Eating Disorders
Feeding and Eating Disorders (DSM-5-TR)
Severe disturbances in eating behaviors and related thoughts/emotions. Includes anorexia nervosa, bulimia nervosa, binge eating disorder, and ARFID. FBT is gold standard for adolescent anorexia; CBT-E leads for bulimia and BED.
Prevalence: ~5% lifetime; highest mortality of any mental disorder (anorexia)
Clinical Picture
Eating disorders have the highest mortality rate of any psychiatric condition and are among the most complex to treat. They interweave body image, identity, control, family dynamics, cultural pressures, trauma history, and neurobiological factors in ways that resist simple formulation. Anorexia, bulimia, binge eating disorder, and ARFID are distinct conditions with different clinical profiles and evidence bases. The therapist must navigate the tension between the medical urgency of nutritional restoration and the psychological work of understanding what the eating disorder means and does for the client.
Treatment Considerations
For adolescent anorexia, Family-Based Treatment (FBT/Maudsley) has the strongest evidence. For adult bulimia and binge eating, CBT-E (Enhanced) is the first-line treatment. For anorexia in adults, no single approach has clearly superior outcomes — CBT-E, SSCM, and psychodynamic approaches show similar results, which may reflect the difficulty of the condition rather than treatment equivalence. Many eating disorder specialists integrate multiple approaches. DBT-informed approaches are increasingly used for the emotional dysregulation component. Body-oriented and somatic approaches may address the lived-body dimension that purely cognitive approaches miss.
13 Therapeutic Approaches
Sorted by evidence tier: guideline-recommended first, then RCT-supported, then emerging/limited evidence.
Related Clinical Vignettes
Sources & References
Prevalence data from NIMH, WHO, and DSM-5-TR field trial publications. Evidence tiers reflect guideline status (APA, NICE, VA/DoD, WHO) and meta-analytic findings as of early 2025. Individual modality citations are listed on each modality page. Full bibliography available on the Sources page.