Key points
- Eating disorders are serious illnesses, not a choice, and they can be treated.
- They affect people of all ages, backgrounds, body sizes and sexes, so appearance is not a reliable guide.
- Early signs are often changes in thoughts, feelings and routines around food.
- Care usually involves a team: therapy, medical care and monitoring, and nutritional counseling.
- Outpatient therapy is one part of care, and physical symptoms or medical risk belong with a medical team.
Disordered eating is not about willpower
The National Institute of Mental Health (NIMH) describes eating disorders as serious illnesses marked by severe disturbances in a person's eating behaviors. It is direct on a point that matters to anyone feeling ashamed: eating disorders are not a choice.
Many people think about food and their bodies from time to time. It becomes a concern when someone is fixated on body shape or on controlling what they eat. NIMH says these may be signs of an eating disorder.
Researchers believe a mix of genetic, biological, behavioral, psychological and social factors raises a person's risk. No one causes an eating disorder by being weak, vain or difficult, and no family should carry that blame.
Early signs to notice
Not everyone will have every sign, and one sign on its own does not mean a person has an eating disorder. A pattern is what deserves attention. These examples come from the signs NIMH lists across different eating disorders.
- Thinking about food, eating or body shape much of the time
- Eating far less than the body needs, or strict rules about what, when or how to eat
- Intense fear about how the body might change
- Eating when full or not hungry
- Eating alone or in secret to avoid embarrassment
- Feeling distressed, ashamed or guilty about eating
- Dieting again and again
- Trying to make up for eating, for example by exercising excessively, fasting or throwing up
- A short list of accepted foods that keeps getting shorter, or little interest in food at all
Why you cannot tell by looking
A common myth is that you can see an eating disorder. NIMH states that eating disorders can affect people of all ages, racial and ethnic backgrounds, body weights and sexes, and that even people who appear healthy can have an eating disorder and be extremely ill.
MedlinePlus adds that eating disorders often start in the teen years or young adulthood, but can begin in childhood or later in life. Anyone can develop one.
This is why weight-neutral language matters. Comments about a person's size, even kind ones, tend to miss what is going on. It helps more to ask about how someone is feeling, how much room food is taking up in their mind, and what they have stopped doing because of it.
Outpatient support and medical care are different things
Eating disorders affect the body as well as the mind. MedlinePlus notes they can lead to health issues such as heart and kidney problems. For that reason, care is usually shared by a team. NIMH lists the usual parts of a treatment plan as individual, group or family psychotherapy, medical care and monitoring, and nutritional counseling. A prescriber may also discuss medication for some people.
Outpatient therapy is the talking part of that plan. It is a place to work on the thoughts, feelings and habits around food and body image. It is not medical monitoring. A therapist cannot check your heart, order lab work or judge whether your body is medically stable.
Some people with a serious eating disorder may need care in a hospital or a residential treatment program. Needing a higher level of care is not a failure. It is the right care for that moment.
See a medical provider, not only a therapist, if
- You have any physical symptoms that worry you
- You are severely restricting food, throwing up or using laxatives
- A doctor has told you that you need medical monitoring
When to get support
You do not need to be sure it is "bad enough." NIMH says early detection and treatment are important for recovery. If food, eating or your body is taking up more and more of your day, that is reason enough to talk with someone.
A good first step is your primary care provider or your child's pediatrician, who can check on physical health and talk through next steps. For teens, family can play a crucial role. NIMH notes that research suggests family-based treatment can improve outcomes, particularly for adolescents.
If you or someone you love is in crisis or having thoughts of suicide, call or text 988, or call 911. Locascio Wellness does not provide emergency services. Our crisis resources page lists more options.
How we can help
Therapists on our team have experience working with people who have a hard relationship with food and body image. We offer outpatient support only, by secure video, and it works alongside your medical team, not in place of it. If you need more than outpatient support, we will say so and encourage you to seek that care with your medical team. Our eating disorder support page explains what this looks like.
Worry and low mood often travel with eating concerns, so you may also want to read about anxiety therapy. Parents can find more on our teen therapy page.
Clients must be physically in Pennsylvania, West Virginia or Arizona during a session. You can book a free 15-minute consultation or contact us with questions. Eating disorders can be treated, and the first conversation is often the hardest part.
Common questions
What is the difference between disordered eating and an eating disorder?
Disordered eating is an everyday term for eating habits and thoughts about food that are causing distress or getting in the way of life. An eating disorder is a diagnosed illness. Only a qualified professional can make a diagnosis. You do not need one to ask for help, and early support matters either way.
Can someone have an eating disorder and look healthy?
Yes. The National Institute of Mental Health states that eating disorders affect people of all body weights, and that even people who appear healthy can have an eating disorder and be extremely ill. Appearance is not a reliable guide. Changes in thoughts, feelings and habits around food tell you more.
Is online therapy enough for an eating disorder?
It depends on the person. Therapy is one part of care, alongside medical care and monitoring and nutritional counseling. We offer outpatient support by secure video and do not provide medical monitoring. Anyone with physical symptoms or medical risk needs a medical team, and some people need a hospital or residential program.
Who should I see first if I am worried about my eating?
A medical provider is a sound first stop, because eating disorders can affect physical health and a treatment plan usually includes medical care and monitoring. Therapy and nutritional counseling are the other usual parts of a plan. You can also book a free 15-minute consultation with us to ask how outpatient therapy could fit alongside your medical care.
Sources
Published by Locascio Wellness. Published October 13, 2026. Clinically reviewed by Anthony Locascio, PsyD, LPC. This page is general information, not medical advice or a diagnosis.