Eating Disorder Treatment in Massachusetts

Eating disorders are serious, complex conditions that affect your physical health, your emotional well-being, and your relationship with food and your own body. As a psychiatric clinical nurse specialist, I work alongside primary care providers and nutritionists to address the mental health dimensions of eating disorders, including medication management for co-occurring conditions and counseling to support your recovery. You do not have to navigate this alone, and reaching out for help is a sign of strength.

Types of Eating Disorders I Treat

Eating disorders are not a choice or a lifestyle. They are diagnosable psychiatric conditions with real neurobiological underpinnings, and they require professional treatment. The eating disorders I most commonly work with include:

Anorexia Nervosa

Anorexia nervosa is characterized by persistent restriction of food intake leading to significantly low body weight, an intense fear of gaining weight, and a distorted perception of body shape or size. People with anorexia often do not recognize the severity of their low body weight and may engage in excessive exercise, food rituals, or other compensatory behaviors. Anorexia carries the highest mortality rate of any psychiatric disorder, which is why early intervention and a coordinated treatment team are so critical. The psychiatric component of anorexia treatment often involves managing the anxiety, depression, and obsessive-compulsive patterns that fuel and maintain the restrictive behaviors.

Bulimia Nervosa

Bulimia nervosa involves recurrent episodes of binge eating followed by compensatory behaviors such as self-induced vomiting, misuse of laxatives or diuretics, fasting, or excessive exercise. Unlike anorexia, people with bulimia may maintain a weight that appears normal, which can make the disorder less visible to others. However, the physical consequences can be severe, including electrolyte imbalances, dental erosion, and gastrointestinal complications. The shame and secrecy that often accompany bulimia can make it especially isolating. From a psychiatric perspective, bulimia frequently co-occurs with depression, anxiety, and impulsivity, all of which can be addressed through medication and counseling.

Binge Eating Disorder

Binge eating disorder is the most common eating disorder in the United States. It is characterized by recurring episodes of eating significantly more food than most people would eat in a similar time period, accompanied by a feeling of loss of control during the episode. Unlike bulimia, binge eating disorder does not involve regular compensatory behaviors. People with binge eating disorder often experience intense guilt, shame, and distress after episodes. The condition frequently co-occurs with depression, anxiety, and low self-esteem, and it can contribute to medical complications related to weight. Treatment focuses on breaking the binge cycle, addressing emotional triggers, and managing co-occurring mood symptoms.

Other Specified Feeding or Eating Disorders (OSFED)

OSFED is a diagnostic category for eating disorders that cause significant distress and impairment but do not meet the full criteria for anorexia, bulimia, or binge eating disorder. This is not a less serious diagnosis. OSFED can include atypical anorexia nervosa, where all criteria for anorexia are met but weight remains within or above the normal range; purging disorder without binge eating; night eating syndrome; and subthreshold presentations of bulimia or binge eating disorder. These conditions are just as deserving of treatment and can be just as debilitating as the more commonly recognized eating disorders.

The Psychiatric Role in Eating Disorder Treatment

Eating disorders rarely exist in isolation. The vast majority of people I see with eating disorders also have one or more co-occurring psychiatric conditions, most commonly anxiety, depression, and obsessive-compulsive disorder. These conditions often fuel and maintain disordered eating patterns, and addressing them is a critical part of achieving lasting recovery.

As a psychiatric clinical nurse specialist, my role on the treatment team is to manage the mental health aspects of your care. This includes conducting a thorough psychiatric evaluation, prescribing and monitoring medications when appropriate, and providing counseling that addresses the thoughts, feelings, and behaviors connected to your relationship with food and your body. I work closely with your primary care provider, who monitors your physical health and lab work, and with your nutritionist, who provides structured guidance around meal planning and nutritional rehabilitation.

This collaborative, multidisciplinary approach is the gold standard for eating disorder treatment because these conditions affect your body, your brain, and your behavior simultaneously. No single provider can address all of these dimensions alone, and I believe the best outcomes come from a coordinated team working together toward your recovery.

My Treatment Approach: Medication and Counseling

Medication Options

Medication can play an important role in eating disorder treatment, particularly for managing co-occurring conditions and reducing specific eating disorder symptoms. The evidence base for medication varies depending on the type of eating disorder, and I always discuss what the research shows so you can make informed decisions about your care.

For bulimia nervosa, fluoxetine (an SSRI) is the most well-studied medication and has FDA approval specifically for this condition. At higher doses, fluoxetine has been shown to reduce the frequency of binge-purge episodes and improve mood. Other SSRIs may also be considered depending on your individual response and history.

For binge eating disorder, SSRIs can help reduce binge frequency and improve the depression and anxiety symptoms that often accompany the condition. Other medication options may be discussed depending on your specific presentation and treatment goals.

It is important to note that bupropion is generally avoided in patients with active eating disorders, particularly those with a history of purging, due to an increased risk of seizures. I always take a careful history to ensure that any medication I prescribe is safe and appropriate for your specific situation.

For anorexia nervosa, the evidence for medication is more limited. While there is no medication that directly treats the core symptoms of restriction, psychiatric medication can be very helpful for managing the anxiety, depression, and obsessive thinking patterns that maintain anorexic behaviors. Medication decisions in the context of anorexia also need to account for the physiological effects of low weight and malnutrition, which is another reason why coordination with your medical team is essential.

Counseling for Body Image and Your Relationship with Food

In addition to medication management, I provide counseling that addresses the psychological components of eating disorders. Our sessions may focus on exploring the thoughts and beliefs that drive disordered eating, such as rigid rules about food, distorted body image, or the use of food restriction or binge eating as a way to cope with difficult emotions.

I draw on cognitive behavioral therapy principles to help you identify and challenge the thinking patterns that maintain your eating disorder. This might include examining all-or-nothing thinking about food, catastrophic predictions about weight gain, or the belief that your worth is tied to your appearance or body size.

We also work on developing healthier coping strategies for the emotions that trigger disordered eating behaviors. Many people with eating disorders use food, whether through restriction, bingeing, or purging, as a way to manage anxiety, sadness, anger, or a sense of being out of control. Building alternative ways to process and cope with these emotions is an essential part of sustained recovery.

The Importance of Multidisciplinary Care

I want to be transparent about what I provide and where the boundaries of my role lie. Eating disorder treatment is most effective when it involves a team of providers working together. My role focuses on psychiatric medication management and counseling. I do not provide nutritional counseling or medical monitoring of the physical complications of eating disorders.

If you do not already have a primary care provider and nutritionist involved in your care, I can help you identify referrals in your area. If you are already working with a treatment team, I am happy to coordinate with your existing providers. This kind of communication between providers leads to better outcomes and ensures that everyone is working from the same treatment plan.

For individuals who may need a higher level of care, such as intensive outpatient programs, partial hospitalization, or residential treatment, I can help assess whether a step up in care is appropriate and provide guidance on programs in Massachusetts and beyond.

Why Telehealth Works Well for Eating Disorder Treatment

Eating disorders often carry a heavy burden of shame and secrecy. Many people delay seeking help because they feel embarrassed, because they do not believe their condition is serious enough, or because the prospect of sitting in a waiting room feels overwhelming. Telehealth lowers many of these barriers. You can attend your appointments from the privacy of your own space, which for many patients makes it easier to open up about difficult topics.

Telehealth also supports the consistency that eating disorder treatment requires. Regular follow-up appointments are important for monitoring medication effectiveness, checking in on symptoms, and continuing the counseling work that supports recovery. Being able to attend appointments without disrupting your entire day makes it more likely that you will maintain the frequency of care that leads to the best outcomes.