adolescents. Pediatrics. 2021;147(1).
Lock J, La Via MC. Practice parameter for the assessment and treatment of children and adolescents with eating disorders. Journal of the American Academy of Child & Adolescent Psychiatry. 2015;54(5):412-425.
Hay P. Current approach to eating disorders: a clinical update. Internal Medicine Journal. 2020;50(1):24-29.
Golden NH, et al. Medical management of restrictive eating disorders in adolescents and young adults. Journal of Adolescent Health. 2022.
Trapani S, Rubino C. Medical complications of anorexia nervosa. Pediatrics. 2025.
Wilfley DE, Citrome L, Herman BK. Characteristics of binge eating disorder in relation to diagnostic criteria. Neuropsychiatric Disease and Treatment. 2016;12:2213-2223.
Kornstein SG, Kunovac JL, Herman BK, Culpepper L. Recognizing binge-eating disorder in the clinical setting: a review of the literature. Primary Care Companion for CNS Disorders. 2016;18(3).
Brigham KS, Manzo LD, Eddy KT, Thomas JJ. Evaluation and treatment of avoidant/restrictive food intake disorder in adolescents. Current Pediatrics Reports. 2018;6(2):107-113.
Wilkop M, Wade TD, Keegan E, Cohen-Woods S. Impairments among DSM-5 eating disorders: a systematic review and multilevel meta-analysis. Clinical Psychology Review. 2023;101:102267.
Dang TB, Hughes EK, Dang AB, et al. Taking a deeper dive into OSFED subtypes: a meta-analysis and systematic review. International Journal of Eating Disorders. 2024;57(10):2006-2040.
Austin A, Flynn M, Richards K, et al. Duration of untreated eating disorder and relationship to outcomes: a systematic review of the literature. European Eating Disorders Review. 2021;29(3):329-345.
López-Gil JF, et al. Global proportion of disordered eating in children and adolescents: a systematic review and meta-analysis. JAMA Pediatrics. 2023.
Bohon C, et al. United States-based practice guidelines for children and adolescents with eating disorders: synthesis of clinical practice guidelines. Journal of Eating Disorders. 2025.
Austin A, et al. Efficacy of eating disorder focused family therapy for adolescents with anorexia nervosa: a systematic review and meta-analysis. International Journal of Eating Disorders. 2024.
Atwood ME, Friedman A. A systematic review of enhanced cognitive behavioral therapy (CBT-E) for eating disorders. International Journal of Eating Disorders. 2020;53(3):311-330.
Butler RM, Heimberg RG. Exposure therapy for eating disorders: a systematic review. Clinical Psychology Review. 2020;78:101851.
