Topic
Eating Disorders
Every eating disorder is doing work. Treatment starts with understanding what.
This specialization covers the four clinical presentations the EDFE distinguishes: ARFID, anorexia nervosa, bulimia nervosa, and binge eating disorder. Fairburn's transdiagnostic model is the theoretical spine on the body-image axis. Thomas's three-dimensional model frames the ARFID axis. Each presentation has its own hub and its own evidence-based treatment target, because the maintenance mechanisms differ in ways that matter for which intervention will actually work.
Start with the assessment
Presentation-specific hubs
Avoidant/Restrictive Food Intake
Sensory, fear-based, or low-appetite restriction that does not run through body image. CBT-AR, graded exposure, interoceptive work. Free 11-module course and parent checklist.
Open the ARFID hub →AnorexiaAnorexia Nervosa
Restriction organized around control, competence, and shape evaluation. CBT-E for adults, FBT for adolescents. Medical coordination is often essential.
Open the anorexia hub →BulimiaBulimia Nervosa
The restraint-binge-purge cycle Stice's dual-pathway model described and Fairburn's transdiagnostic model maintained. CBT-E is first-line; affect-focused adaptations fit when escape is primary.
Open the bulimia hub →Binge EatingBinge Eating Disorder
Heatherton and Baumeister's escape theory plus the EMA meta-analytic evidence. DBT-BED for the affect-dysregulation pattern; CBT-E when the binge sits inside body-image over-evaluation.
Open the BED hub →All articles
Somatic Treatment for ARFID: What the Evidence Does and Does Not Support
As of November 2026, no published trial or case report tests somatic treatment for ARFID. Where body-based work fits beside CBT-AR, and where it does not.
Refeeding Syndrome and the Medically Compromised Patient: A Family's Guide to the First Seventy-Two Hours
What families should know about refeeding syndrome, phosphorus in week one, inpatient versus outpatient criteria, and what to watch for once the patient is home.
Why Recovery Feels Like Death: The Identity Grief No One Names
The anorexic who recovers is not the same person who became ill, and the transition between the two is a grief no treatment manual names with precision. This essay describes the identity loss at the center of anorexia recovery through Bruch's clinical phenomenology, Woodman's archetypal reading, and the nondual literature on dissolution, with specific attention to the clinical approaches that make room for the grief instead of arguing with it.
The Pregnant Virgin in the Starving Woman: Marion Woodman on What Anorexia Is Refusing
Marion Woodman read anorexia as a refusal of matter at the archetypal level. How her reading sits beside medieval fasting women and what it adds to treatment.
The Six Meanings of Self-Starvation: A Patient-Readable Summary of the Nordbø Study
In 2006 Rune Nordbø and colleagues interviewed eighteen Norwegian women with anorexia and coded six meanings of restriction. Each is explained in plain prose.
What Bulimia Does to the Body: The Medical Picture Without Alarm
Lingual enamel loss on a thirty-two-year-old. Hypokalemia on a routine draw. A Russell's sign the internist missed. The clinical picture of bulimia nervosa, mapped across eight specialist domains, written for the patient and the family member who want the medical reality without catastrophizing.
The Room No One Else Knows About: Bulimia and the Architecture of Secrecy
A thirty-eight-year-old woman has spent twelve years with the same partner. He has never seen the inside of the downstairs bathroom while she is in it. The architecture of her day has been built around one door. The secrecy is not a symptom of the bulimia. It is part of how the bulimia holds.
Why 'Just Stop' Does Not Work: The Fairburn Mechanism Behind Bulimia
The transdiagnostic maintenance model predicts, with startling precision, what happens between a 7:05 AM resolution and a 7:05 PM binge. Willpower is the wrong tool because the mechanism is a closed loop, not a character defect.
DBT for Binge Eating: What Safer, Telch, and Chen Built for the Affect-Regulation Pattern
How Christy Telch adapted DBT for binge eating, what the Safer, Telch, and Chen manual contains, and when DBT-BED is indicated over Fairburn's CBT-E.
The Binge Before the Purge: Heatherton and Baumeister on What Bulimia Is Escaping
In 1991, two social psychologists named the mechanism the affect-regulation bulimic patient has been using without a name for it. The binge narrows attention to the immediate sensory, shutting off the higher-order self-evaluation that has been running all day. The purge is what lets her go to bed.
Why Dieting Causes Binging: Restraint Theory Explained
In 1985, Janet Polivy and C. Peter Herman published the experimental work at the University of Toronto that demolished the willpower model of binge eating. Restraint theory proposes that cognitive dietary restraint, not hunger or lack of discipline, is the proximal cause of the disinhibited eating that follows a breach of a self-imposed rule. Four decades of subsequent research, including Eric Stice's dual-pathway confirmation, have substantiated the basic mechanism and informed why Christopher Fairburn's CBT-E drops dietary restraint early in treatment.
The Obesity Clinic That Discovered Trauma: Vincent Felitti, the ACE Study, and What Your Binge Is Holding
In the late 1980s, Vincent Felitti ran the obesity clinic at Kaiser Permanente in San Diego. He could not understand why his best-outcomes patients were the ones who quit the program, until he began following them up and discovered what his liquid-diet protocol had been treating without knowing it was treating. The ACE Study grew out of those interviews. What the study found about the relationship between adverse childhood experiences and adult health outcomes, including binge eating and body size, reorganized the epidemiology of trauma in the United States and has not yet reorganized most of the treatment the culture offers.
