Eating disorder and body image therapy in Philadelphia

An Eating Disorder Is Never Only About Food

For some people the day is organized around eating or not eating: which foods are safe, what was already consumed, what must be earned or undone. For others it is the cycle of restraint and loss of control, the secrecy afterward, the promise that tomorrow will be different. For others still there is no diagnosable disorder at all, just a running commentary about their body that never shuts off, a mental tax paid at every meal, every photo, every doctor’s appointment, every swim.

An estimated 9 percent of Americans, roughly 28.8 million people, will experience an eating disorder in their lifetime (Deloitte Access Economics and Harvard STRIPED, 2020), and eating disorders carry one of the highest mortality rates of any psychiatric condition. Yet most people who struggle never receive specialized care, often because the disorder itself insists they are not sick enough to deserve it.

You do not need to look a certain way to have an eating disorder. Most people with eating disorders never do. If your relationship with food or your body is taking up more of your life than it should, that is reason enough to start.

What the Symptom Is Protecting

At Turning Leaf Therapy, we practice from a relational psychodynamic foundation, and that changes how we understand eating disorders. Symptom-focused treatment asks what: what you are eating, what you are avoiding, which behaviors need to stop. Those questions matter, and we use structured, evidence-based tools to address them. But we also ask why. Why restriction, why now, what it solved when it began, what it is still doing for you.

An eating disorder almost always started as an adaptation. Control, when everything else was chaotic. Numbness, when feeling was unbearable. Achievement, in a family that graded bodies. Smallness, when taking up space felt dangerous. Where behavior-focused treatment changes the behavior, depth work understands what the behavior is protecting and provides the conditions for it to become unnecessary.

The research supports this frame. Trauma histories are dramatically overrepresented among people with eating disorders, and in a city where nearly 70 percent of adults report at least one adverse childhood experience (Philadelphia Urban ACE Study), a trauma-informed lens is not an add-on for this work. It is the context for most of it.

Eating Disorders We Treat

Anorexia Nervosa

Restriction of intake, intense fear of weight gain, and a self-worth fused to body size. Anorexia is often invisible to the person living with it; the disorder insists they are fine, or that they have not earned help yet. We also treat atypical anorexia, in which every psychological feature of anorexia is present in a body that is not underweight. It is just as serious, and just as deserving of treatment.

Bulimia Nervosa

Cycles of binge eating followed by compensatory behaviors, held together by shame and secrecy. Bulimia often hides inside outwardly high-functioning lives for years. The cycle is not a character flaw. It is a physiological and emotional loop, and it is treatable.

Binge Eating Disorder

The most common eating disorder in the United States, more prevalent than anorexia and bulimia combined, and the most misunderstood. Recurrent episodes of eating with a sense of loss of control, followed by distress, guilt, or self-punishment. Binge eating disorder is not a willpower problem. It is very often the predictable rebound of chronic restriction and dieting, tangled with emotion regulation and shame. Treating it means treating the whole cycle, not lecturing the binge.

ARFID

Avoidant/restrictive food intake disorder involves significant limits on eating that are not driven by body image: sensory sensitivity, fear of choking or vomiting, or little natural drive to eat. ARFID affects adults as well as children and is routinely mislabeled as picky eating long past the point where it is interfering with health, energy, and social life.

OSFED and Disordered Eating

Most people who reach out to us do not fit a textbook diagnosis. Chronic dieting that never ends. Food rules that keep multiplying. Clean eating that turned rigid. Exercise that functions as punishment or permission. Fear foods, body checking, mental math at every meal. Subclinical does not mean insignificant. Disordered eating deserves treatment before it becomes a disorder, not after.

Body Image Is Its Own Clinical Concern

Body image distress does not require an eating disorder to deserve care, and it rarely resolves on its own with time, weight change, or compliments.

