What Kind of Care Does My Teen Need in Eating Disorder Treatment?

Written by Cristina Luibil MS, RD, LDN with support from Sabrina Stadelman

If your teen has recently been diagnosed with an eating disorder, you may be wondering what treatment will look like. While treatment will be individualized for every teen, it will always require a treatment team. This treatment team will determine your teen’s recovery plan based on their individual needs, can also support you as a parent or caregiver by answering questions, and will support your teen every step of the way. 

Who Should Be On My Teen’s Care Team in Eating Disorder Recovery?

In eating disorder recovery, a care team should include a primary care provider (such as a pediatrician or another medical doctor), a registered dietitian, a therapist, and a psychiatrist. Each member of your teen’s care team plays an important role in monitoring their recovery, and the expertise of an entire treatment team is important to achieving the best recovery outcomes. 

Registered Dietitian

A registered dietitian’s main role is to stabilize nutrition status, monitor weight status, and correct any deficiencies. Registered dietitians will provide a recovery nutrition plan tailored to your teen's individual needs. The recovery meal plan will be designed to correct nutrient deficiencies, meet energy and nutritional needs, and create a sustainable eating pattern. Registered dietitians will also work with teens to build a healthier relationship with food and reduce fear around food and eating. 

Primary Care Physician

The role of a primary care physician is to assess your teen’s physical conditions. This is an ongoing step in the process of treatment, and a primary care physician will continue to be a part of the treatment team and monitor your teen throughout recovery. 

Therapist

The role of a therapist is to focus on eating disorder symptoms, behaviors, and the underlying emotional issues that contribute to an eating disorder. A therapist will help your teen to work through thoughts and feelings that lead to disordered eating behaviors, as well as to develop coping skills and stress management techniques so they know what to do if the eating disorder voice gets loud. 

Psychiatrist

A psychiatrist can prescribe medications, if needed, for a variety of mental health needs, including but not limited to improving mood disturbances such as depression and anxiety, or to help reduce obsessive behaviors surrounding food. 

What Treatment Methods are Common in Eating Disorder Recovery?

There are different treatment methods commonly used when navigating eating disorder recovery, including Family Based Treatment, Cognitive Behavioral Therapy, and nutritional rehabilitation and counseling. Other modalities such as Dialectical Behavior Therapy (DBT), Acceptance and Commitment Therapy (ACT), or Motivational Interviewing (MI) could also be helpful depending on the individual’s needs. There are also additional specialty treatment modalities that clinicians can use, depending on the situation. For teens, Family-Based Treatment is considered a top choice, as it involves parents being part of the treatment team, with the goal of teens eventually regaining autonomy over their own treatment, nutrition, and recovery.  

Family-Based Treatment

Family-Based Treatment (FBT) is considered a gold-standard choice, especially for teens struggling with anorexia nervosa and ARFID. With FBT, parents or caregivers have the responsibility to ensure that their teen is eating their meals and following their recovery meal plan, as well as to have open conversations and communication with their teen and their teen’s treatment team. Parents and caregivers are part of the treatment team involved in ensuring their teen regains weight (if needed), minimizes eating disorder behaviors, and eats enough food regularly. Parents will gradually become less involved as more responsibility is placed on the teen as they progress through recovery and gain more autonomy over their treatment and eating habits. Still, one of the most important responsibilities for parents and caregivers during FBT is supporting their teen, and that support is needed throughout all stages of recovery. 

Cognitive Behavioral Therapy

This treatment modality is considered especially helpful for treating eating disorders.  It is targeted towards helping individuals recognize how their thoughts and behaviors related to food and body image affect their relationship with food and lead to eating disorder behaviors. These eating disorder behaviors can also be brought on by more than just struggles with body image, as food/eating can sometimes be used as a coping mechanism. Cognitive behavioral therapy helps individuals to recognize and change these unhelpful behaviors by teaching healthy coping strategies. 

Nutritional Rehabilitation and Counseling

Nutritional rehabilitation and counseling consist of a registered dietitian helping to restore optimal eating patterns and adequate nutrition. This is done through both medical nutrition therapy (MNT) and nutrition education. With MNT, the dietitian will focus on the nutrition-related medical complexities of the disease and ensure the teen is meeting their energy, protein, fluids, and other macro and micronutrient needs. During education and counseling, the dietitian will help the teen dig a little deeper into their motivation and confidence to change behaviors as they relate to the eating disorder, including, but not limited to, helping reduce fears surrounding food, eating, body image, and body changes. Registered dietitians help patients to understand the importance of adequate nutrition and consuming enough food to support overall health and well-being. 

