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Therapy for Eating Disorders in St. Louis

We can help you build fulfilling relationships with food, exercise, and your body.

What are eating disorders?


Eating disorders are a group of mental health conditions that involve an unhealthy relationship with food or eating. Common symptoms of eating disorders include restricting the amount or type of food or drink someone consumes, consuming very large quantities of food or drink in a short period of time, and “purging” or “compensatory” behaviors, such as vomiting, exercise, or laxative abuse. 


However, eating disorders are about more than just food. For example, many individuals with eating disorders also struggle with related issues, such as body image concerns and compulsive exercise. Many folks with eating disorders also have other mental health concerns, such as anxiety, depression, trauma, and addiction. 


Eating disorder behaviors often have very big impacts on our physical health as well as mental health. Because of this, people with eating disorders are at a higher risk of disease and death than individuals with most other mental health conditions. This also means that eating disorder treatment often involves a team approach, with therapists collaborating with other healthcare providers–such as psychiatrists, dieticians, and medical doctors–to support clients in recovery.

Does your relationship with food or exercise
seem to run your life? 


  • Anxious about attending holiday dinners, family meals, or dinners with friends.

  • Overwhelmed from constantly thinking about the calories and nutrients in the food that you eat.

  • Guilty about the amount or type of food that you eat.

  • Disconnected from friends or family because you don’t want them to worry about your wellbeing.

  • Afraid of not measuring up to other people’s expectations.

  • Exhausted from hiding your eating or exercise behaviors from your loved ones.

  • Conflicted about whether or not your relationship with food is healthy.

  • Hopeless that you will ever be able to recover and find happiness.


Woman looks down at son while holding a plate of food and glass of wine

Food is a big part of how humans connect to one another. From celebrating birthdays or holidays with a family meal, to meeting someone for a first date over dinner and a movie, eating together is a huge part of how we form and maintain relationships with the people in our lives. Food, like connection, is a basic need that all humans share. 


For many of us, food is about more than just nourishing our bodies. It can also be a way that we show others we care for them. When someone makes us soup when we are feeling sick, or brings us a home cooked meal when we are grieving, they aren’t just bringing us food to eat. Often, they are telling us, “I’m here for you.”


But for those of us who struggle with eating disorders or disordered eating, sharing a meal with a loved one may bring more anxiety than comfort. We may begin to avoid eating with others, and we may end up pushing away those closest to us. As a result we can feel incredibly lonely, and cut off from support, care, and love.


At Healing Exchange, we are committed to providing treatment that affirms the diverse identities and experiences of our clients. While depictions of people with eating disorders in movies, TV shows, and social media almost always focus on young, thin, white women, we know that eating disorders impact people of all identities. 


Often, those of us who don’t match the stereotypical image of a person with an eating disorder, struggle to have our stories believed and taken seriously. And as a result, we often don’t receive the care that we both deserve and desperately need.


People with marginalized identities are often unseen and unsupported by the eating disorder treatment industry. At Healing Exchange we believe that working against systemic oppression is a key element of eating disorder care. We utilize a fat-positive, weight-inclusive approach to care, which is informed by health at every size (HAES) and intuitive eating principles. As providers, we strive to confront our own biases and create a space for clients that is inclusive, accessible, and trauma-informed.

Did you know… 

(stats taken from ANAD website)


  • Less than 6% of people with eating disorders are underweight, and people at a higher weight are more likely to develop eating disorders during their lifetime, yet people in larger bodies are half as likely to be diagnosed with an eating disorder as those in smaller bodies.

  • Despite having similar–or in some cases even higher–rates of disordered eating compared to their white counterparts, BIPOC are significantly less likely to be assessed for, diagnosed with, or treated for eating disorders.

  • LGBTQ people are at a much higher risk for developing eating disorders than straight, cisgender folks. This is especially true for trans and nonbinary folks, who often have very high rates of body image concerns and disordered eating.

  • Neurodivergence, including autism and ADHD, are very common among folks with eating disorders.

stressed man looks down with a hand on his head. a loved one reached out with a hand on his shoulder


When it comes to treating eating disorders, it can be easy to get caught up trying to treat symptoms, and never get to the underlying cause. For many people with eating disorders, the underlying cause is trauma.

When we do not feel safe in our homes, our bodies, or the world in general, we may change our relationship to food in order to try to keep ourselves safe. For example, if we struggle to regulate our emotions, we may turn to food to soothe feelings of fear, anger, or sadness. Or if we have experienced violence or discrimination based on our appearance, we may use food to change our body shape or size, to try to protect ourselves from future harm.

