Eating disorder therapy

Online Eating Disorder Therapy for Adolescents & Adults in Huntersville, North Carolina, South Carolina, Florida, and Vermont

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Eating disorder therapy addresses a condition that is often misunderstood as a lifestyle choice, when in reality, eating disorders are serious illnesses that cause severe disturbances to a person's eating behaviors. These struggles go far beyond food and can involve obsessions with body weight and shape that affect every aspect of daily life. Common eating disorders include anorexia nervosa, bulimia nervosa, binge-eating disorder, and ARFID (Avoidant/Restrictive Food Intake Disorder). At Calm Blue Waters Counseling, we understand the complexity of these conditions and provide compassionate, personalized support to help you move toward healing.

Eating disorder therapy also addresses the body image concerns that frequently accompany disordered eating patterns. Body image is the mental representation you create in your mind, but it may not reflect how others actually see you. This skewed perception affects people across the globe, regardless of ethnicity, culture, gender, or age. According to ANAD (National Association of Anorexia Nervosa and Associated Disorders), approximately 30 million Americans experience some form of eating disorder, highlighting how widespread these struggles truly are. Our therapists work with you to challenge distorted beliefs about your body and build a healthier, more compassionate relationship with yourself.

Requirements for Starting Online Eating Disorder Therapy

• Do not use the online scheduler — eating disorder clients must email or call to request an appointment.
• Weekly therapy sessions are required.
• You must be working with a Registered Dietitian/Nutritionist on a regular basis.
• You must maintain regular medical check-ins with a Primary Care Physician to monitor for medical stability.
• All therapy services are provided exclusively online via secure video sessions.

Signs and Symptoms of Anorexia Nervosa

People with anorexia nervosa may see themselves as overweight, even when they are dangerously underweight. People with anorexia nervosa typically weigh themselves repeatedly, severely restrict the amount of food they eat, and eat very small quantities of food. While many young women and men with this disorder die from complications associated with starvation, others die of suicide. In women, suicide is much more common in those with anorexia than with most other mental disorders.

Symptoms include:

• Extremely restricted eating
• Extreme thinness (emaciation)
• A relentless pursuit of thinness and unwillingness to maintain a normal or healthy weight
• Intense fear of gaining weight
• Distorted body image, a self-esteem that is heavily influenced by perceptions of body weight and shape, or a denial of the seriousness of low body weight
• Thinning of the bones (osteopenia or osteoporosis)
• Mild anemia and muscle wasting and weakness
• Brittle hair and nails
• Dry and yellowish skin
• Growth of fine hair all over the body (lanugo)
• Severe constipation
• Low blood pressure, slowed breathing and pulse
• Damage to the structure and function of the heart
• Brain damage
• Multiorgan failure
• Drop in internal body temperature, causing a person to feel cold all the time
• Lethargy, sluggishness, or feeling of always being tired
• Infertility

 

Bulimia Nervosa

People with bulimia nervosa have recurrent and frequent episodes of eating unusually large amounts of food and feeling a lack of control over these episodes. This binge-eating is followed by behavior that compensates for the overeating such as forced vomiting, excessive use of laxatives or diuretics, fasting, excessive exercise, or a combination of these behaviors. Unlike anorexia nervosa, people with bulimia nervosa usually maintain what is considered a healthy or relatively normal weight.

 

Symptoms of Bulimia Nervosa include:

•  Chronically inflamed and sore throat
•  Swollen salivary glands in the neck and jaw area
•  Worn tooth enamel and increasingly sensitive and decaying teeth as a result of exposure to stomach   acid
•  Acid reflux disorder and other gastrointestinal problems
•  Intestinal distress and irritation from laxative abuse
•  Severe dehydration from purging of fluids
•  Electrolyte imbalance (too low or too high levels of sodium, calcium, potassium and other minerals) which can lead to stroke or heart attack

 

Binge-eating disorder

Individuals with binge-eating disorder lose control over his or her eating. Unlike bulimia nervosa, periods of binge-eating are not followed by purging, excessive exercise, or fasting.  Individuals who suffer from binge-eating disorder often are overweight or obese.

 

Symptoms of Binge-Eating Disorder include:

• Eating unusually large amounts of food in a specific amount of time
• Eating even when you're full or not hungry
• Eating fast during binge episodes
• Eating until you're uncomfortably full
• Eating alone or in secret to avoid embarrassment
• Feeling distressed, ashamed, or guilty about your eating
• Frequently dieting, possibly without weight loss

 

Risk Factors:

Eating disorders frequently appear during adolescence or young adulthood but may also develop during childhood or later in life. These disorders affect both genders, although rates among women are higher than among men. Like women who have eating disorders, men also have a distorted sense of body image. For example, men may have muscle dysmorphia, a type of disorder marked by an extreme concern with becoming more muscular.

