Eating disorders affect millions of teens around the world. According to the National Eating Disorders Association (NEDA), about 3-5 percent of adolescents in the U.S. live with anorexia, bulimia, binge eating disorder, or an otherwise specified feeding and eating disorder. Additionally, eating disorders have the highest mortality rate of any psychiatric illness.

If your teen has an eating disorder, you might have trouble deciding which treatment center is the right fit.

We can help you with that.

Treatment Options for Teens Struggling with Eating Disorders

First, let’s discuss your options. Here are the most common choices:

• An eating disorder facility. This kind of treatment center focuses on the medical and clinical aspects of treating adolescent eating disorders such as anorexia, bulimia, binge eating disorder, and others. These facilities often have nursing staff, daily weigh-ins, and food monitoring. Teens who attend an eating disorder treatment center typically have a Body Mass Index (BMI) below a certain threshold.
• A dual diagnosis treatment facility. These treatment centers focus on eating disorders and co-occurring mental health issues. They’re equipped with the clinicians and staff necessary to supervise treatment for teens diagnosed with an eating disorder and a mental health issue like depression or anxiety.
• A mental health treatment center. Mental health treatment centers focus on treating mental health disorders such as depression, anxiety, trauma, bipolar disorder, obsessive-compulsive disorder (OCD), borderline personality disorder, and others. Mental health treatment centers offer evidence-based therapies like Dialectical Behavior Therapy (DBT) and Cognitive Behavioral Therapy (CBT). Teens in mental health treatment centers may struggle with disordered eating patterns, but it’s typically a secondary diagnosis.

Adolescents who have an eating disorder as primary diagnosis require a specialized eating disorder treatment facility or a dual diagnosis treatment facility. Teens who have an eating disorder as a secondary diagnosis as well as another mental health issue will benefit most from a mental health treatment center where treatment addresses their primary mental health issues first.

Primary vs. Secondary Diagnosis: How do I Know?

The best way to determine this is to ask your teen’s therapist and primary care doctor. A mental health professional can offer a clinical assessment, while a physician can offer a medical one.

If your teen attends routine outpatient therapy sessions, their therapist has a comprehensive knowledge of their clinical history. Ask the therapist whether the eating disorder is the primary diagnosis or the secondary diagnosis. Based on this information, the mental health professional can recommend what kind of adolescent treatment center is best. They may recommend a specialized eating disorder facility, a dual diagnosis treatment center, or a mental health rehab center.

If your teen has not started therapy of any kind, you can contact an adolescent mental health treatment center for a clinical assessment. Most teen treatment centers offer complementary clinical assessments for teens. Make sure the assessment is administered by a licensed mental health professional rather than an admissions representative. The clinician can offer their professional assessment on whether your teen’s eating disorder is a primary or secondary diagnosis.

At the same time, we suggest consulting your pediatrician to confirm the diagnosis. A pediatrician will conduct a full medical examination and may order bloodwork or other laboratory tests. A doctor’s professional assessment is particularly helpful. If your teen does not believe they have an eating disorder or a problematic relationship with food and eating, they might believe their pediatrician.

Primary vs. Secondary Diagnosis: What’s the Difference?

How do mental health clinicians determine whether your teen’s eating disorder is their primary or secondary issue?

“It depends on the severity of your teen’s symptoms, and the frequency,” says Megan Johnston, MS, LMFT, Admissions Clinician at Evolve Treatment, a network of adolescent mental health treatment centers in the Bay Area and Southern California. “When, and how often, are they bingeing, purging, or restricting? Does it happen once every few months, or every single day? If a teen is medically unstable because of their food issues, which often occurs due to severe body dysmorphia, then the eating disorder is definitely a primary diagnosis. But if they sometimes refuse to eat during bouts of depression, or they use binge eating as a way to cope with their anxiety, the disordered eating is more likely a secondary diagnosis that stems from the first.”

Signs of an Eating Disorder

Signs that indicate your teen is suffering from an active eating disorder may include some or all of the following:

• Intense fear of gaining weight
• Extreme weight loss
• Calorie restriction
• Refusal to eat certain food groups
• Compulsive exercising
• Avoiding eating with others
• Unusual food rituals
• Physical symptoms such as dry skin, dental problems, thinning of hair, lanugo
• Intense focus on body shape and image

Warning

If symptoms have progressed to the point of extreme severity (e.g. if your teen is severely malnourished or dehydrated and/or has lost a great deal of weight, or if your teen is experiencing medical complications) then they usually require inpatient hospitalization.

Medical complications as a result of an eating disorder include unstable heart rate, unstable blood pressure, fainting, or bleeding from vomiting. Teens with an active eating disorder can also face electrolyte imbalance, anemia, low blood sugar, and many other health risks. Without professional medical treatment, your adolescent may face heart, kidney and/or liver failure and even death.

The Importance of Choosing the Right Facility

That’s why choosing the right treatment center is vital. It could be a matter of life and death. If the eating disorder symptoms are severe and highly acute, placing them in a mental health rehab center would be unwise and dangerous.

“If a teen is medically unstable due to an eating disorder, staff at mental health treatment centers should not even attempt to treat such a teen for depression, anxiety or other emotional issues. First and foremost, a teen needs to be medically monitored,” Johnston says.

“At Evolve Treatment Centers, we have a certain safety protocol that if a teen refuses to eat anything for 24 hours then we refer them out to a hospital to ensure medical safety. Once they are cleared medically, we give their family a referral for an eating disorder treatment facility. Because not only is such behavior medically dangerous, it also interferes with mental health treatment adherence.”

On the other hand, if depression, anxiety, or another mood disorder is your teen’s primary issue, then placing them in an eating disorder facility is not the right decision, either. These teens require a residential mental health treatment center that will treat their mental health disorder with evidence-based treatment modalities mentioned above, such as cognitive behavioral therary (CBT) or dialectical behavior therapy (DBT).

Discharge from an Eating Disorder Facility: What Happens Next?

Eating disorders like anorexia or bulimia often co-occur with mental health or emotional issues like depression, obsessive-compulsive disorder, anxiety, emotion dysregulation, or body dysmorphia. Teens with an eating disorder may also engage in nonsuicidal self-inury, substance use, or suicidal ideation. This is why, even after successful discharge from an eating disorder rehab facility, additional support may be necessary. They may need treatment at a residential mental health treatment center or intensive outpatient/partial hospitalization program.

As NEDA writes in its Parent Toolkit about those struggling with anorexia:

“Once an anorexia sufferer has returned to a weight that is healthy for them, they can usually participate more fully and meaningfully in psychotherapy. Other psychological work usually needs to be done so the person can manage difficult emotions without resorting to anorexic behaviors. Weight recovery alone does not mean the eating disorder is cured.”

Evolve Treatment Centers for Teens provides complimentary assessments and referrals for teen eating disorders. A licensed mental health clinician will assess your teen and provide complimentary referrals if necessary. Call 1-800-GROW to receive your free assessment.