Eating Disorders (Anorexia/Bulimia/Binge)

Nutritional rehabilitation under dietitian supervision (structured meal plan, gradual calorie increase, monitor for refeeding syndrome—life-threatening if too rapid refeeding after severe malnutrition), regular balanced meals and snacks (3 meals, 2-3 snacks—structure critical), all food groups (no restrictions—'challenge foods' reintroduced), adequate calories (restore weight, heal metabolism—often 2500-3500+ cal/day for weight restoration), adequate protein, fats, carbs (don't restrict macros), calcium and vitamin D (bone health), avoid 'health food' trap (orthorexia—obsession with 'clean eating' can be eating disorder), intuitive eating (long-term goal—after weight restoration and reduced symptoms, reconnect with hunger/fullness cues), address food rules and rituals (challenge black-and-white thinking), family meals (support, normalize eating), avoid dieting or weight loss focus (lifelong—triggers relapse).

Specialized eating disorder treatment (outpatient, intensive outpatient, partial hospitalization, residential, inpatient—based on severity), Psychotherapy CRITICAL: CBT-E (enhanced cognitive-behavioral therapy for eating disorders—evidence-based), DBT (dialectical behavior therapy—emotion regulation, especially for bulimia/binge), FBT (family-based treatment—gold standard for adolescents, parents take control of refeeding), Individual therapy (trauma work if PTSD, address underlying issues), Group therapy (support, reduce isolation), Medical monitoring (vital signs, labs, cardiac—especially during refeeding), Psychiatry (if comorbid depression, anxiety, OCD—medications may help, SSRIs for bulimia/binge), Nutritional counseling (meal planning, challenge food fears, heal relationship with food), Treat co-occurring conditions (anxiety, depression, OCD, PTSD, substance abuse—common), Remove triggers (social media, pro-ana content, diet culture, toxic relationships), Support groups (after acute treatment—NEDA, EDA), Family support and education (eating disorders affect whole family), Avoid weight-focused exercise (during acute treatment—often compulsive, driven by eating disorder), Reintroduce joyful movement (after weight restoration, with healthy mindset), Address body image (not just weight—thoughts, feelings about body, challenge distortions), Relapse prevention (identify triggers, coping strategies, ongoing support), Long-term recovery focus (eating disorders are chronic—50% full recovery, 30% partial, 20% chronic, relapses common, ongoing support needed).