The DSM-5 Criteria for Binge Eating Disorder, Read Plainly
The DSM-5-TR criteria for binge eating disorder in plain language, with answers to the three questions patients most often ask when a referral form lists them.
I Forget to Eat: Low-Interest ARFID and the Interoception Problem
Low-interest ARFID is a measurable deficit in interoceptive signaling, not suppressed appetite. What the research says and why the autism overlap keeps appearing.
When It Is Both: ARFID-Spectrum Features Inside Restrictive Anorexia
A nineteen-year-old with a confirmed anorexia nervosa diagnosis also has a lifelong sensory profile that predates the weight pathology. When clinicians treat ARFID features as part of the AN, refeeding protocols fail in predictable ways. How to read the overlay.
What ARFID Is Protecting You From
Food restriction in ARFID is not random. It serves a psychological function: managing overwhelm, maintaining control, avoiding vulnerability. Understanding what the restriction protects changes how you approach treatment.
The Beige Food Plate: What a Twenty-Food Repertoire Is Actually Telling You
When a child eats only beige foods from specific brands at specific temperatures, the pattern reflects a measurable sensory profile, not a discipline problem. A clinical reading of the twenty-food repertoire.
The Swallow That Will Not Come: Fear-Based ARFID After a GI Event
Fear-based ARFID often begins with a single GI event and persists for years through an autonomic loop the conscious mind cannot reason its way out of. The clinical mechanism, the brain-gut circuitry, and what exposure work actually looks like.
ARFID and Nutritional Deficiency: When Limited Eating Affects Your Health
ARFID often causes iron, zinc, B12, vitamin D, and calcium deficiencies. Learn the health signs of nutritional gaps and how rehabilitation works alongside ARFID treatment.
How to Support Someone With ARFID: A Guide for Family and Friends
Supporting someone with ARFID means reducing mealtime pressure, offering safe foods without judgment, and knowing when professional help is needed. A guide for family and friends.
ARFID Treatment: What CBT-AR Sessions Actually Look Like
Exposure hierarchies, food chaining, sensory and interoceptive work. What ARFID therapy looks like week to week and how to recognize a specialist.
ARFID and Anxiety: How Fear Drives Food Avoidance
Fear-based ARFID develops when choking, vomiting, or allergic reaction fears generalize into broad food avoidance. Learn how the anxiety cycle works and how CBT breaks it.
ARFID in Teenagers: What Parents Should Know
ARFID in teens causes social isolation, nutritional gaps during growth spurts, and daily stress around food. Learn how to distinguish ARFID from picky eating and what treatment options exist.
CBT-AR for Adults: The Four Stages, the Three Mechanisms, the Honest Limits
CBT-AR is a 20 to 30 session ARFID protocol from Thomas and Eddy at Mass General: four stages, three maintaining mechanisms, adult evidence, and limits.
ARFID in Adults: When the Pattern Has Been There the Whole Time
Adult ARFID is rarely a new development; it is an old pattern that finally has a name. A clinician on the differential, the four maintaining mechanisms, and what changes when CBT-AR meets a thirty-year history of restriction.
The Ego-Syntonic Problem: Why the First Month of Anorexia Treatment Is About Identity, Not Food
Anorexia is ego-syntonic: restriction feels consistent with who the person is. Why treatment has to address identity fusion before behavior change will hold.
ARFID and Autism: Where the Overlap Actually Lives
ARFID and autism share a neurological substrate in sensory processing, interoception, and autonomic reactivity. Learn why up to 70 percent of autistic children show severe food selectivity and what dual-track assessment looks like.
Adult Food Texture Aversion: The Sensory Subtype of ARFID
Texture aversion in adults can be the sensory form of ARFID, not pickiness: the gag is involuntary. Four trigger types, and how food chaining treats it.
Escape from Self-Awareness: The Heatherton and Baumeister Theory of Binge Eating
Heatherton and Baumeister's 1991 escape theory: binge eating as relief from aversive self-awareness, and why night-time bingeing rises after days of high demand.
The Restraint-Binge-Purge Cycle: Why the Loop Closes Itself
Bulimia nervosa is maintained by a mechanistic loop in which dietary restraint, not the binge, is the destabilizer. Understanding why the cycle closes itself explains why willpower fails structurally rather than morally.
What Is ARFID? A Complete Guide to Avoidant/Restrictive Food Intake Disorder
ARFID is a serious eating disorder involving food avoidance driven by sensory sensitivity, fear, or low appetite. Learn the DSM-5 definition, who it affects, and when to seek help.
What Your Eating Disorder Is Trying to Become
Eating disorders often function as failed individuation attempts, where restriction and control serve deep autonomy needs the person cannot meet directly. When treatment targets only the behavior without understanding its developmental function, recovery stalls because the symptom was doing psychological work the person still needs done.
How to Explain ARFID to Your Child's School
A parent's guide to explaining ARFID to teachers, lunch aides, and principals. Includes what to say, what accommodations to request, and how to use a 504 plan to protect your child.
ARFID vs Picky Eating: How to Tell the Difference
ARFID (Avoidant/Restrictive Food Intake Disorder) isn't picky eating. Learn the key differences, warning signs, and when to seek professional help.
Is It Normal to Struggle With Food? What That Actually Means
If you count, hide, avoid, or plan around food in ways you don't talk about, you are not alone. What the quiet version looks like and when it matters.
Schedule a Consultation
If you are struggling with any of the four presentations above, a consultation can help determine the right level of care and whether individual therapy, family-based treatment, or higher-level-of-care coordination fits your situation.
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