We work with clients whose lives have quietly contracted around their bodies: avoiding photos, mirrors, intimacy, pools, reunions, and doctors. Clients caught in comparison loops that social media is engineered to feed. Clients navigating body change through postpartum recovery, illness, aging, menopause, or medical treatment. Clients for whom body image and gender identity are intertwined, where an affirming frame matters as much as a clinical one. And clients whose appearance preoccupation has crossed into obsessive territory, where we assess for body dysmorphic disorder and either treat it or connect you with the right specialized care.

Body dissatisfaction is one of the strongest known predictors of future eating disorder onset. Treating it early is not cosmetic. It is prevention.

How We Treat It: Depth Plus Structure

Most eating disorder treatment is manualized: a protocol, a workbook, a fixed number of sessions. Those tools have real evidence behind them, and we use them. At Turning Leaf, they are held inside a therapeutic relationship, not substituted for one. Your pattern with food and your body formed in relationship: to caregivers, to family food culture, to coaches and doctors and partners, to a culture that treats body size as a moral report card. It heals in relationship too. No meal log can do what a consistent, attuned, trustworthy relationship can do.

Within that relational foundation, our clinicians draw on:

• CBT and CBT-E (enhanced cognitive behavioral therapy for eating disorders), the leading evidence-based structure for interrupting the restriction and binge cycle and rebuilding regular, flexible eating.
• DBT skills for urges, emotion regulation, and distress tolerance, especially where bingeing or compensatory behaviors function as emotional escape.
• IFS (Internal Family Systems), particularly powerful for this work: the part of you that restricts or binges is not the enemy, it is a protector doing an outdated job.
• EMDR to reprocess the trauma that so often sits underneath the eating disorder.
• ACT and self-compassion approaches for body image flexibility, values-based living, and unhooking from the inner critic.
• Gradual, collaboratively paced exposure work for fear foods and body image avoidance, never forced.

Two commitments shape all of it. First, we are weight-inclusive: we treat your relationship with food and your body, not your body size. There are no weigh-ins in our therapy offices, no diets, and no moral language about food. Second, we work as a team. For active eating disorders, best-practice care involves coordination with your physician and, when appropriate, a registered dietitian. We collaborate with your existing providers or help you build that team. Clinicians on our team work in eating disorders and body image every week, meet the team.

Who We See

Adolescents (13 to 17) and adults. Women, men, and people of every gender. Roughly one in three people with an eating disorder is male, and men are dramatically underdiagnosed, in part because male presentations often center muscularity, supplement and training rigidity, and binge eating rather than the thinness-focused picture most screening was built around.

We bring particular depth to:

• LGBTQIA+ clients, who experience elevated rates of eating and body image concerns and for whom identity and body are often intertwined.
• Athletes, lifters, dancers, and performers, where sport culture, weight classes, and aesthetic demands can turn discipline into disorder.
• Pregnancy and postpartum, when body change, appetite change, and identity change collide.
• Higher-weight clients whose symptoms have been dismissed, or worse, prescribed. In one body, restriction is diagnosed. In another, it is congratulated. We know the difference.

Is Outpatient Therapy the Right Level of Care?

Honest answer: not always. Weekly outpatient therapy is the right fit when you are medically stable, safe, and able to work on change between sessions. Signs that a higher level of care (intensive outpatient, partial hospitalization, or residential treatment) may be the better starting point include medical concerns flagged by a physician, rapid physical changes, safety concerns, or behaviors that will not interrupt despite consistent outpatient work.

Eating Disorder Therapy in Old City Philadelphia

Turning Leaf Therapy is a group practice of licensed clinicians at 123 Chestnut Street, Suite 304, in Old City Philadelphia, steps from the 2nd Street Market-Frankford Line station. We see clients in person from Old City, Society Hill, Northern Liberties, Fishtown, Queen Village, Washington Square West, and across Center City, and by secure telehealth throughout Pennsylvania and New Jersey.

Most specialized eating disorder therapy in Philadelphia is out-of-network, waitlisted, or both. We are in-network with Aetna, BCBS, United, and Optum, and our intake coordinator personally matches you with a clinician within 1 to 2 business days.

Getting Started

Common Questions

Last updated July 2026.