Dialectical Behavior Therapy

Dialectical behavior therapy (DBT) is a skills-based therapy that is especially helpful for patients who use food-related behaviors to cope with overwhelming feelings or interpersonal distress. DBT teaches emotional awareness, distress tolerance, mindfulness, and helps to develop healthy relationships and boundaries. DBT can be done in individual or group formats and emphasizes validation and skill-building. DBT can be especially helpful for individuals with bulimia, binge eating disorder, co-occurring mood disorders, trauma, or impulsivity. It is often used in combination with other treatment modalities and is effective in helping to build healthier coping skills and emotional resilience. 

Acceptance and Commitment Therapy 

Acceptance and commitment therapy (ACT) is a mindfulness and values-based approach to therapy. In eating disorder recovery, ACT encourages clients to take recovery-oriented actions that align with their own values. ACT encourages clients to learn to accept uncomfortable thoughts, sensations, or feelings without trying to avoid or control them. It’s especially helpful for individuals who are very rigid in their thinking or feel an intense need for control, and it can be helpful for individuals with a variety of eating disorders, especially chronic or long-standing eating disorders. This treatment modality can feel slow-moving at first, but it also encourages long-term change and can feel very empowering for clients. 

Motivational Interviewing

Motivational interviewing is a client-centered, goal-oriented approach that is designed to boost an individual’s motivation and commitment to change. Motivational interviewing emphasizes partnership and that eating disorder recovery is a collaborative process where the dietitian and client are working together to identify potential barriers to dietary changes and brainstorm potential solutions. A registered dietitian using motivational interviewing techniques will use compassion and empathy to help the client feel accepted and comfortable sharing openly and honestly. They will also focus on helping the client achieve their own goals rather than creating goals on behalf of the client. Motivational interviewing is useful for clients with a variety of conditions, as well as for clients who may be resistant to making dietary or behavioral changes. Motivational interviewing is often used in combination with other treatment modalities, and it can be helpful in eating disorder recovery by helping clients to set and achieve their own personal goals and to feel as if their concerns or struggles are being heard. 

How Do I Know Which Treatment Method is Best for My Teen?

There is no “best” approach to eating disorder treatment. All of the treatment methods described above can be effective, and treatment methods are typically combined because they each focus on treatment of a specific part of the disordered behavior. The best treatment option for your teen depends on many factors, such as diagnosis, age and developmental stage, family involvement, personality, temperament, mental health conditions, level of motivation and insight, and medical and nutritional status. 

Family-based treatment (FBT) is often recommended, especially for younger teens and teens who have been diagnosed with anorexia nervosa or ARFID. Some young adults may even benefit from an FBT approach, depending on their support system. Family-based treatment can be beneficial in allowing teens to remain in a familiar environment, empowering parents and caregivers as part of the treatment team and doesn’t require long-term hospitalization in most cases. FBT can require significant time and energy from parents and can be very emotional in the beginning (as with all ED recovery situations). It’s okay if this treatment modality isn’t what works best for your teen and your family, and other treatment modalities can be equally effective. Your dietitian and treatment team can help you decide what would work best for your family. 

To determine what is best for your teen, it is important to have open and honest communication with your teen and their treatment team to understand your teen’s specific challenges, personality, and environment. Your treatment team can help to determine which approach may be best for your teen, and skilled clinicians may even blend elements of different modalities depending on their needs. 

The most important thing to remember in eating disorder treatment is that you don’t have to figure it out alone. Your teen’s care team has the expertise and knowledge to guide you and your teen in determining their recovery plan, and they will use this expertise to provide support and determine the best path forward based on your teen’s individual needs. 

If you’re looking for support for a teen struggling with an eating disorder, Aterra Nutrition offers virtual nutrition counseling and support for eating disorder recovery with a registered dietitian. We offer one-on-one nutrition counseling for those in DC, Maryland, Virginia, New Jersey, and Michigan. Learn more about the eating disorder services Aterra Nutrition offers on our website at aterranutrition.com.

About the Author

Cristina Luibil, MS, RD, LDN specializes in eating disorder recovery and Intuitive Eating for teens and adults. Aterra Nutrition provides virtual nutrition counseling for those in DC, Maryland, Virginia, New Jersey, and Michigan. This post was researched and written in conjunction with Sabrina Stadelman, dietetics student and nutrition assistant at Aterra Nutrition. Learn more about the whole team here.

Disclaimer: The information shared in this blog is for general educational and informational purposes only. It may not be tailored to your specific health needs as it is written here. This content is not intended to replace personalized medical advice, nutrition counseling, or medical nutrition therapy. Any recipes or suggestions provided are meant to inspire and should be used at your discretion. Always consult with your own registered dietitian, physician, or healthcare provider before making changes to your nutrition, lifestyle, or treatment plan. If you choose, Aterra Nutrition would be happy to help you in your own, individual nutrition and intuitive eating journey.