Where Does Psychiatry Fit Into Eating Disorder Recovery?
For a long time, I thought problems around food fit into fairly neat boxes. There were people who had eating disorders, people who were dieting and people who didn’t really think about food very much at all.
The older I’ve got, and the more complicated my own relationship with food and weight has become, the more I’ve realised just how unrealistic those neat little boxes are.
I’ve written before about losing 10 stone, regaining weight and how, at one point, what looked from the outside like successful weight loss had become far too important to me. I was obsessed with the scales. I skipped meals. The number I saw when I weighed myself could influence how I felt about myself that day. Looking back, I see things very differently than I did at the time. Whilst I was referred to an eating disorder service, I have never seen psychiatry about it.
That’s one of the reasons I think conversations about eating disorders need to go much further than simply talking about food, weight or what somebody eats. There can be so much going on underneath, and sometimes even the person experiencing it doesn’t quite know where one problem ends, and another begins.
This is also where specialist psychiatry can come into eating disorder treatment. I think psychiatry is sometimes misunderstood as the part where somebody decides whether you need medication, when its role can actually be much broader than that. It can look at how you deal with food noise and what they can do to help.
What does an eating disorder psychiatrist actually do?
A psychiatrist is a medically trained doctor who specialises in mental health. Within eating disorder care, their job can involve looking at the bigger picture rather than concentrating on food or weight alone.
That might mean helping to establish exactly what somebody is experiencing and whether a particular diagnosis fits. It can also involve assessing psychological or medical risk, considering other mental health or neurodevelopmental conditions and looking at whether medication could be useful.
For somebody already receiving therapy or working with a dietitian, psychiatric input doesn’t necessarily replace any of that. Instead, it can add another piece to the puzzle.
The London Centre, for example, describes its psychiatry service as part of a wider psychology-led multidisciplinary approach. Its eating disorder psychiatrist service can be used for things such as diagnostic clarification, medication advice, assessment of co-occurring mental health difficulties and evaluating medical or psychological risk.
I think that distinction is important because “seeing a psychiatrist” can sound far more frightening or dramatic than it needs to. It doesn’t automatically mean that somebody is extremely unwell, that they’re going to be prescribed medication or that everything else they’ve been doing has failed.
Sometimes it simply means that another specialist needs to look at what is happening.
Eating disorders don’t always come neatly packaged
Mental health would probably be much easier to understand if everyone had one clearly defined condition with one obvious set of symptoms. Real people aren’t generally like that.
Someone struggling with an eating disorder may also be living with anxiety or depression. There can be obsessive or compulsive thoughts, previous trauma or difficulties around body image. ADHD and autism can also be relevant, as can other neurodevelopmental differences.
Sometimes symptoms overlap so much that it isn’t immediately obvious what is driving what.
Is somebody avoiding particular foods because of concerns around their body, for example, or could sensory difficulties be involved? Are obsessive thoughts entirely connected to the eating disorder, or could OCD also need exploring? Could ADHD be influencing impulsivity, routines or eating patterns?
Those aren’t questions I could answer about another person from reading about their symptoms online, and they’re exactly the sort of reason specialist assessment matters.
It isn’t about finding another label to attach to somebody. A diagnosis can be useful when it helps professionals and the person themselves understand what is happening and work out what support is most appropriate.
Psychiatry isn’t simply another word for medication
I think this is probably one of the biggest misconceptions. You can see why it happens. We tend to associate psychologists and therapists with talking and psychiatrists with prescribing tablets.
Psychiatrists can prescribe medication, but that doesn’t mean medication is automatically recommended. There isn’t one tablet that treats every eating disorder, either. Medication might sometimes be considered because somebody is also experiencing depression, anxiety, OCD or another condition. In other circumstances, it might not be appropriate at all.
The important part is that the decision is made after looking at the individual rather than assuming everyone with the same diagnosis needs the same thing.
Where medication is considered, there should also be a conversation about why it is being suggested, what it is expected to help with, possible side effects and how it fits with the rest of the person’s treatment. For many people, psychological therapy remains an important part of recovery.
Why different professionals can be involved in eating disorder treatment
When we talk about eating disorder treatment, it’s tempting to imagine one professional taking responsibility for everything. In reality, different people can bring very different expertise.
