Eating Disorders Program

Untreated eating disorders may lead to significant medical complications and can also be extremely difficult on teens and their families. At CHOC, we offer both inpatient and outpatient treatment as a part of our comprehensive eating disorder program that includes adolescent medicine doctors, mental health professionals and specialized nutritionists to care for our patients.

If you are experiencing a life-threatening emergency, call 911.
To reach the Crisis Text Line, text HOME to 741-741 or visit crisistextline.org.
To reach the National Suicide Prevention Lifeline, call 9-8-8 or visit suicidepreventionlifeline.org.

The CHOC Difference

Treating eating disorders in adolescents and young adults can be complex and often requires a team of caregivers. Through partnering with caregivers and patients, we support long-term recovery and prevention of early identification of medical complications associated with eating disorders.

• We treat adolescents struggling with eating disorders such as anorexia nervosa, bulimia nervosa and in some cases ARFID.
• Our specialists address the unique physical, emotional and social needs of eating disorder patients.
• We address the special nutritional needs of adolescents.
• We have a nurse care manager collaborates with community mental health services and school districts.

What is an eating disorder?

An eating disorder can include a complex relationship with food, or weight, or the experience of food. These are the 4 main types of eating disorders:

Anorexia nervosa

Anorexia nervosa (AN) involves restrictive eating, weight loss, or both. There’s no single weight that defines it. What matters is whether someone is at a low weight compared with their own growth history. In children and teens, it can also show up as not gaining weight as expected while growing, with no weight loss at all.

Those struggling with anorexia may fear gaining weight, base their self-worth heavily on their body shape or size, or eat in ways that keep them from getting enough. For example, someone might say they want to gain weight but often skip meals because they’re “too busy,” or cut out foods for no medical reason. Many also have trouble seeing how serious their symptoms are, even when doctors, coaches or parents raise concerns. Without treatment, anorexia can be dangerous and long-lasting.

Bulimia nervosa

Bulimia nervosa involves cycles of binge eating and purging. People use both words casually, but they have specific clinical meanings. A binge means eating far more food within about two hours than most people would in a similar situation. For a child or teen, that means comparing them with peers of the same age, activity level and growth pattern. Binges also come with a sense of losing control, as if you couldn’t stop even if you wanted to.

Purging covers any unhealthy behavior used to make up for eating or to prevent weight gain. That includes forcing yourself to vomit, misusing laxatives or diuretics, fasting, or exercising too much. It can also include smoking or misusing medications, even prescribed ones like stimulants or insulin, to suppress appetite. As with anorexia, people with bulimia often base their self-worth heavily on their body shape and weight, which can lead to deep shame and depression.

Avoidant Restrictive Food Intake Disorder (ARFID). 

Avoidant/restrictive food intake disorder (ARFID) is diagnosed when someone isn’t meeting their nutritional needs. Signs can include weight loss or not gaining weight as expected, slowed growth, nutritional deficiencies, or eating problems that get in the way of daily life.

Some people with ARFID are extremely picky eaters, which can result in significant nutrient deficiencies. This may be associated with how food feels, looks or tastes. Avoidance may also be due to fear of what might happen, like stomach pain, nausea, constipation or diarrhea, choking or vomiting. Unlike other eating disorders, ARFID doesn’t involve concerns about body image.

Binge-eating disorder

Binge eating disorder (BED) involves repeated binge eating episodes without the purging behaviors seen in bulimia. During a binge, someone might eat faster than usual, keep eating past the point of feeling uncomfortably full, eat when they aren’t hungry, or eat alone out of embarrassment. Afterward, they often feel very upset or disgusted with themselves. That distress is part of the diagnosis, so someone who eats large amounts but isn’t bothered by it wouldn’t meet the criteria for BED.

At this time, the CHOC Eating Disorders Program does not treat patients with binge-eating disorder; please talk to your child’s pediatrician about a referral to a psychologist, psychiatrist or weight management program. For more resources, visit nationaleatingdisorders.org and feast-ed.org.

How can I identify an eating disorder in my child?

There are several behaviors or key indicators you can observe in your child to evaluate whether or not they have an eating disorder or are showing signs of disordered eating. Common symptoms include:

• Preoccupation with weight, food, calories, body image, and/or dieting.
• Fluctuations in weight (both up and down).
• Refusing to eat certain foods or whole food categories (e.g., no carbohydrates, no dairy).
• Development of abnormal, secretive, extreme, or ritualized food or eating habits.
• Eating beyond the point of comfortable fullness.
• The disappearance of a large amount of food.
• Intense fear of weight gain.
• Loss of menstrual period in women.
• Extreme mood swings.
• Skipping meals or eating small portions.
• Frequent trips to the bathroom after meals.
• Abuse of laxatives, diet pills, or diuretics.
• Dizziness or fainting.
• Fear of eating after a scary experience with food (e.g., choking, vomiting).
• Excessive exercise.

Inpatient vs. Outpatient Treatments

Inpatient Care

When your child has medical issues due to an eating disorder, it is important to stabilize them as quickly and safely as possible. The Eating Disorder Medical Stabilization Program at CHOC at Mission Hospital provides inpatient care for children and adolescents with eating disorders such as anorexia nervosa, bulimia nervosa and avoidant restrictive food intake disorder (AFRID).

Our team will coordinate any required inpatient care through the outpatient program to ensure continued treatment and recovery.

Outpatient Care

The Eating Disorder Clinic at CHOC is a multidisciplinary outpatient program designed to help families identify and manage a variety of concerns related to nutrition and eating behaviors.

Eating disorders can be treated successfully, but the answer isn’t as simple as changing eating habits because eating disorders are about much more than food. No one-size-fits-all treatment is available for eating disorders. Rather, treatment is specifically tailored to each individual.

Treatment through the outpatient or inpatient program will be determined by the provider.