 

Treatments and Therapies:

Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), and Family Based Therapy (FBT) have all been proven to help in the treatment of eating disorders. Adequate nutrition, reducing excessive exercise, and stopping purging behaviors are the foundations of treatment.

Treatment plans may include one or more of the following:

• Individual, group, and/or family psychotherapy
• Medical care and monitoring
• Nutritional counseling
• Medications

Source: National Institute of Mental Health, https://www.nimh.nih.gov/index.shtml

 

 Avoidant/Restrictive Food Intake Disorder (ARFID)

 

What is ARFID?

Avoidant/restrictive food intake disorder (ARFID) is an eating or feeding disturbance that is characterized by a persistent failure to meet appropriate nutritional and/or energy needs that leads to one or more of the following:

 

• Significant weight loss (or failure to achieve expected weight gain or faltering growth in a child)
• Significant nutritional deficiency
• Dependence on oral nutritional supplements or enteral feeding (the delivery of a nutritionally complete feed, containing protein, carbohydrate, fat, water, minerals and vitamins, directly into the stomach, duodenum or jejunum)
• Marked interference with psycho social functioning

 

It’s also important to understand what ARFID is not. It is NOT :

• Associated with body image issues or any abnormalities related to how one perceives their body weight or shape
• The result of lack of available food
• A culturally sanctioned practice
• Explained by another medical or mental disorder (“If we treat that issue, the eating problem will go away”).

 

Causes of ARFID:

Like other eating disturbances, there is no singular cause of avoidant/restrictive food intake disorder (ARFID). However, the evolving scientific literature suggests that this pattern of disordered eating develops from a complex interplay between genetic, psychological and sociocultural factors.

 

Genetic factors:

Eating disorders are familial illnesses, and temperamental traits predisposing individuals toward developing an illness are passed from generation to generation.

 

Psychological factors: 

Obsessive compulsive features tend to accompany eating disturbances, as do co-occurring mood and anxiety disorders.

 

Sociocultural factors: 

Cultural pressures to eat clean/pure/healthy as well as growing emphasis on food processing, sourcing, packing and environmental impact can influence food beliefs and intake.

 

Symptoms of Avoidant/Restrictive Food Intake Disorder (ARFID) 

Symptoms of avoidant/restrictive food intake disorder (ARFID) vary widely, and may evolve with the developmental context of the individual (especially in children and adolescents).

 

Types and symptoms of ARFID include: 

• Avoidant: Patients who only accept a limited diet in relation to sensory features (sensory sensitivity); sensory aversion; sensory over-stimulation
• Aversive: Individuals whose food refusal is related to aversive or fear-based experiences (phobic avoidance) including choking, nausea, vomiting, pain and/or swallowing
• Restrictive: Individuals who do not eat enough and show little interest in feeding or eating (low appetite); extreme pickiness; distractible and forgetful
• ARFID “Plus”: Individuals with avoidant, aversive, or restrictive types of ARFID presentations who begin to develop features of anorexia nervosa, including concerns about body weight and size, fear of weight gain, negativity about fatness, negative body image without body image distortion and preference for less calorically-dense foods
• Adult ARFID : Individuals with avoidant, aversive, or restrictive types of ARFID presentations beyond childhood; may have had similar symptoms since childhood including selective or extremely picky eating, food peculiarities, texture, color or taste aversions related to food.

 

Seek a diagnosis if you have ANY of these ARFID symptoms:

 If left untreated, ARFID symptoms can build in intensity and seriousness, which is especially concerning for children and adolescents going through the most developmentally important stages of their life.

 

Health risks associated with (ARFID) include: 

• Weight loss or being severely underweight.
• Nutritional deficiencies (e.g., anemia or iron deficiency) and malnutrition that can be characterized by fatigue, weakness, brittle nails, dry hair/hair loss, difficulty concentrating, and reduction in bone density.
• Growth failure in adolescents or an increased risk to not thrive. Many sufferers have stunted growth or have fallen off their growth curves for weight and height.

 

    Effective Treatment for ARFID: 

• Many behavioral and psychological interventions have demonstrated promising effects for those recovering from ARFID and may include forms of exposure therapy, cognitive behavioral therapy and more.
• Because underlying biological factors may influence ARFID, seeking out specialized care by a treatment team should be sought for full assessment and diagnosis. This may involve collaboration with a speech language pathologist, occupational therapist, physical therapist, and registered dietitian.
• If you suspect that someone you care for may be suffering with a form of ARFID, it is important to express these concerns to a treatment specialist. A disturbance in eating patterns is not something that should be ignored, and seeking out treatment early can assist with intervention and recovery.

 

 Facts & Statistics of (ARFID):

In addition to understanding the symptoms, causes, health risks, and treatment options for avoidant/restrictive food intake disorder (ARFID), it’s also important to understand the facts and statistics:

 

ARFID 

• More common in children and young adolescents and less common in late adolescence and adulthood
• Often associated with psychiatric co-morbidity, especially with anxious and obsessive-compulsive features.
• More than just “picky eating”; children do not grow out of it and often become malnourished because of the limited variety of foods they will eat.
• Boys may have a higher risk for ARFID than girls.