A psychologist or therapist might work with thoughts, emotions, behaviours and experiences. A dietitian can provide specialist nutritional support. An occupational therapist may help someone with routines, everyday activities and returning to parts of life that have been affected by illness.
A psychiatrist brings medical and psychiatric expertise to that team.
That combination can become particularly important when someone’s situation is complicated, because treatment needs to make sense as a whole rather than becoming a collection of separate appointments in which nobody quite knows what everyone else is doing.
It doesn’t necessarily mean attending endless appointments in London, either. Where psychological treatment forms part of someone’s care, services such as The London Centre can provide eating disorder therapy online.
For someone trying to manage treatment alongside work, university, school, caring responsibilities or family life, being able to access some support remotely could make a considerable difference. It can also widen the options for people who simply don’t live near a specialist service.
ADHD, autism and eating difficulties
This is another area I think we’re beginning to talk about much more openly. Eating isn’t purely about hunger.
Food involves texture, smell, routine, planning, remembering to eat, recognising body signals, impulse control, sensory experiences and emotions. When you think about all of those elements, it isn’t difficult to understand why neurodevelopmental differences can sometimes affect someone’s relationship with food.
That doesn’t mean having ADHD or being autistic causes an eating disorder, nor does it mean that every person with an eating disorder needs a neurodevelopmental assessment. It does mean it can be worth considering the possibility when there are signs that something else may be going on.
The London Centre also provides dedicated ADHD assessments for children aged five and over and for adults, with treatment and follow-up available where appropriate. In a person whose eating difficulties sit alongside possible ADHD, having clinicians who understand that overlap may help build a clearer overall picture.
What about young people moving into adult services?
Turning 18 doesn’t suddenly make somebody a completely different person. Yet healthcare can sometimes feel that way. I know with my son Ben and his autism and learning difficulties, when he turned 18, he suddenly changed from seeing a paediatrician every year to just being under the care of the GP. Many things change and it isn’t always for the better in my opinion.
The move between child and adult services can be difficult for young people and their families, particularly when they’re already dealing with a complicated mental health condition. Treatment approaches, professionals and expectations can change at a point when consistency may feel particularly important.
The London Centre’s Lead Eating Disorder Psychiatrist, Dr Christina Barras MBBS, MRCPsych, works across adolescent and adult presentations and has particular experience around this transition. Alongside her work at The London Centre, she is Clinical Lead for the Eating Disorders Service at Surrey and Borders NHS Foundation Trust.
At The London Centre, she sees young people aged 15 and over as well as adults, which may be useful for families looking for support that understands both sides of that transition.
When could a psychiatric assessment be worth considering?
You don’t necessarily need to wait until everything has reached crisis point before asking whether specialist psychiatric input could help. It might be something to consider if you’re unsure whether an existing diagnosis really explains what you’re experiencing, or if several different things seem to be happening at once.
Perhaps anxiety, depression or obsessive thoughts are becoming difficult to separate from eating difficulties. Maybe ADHD or autism has been suggested, and you’re wondering whether it changes how your difficulties should be understood. You might want advice about medication, or you may simply want somebody with specialist medical training to review the situation and help you understand the options.
Parents and partners can find themselves asking similar questions from the outside, especially when they can see that someone they love is struggling but don’t know what sort of professional they actually need.
Sometimes the next useful step isn’t immediately starting another treatment. It is working out what you’re dealing with.
Eating disorders are far more common than many of us realise
For years, the frequently quoted figure was that around 1.25 million people in the UK were living with an eating disorder.
More recent research suggests the real number could be considerably higher. In 2026, eating disorder charity Beat updated its estimate to around 3.5 million children, young people and adults in the UK, while acknowledging that estimating prevalence is difficult and the true number could be higher or lower. That number surprised me.
Perhaps part of the problem is that we still have a mental picture of what somebody with an eating disorder is supposed to look like.
Eating disorders aren’t restricted to young, very thin women. You can’t look at somebody’s body and know what is happening in their head, how they are eating or how much of their life is being controlled by thoughts about food. I think that matters particularly for anyone living in a larger body.