 

Treatment Team

Like other mental disorders and illnesses, eating disorder treatment should involve a diverse team of experts. It’s recommended that professional caretakers include the following:

• Mental Health Therapist
• Psychiatrist
• Nutritionist
• Primary care physician

Due to the severe toll that eating disorders may have on an individual’s physical health, psychological therapy is not enough. It’s also important, to incorporate family therapy and support groups. Family-Based Treatment is a treatment method used for patients who are minors.

Sources: Eating Disorder Hope and Eating Recovery Center

Located in:

Huntersville, NC

FREQUENTLY ASKED QUESTIONS

What types of eating disorders do you treat at Calm Blue Waters Counseling?

We provide therapy for a range of eating disorders and disordered eating patterns, including anorexia nervosa, bulimia nervosa, binge-eating disorder, ARFID (Avoidant/Restrictive Food Intake Disorder), and other food-related struggles. Our therapists also work with clients experiencing body image concerns, emotional eating, and restrictive eating behaviors that may not fit a specific diagnosis but still cause significant distress.

How does online eating disorder therapy work?

Our eating disorder therapy sessions take place through a secure, HIPAA-compliant telehealth platform. You can attend sessions from the comfort and privacy of your own home using a computer, tablet, or smartphone with a stable internet connection. This format allows us to serve clients throughout North Carolina, Vermont, and Florida while providing the same quality of care as in-person sessions.

What therapeutic approaches do you use for eating disorder recovery?

We draw from several evidence-based modalities tailored to your unique needs. These include Cognitive Behavioral Therapy (CBT) to address distorted thoughts about food and body image, Dialectical Behavior Therapy (DBT) to help manage intense emotions and reduce impulsive behaviors, mindfulness practices to build present-moment awareness, and person-centered therapy to create a supportive, nonjudgmental space for healing.

How long does eating disorder therapy typically take?

The length of treatment varies depending on your individual situation, the severity of your symptoms, and your personal goals. Eating disorder recovery is a deeply personal process, and we work collaboratively with you to determine the pace and duration that best supports lasting change. Some clients benefit from shorter-term focused work, while others find value in longer-term support.

Can eating disorder therapy help with body image issues even if I do not have a diagnosed eating disorder?

Yes, absolutely. Many clients come to us struggling with body image concerns, negative self-talk about their appearance, or an unhealthy relationship with food that does not meet the criteria for a formal diagnosis. Our therapists are experienced in helping individuals at all stages of their journey toward a healthier relationship with their body and food.

What can I expect during my first eating disorder therapy session?

Your first session is a 50-minute conversation focused on understanding your concerns, history, and goals in a warm, nonjudgmental environment. We will explore your relationship with food and your body, discuss what has brought you to therapy, and begin building a foundation of trust. From there, we will collaboratively develop a personalized treatment plan that addresses your specific needs.

Do you work with adolescents struggling with eating disorders?

Yes, we provide eating disorder therapy for adolescents ages 13 to 17, as well as young adults and adults. We understand that eating disorders often develop during adolescence and that early intervention can make a significant difference. Our therapists create a safe space where younger clients feel heard, respected, and supported throughout their recovery journey.

How do you address the emotional aspects of eating disorders in therapy? 

Eating disorders are rarely just about food. They often serve as coping mechanisms for underlying emotional pain, trauma, anxiety, depression, or a need for control. Our approach explores these deeper layers while teaching practical skills for emotional regulation, distress tolerance, and self-compassion. We address the whole person, not just the eating behaviors.

Will eating disorder therapy help me stop obsessing over food and calories? 

Our goal is to help you develop a more peaceful and flexible relationship with food and your body. Through therapy, you will learn to challenge obsessive thoughts, reduce rigid food rules, and build healthier coping strategies. While the process takes time and commitment, many clients experience significant relief from the constant mental preoccupation with food and calories.

How do I know if eating disorder therapy is right for me? 

If your relationship with food, eating, or your body causes you distress, interferes with your daily life, or affects your emotional wellbeing, therapy may be a helpful step. You do not need to have a formal diagnosis or be at a certain point in your struggle to seek support. We encourage you to reach out for a free 15-minute consultation to discuss your concerns and determine if our approach feels like a good fit for you.

Calm Blue Waters Counseling, led by Amy Castongia (NCC, LCMHC, LPC), is a mental health practice based in Huntersville, NC, providing exclusively online therapy to adolescents and adults. Serving clients across North Carolina, South Carolina, Florida, and Vermont, the practice specializes in treating eating disorders, body image issues, anxiety, and depression. Treatment plans are personalized using evidence-based modalities such as Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), and Mindfulness-Based Stress Reduction.