When so many conversations about larger bodies revolve around losing weight, it can be incredibly easy to praise behaviours because they’re producing weight loss without asking whether those behaviours are actually healthy for the person doing them.
That’s something I understand much better now than I did when I first started losing weight.
Recovery can involve more than one kind of support
There probably isn’t one perfect professional who can solve every part of an eating disorder, because eating disorders themselves aren’t that simple.
For some people, psychological therapy might form the largest part of treatment. Someone else may need considerable dietetic support. Others may benefit from psychiatric assessment, medication, occupational therapy or a combination of different approaches.
What matters is that those different pieces work together and that the person at the centre of it doesn’t become lost among them. If there’s one thing my own experiences with food and weight have taught me, it’s that what we eat is sometimes only the most visible part of a much bigger story.
Understanding why something is happening can be just as important as trying to change the behaviour you can see.
Frequently asked questions about eating disorder psychiatry
Is an eating disorder psychiatrist the same as a therapist?
No. A psychiatrist is a medically qualified doctor who has gone on to specialise in mental health, whereas therapists and psychologists have different training and roles. Within eating disorder treatment, they can work alongside each other rather than one replacing the other.
A psychiatrist may help with diagnosis, assess mental and physical health risks, look at other conditions that could be affecting someone and discuss whether medication has a role. Psychological therapy is more likely to focus on thoughts, emotions and behaviours and helping someone work towards recovery over time.
Is eating disorder psychiatry only about medication?
This is probably one of the biggest misconceptions about seeing a psychiatrist. Medication can be part of psychiatric care, but it isn’t the only reason someone might see an eating disorder psychiatrist and it won’t necessarily be recommended.
Psychiatric input can also help when a diagnosis isn’t clear, when there are concerns about risk or when other mental health conditions may be involved. If medication is suggested, it would usually be considered as one part of someone’s wider treatment rather than a replacement for psychological therapy and other support.
Do you need to be underweight to see an eating disorder psychiatrist?
No. You can’t tell whether somebody has an eating disorder, or how much they’re struggling, simply by looking at their weight.
This is something I think is particularly important to talk about because behaviours that would cause concern in a thinner person can sometimes be praised as “successful weight loss” when they’re happening to somebody in a larger body. NICE guidance also says that a single measure such as BMI shouldn’t be used to decide whether somebody should receive treatment for an eating disorder.
If you’re worried about your relationship with food, eating or your body, you don’t have to wait until you look a certain way before asking for help.
Can you have ADHD and an eating disorder?
Yes. ADHD and eating disorders can occur together, although having ADHD certainly doesn’t mean that someone will develop an eating disorder.
Things such as impulsivity, difficulties with routines, remembering to eat, recognising hunger cues and managing emotions can potentially make someone’s relationship with food more complicated. If ADHD is suspected alongside eating difficulties, a proper assessment can help professionals understand what’s happening rather than assuming every symptom has the same cause.
Can you have anxiety, depression or OCD as well as an eating disorder?
Yes, and this is one of the reasons eating disorder treatment sometimes involves several different professionals. Someone might experience anxiety, depression, OCD, trauma-related difficulties or other mental health problems alongside their eating disorder.
Symptoms can overlap, too, which can make things confusing for the person experiencing them. Specialist psychiatric assessment can help identify what might be happening and consider how the different difficulties should be treated together.
Can eating disorder therapy be done online?
Some psychological eating disorder treatment can be provided remotely, although whether online therapy is suitable will depend on the individual, their circumstances, their level of risk and the treatment they need.
For people who are suitable for remote treatment, online appointments can make ongoing therapy easier to fit around work, education or family commitments. They can also make specialist support more accessible when someone doesn’t live close to an appropriate service.
When should I ask for help with eating difficulties?
You don’t have to wait until your relationship with food has reached a particular level of severity before talking to someone.
If thoughts about food, eating, exercise, weight or your body are taking up a lot of your day, affecting your mental health or changing the way you live your life, it’s worth speaking to your GP or another appropriate healthcare professional. The same applies if you’re worried about someone close to you.
If there are signs of immediate physical danger or a mental health crisis, however, it’s important to seek urgent medical help rather than waiting for a routine eating disorder assessment.