Because trauma and PTSD are so common among individuals with eating disorders, treating eating disorders often involves helping clients process painful and traumatic life experiences. If we can find a sense of safety in our bodies and our lives, this makes it easier for us to stop using disordered eating to cope with painful emotions.


client sits on a couch across from a therapist

Internal Family Systems Therapy (IFS)​

Trauma-Informed Expressive Arts Therapy​

​Somatic Therapy

​Cognitive Behavioral Therapy (CBT)​

Drama Therapy and Psychodrama

Clinicians Specializing in Eating Disorders and Disordered Eating

River Chew, trauma and eating disorder therapist

River Chew (they/them)


River is a Licensed Master Social Worker and Expressive Arts Therapist in training, who specializes in treating trauma and eating disorders. River has experience in the field of eating disorders both as a client and a therapist, and they enjoy bringing their own experience in recovery from an eating disorder into their work with clients. 

River’s specific areas of focus within the eating disorder field include:

  • Working with clients who struggle with their relationship to their bodies, including folks who have experienced body-focused discrimination, folks who are dealing with body-grief related to chronic illnesses, pain, and/or disabilities, and transgender clients who struggle with both gender dysphoria and body dysmorphia. 

  • Working with clients who struggle with “symptom swapping,” meaning that they may attempt to stop using one eating disorder behavior, and find that another behavior comes up in its place. 

  • Working with folks who have co-occurring diagnoses with eating disorders, including folks who also struggle with substance use concerns, PTSD and complex PTSD, ADHD, autism, or anxiety.


What if I’m not sure if I really have an eating disorder? How do I know if things are bad enough to work with a therapist?

It is very common for folks struggling with eating disorders–and with mental health concerns generally–to believe that their symptoms aren’t “bad enough” to seek help. The truth is that if you are feeling unhappy, scared, or concerned, it is a good idea to reach out. Talking to a therapist can help you feel less alone, and help you learn what support would be helpful for you and your unique situation. 

When it comes to eating disorders, early intervention is incredibly important. Often, the longer we wait to get help, the more difficult the recovery process is. By reaching out for support early, you may be avoiding significant pain, distress, or medical complications associated with living with an eating disorder over the long term. 

Can someone have an eating disorder if they are not underweight?

Yes! In fact, the majority of people with eating disorders are not underweight. Many eating disorders do not involve food restriction, and even among folks who do struggle with food restriction, being underweight is not the norm. While many therapists used to consider a client’s weight to be an indicator of the severity of an eating disorder, many eating disorder care providers now understand that weight does not determine severity.

Malnutrition can cause severe health issues, whether or not it leads to weight loss. Other eating disorder behaviors, such as purging and compulsive exercise, can also lead to significant health issues, such as injuries and cardiac concerns. Additionally, eating disorder behaviors can have a huge impact on our mental health, leading to fear, anxiety, depression, brain fog, and difficulty regulating our emotions. You deserve care and support for these concerns, regardless of your body size or shape.

If I open up about my eating disorder behaviors, will you make me go to a treatment center?

As social workers, one of our ethical obligations is to support the right of all of our clients to make their own decisions, and determine what is right for them. This includes the choice to pursue outpatient treatment, or look for support at a higher level of care, such as residential or inpatient treatment.

While there are occasional circumstances where therapists cannot ethically continue working with a client at an outpatient level of care, and where we might have to discontinue treatment if a client is not willing to seek residential or inpatient treatment, we approach these situations very seriously. We will never coerce or guilt you into seeking out treatment at a higher level of care. Our job as therapists is to empower you to make your own choices, not to make them for you.

What if I’m not ready to let go of my eating disorder, but I still need support from a therapist?

At Healing Exchange, we believe in respecting your right to make choices about your body, your healthcare, and your life. This means that we do not turn away clients just because they are not ready to let go of the eating disorder.

We are dedicated to working from a harm-reduction perspective. This means that we can support you in reducing the danger and risk associated with eating disorder behaviors, reducing the frequency of behaviors, and learning additional approaches to coping, whether or not you are ready to stop using eating disorder behaviors altogether.

I have an eating disorder, but I don’t have trauma or PTSD. Can I still work with you for therapy?

Yes! While the majority of clients with eating disorders have experienced trauma in their lifetime, there are some folks who develop eating disorders who have not experienced trauma. We have the skills and training to support you in reconnecting to your body, unlearning harmful messages about food and eating, and learning adaptive ways to regulate your emotions, whether or not you have experienced trauma.

What is the difference between “an eating disorder” and “disordered eating”?

Eating disorders are specific diagnoses, such as anorexia, bulimia, avoidant restrictive food intake disorder (ARFID), and binge eating disorder. Each disorder is associated with a group of symptoms or criteria, which someone has to meet in order to receive a diagnosis.

Disordered eating is not a diagnosis. Instead, it refers to any behavior related to food or eating that is maladaptive or harmful to a person’s physical body or mental health. Disordered eating is common among people who have mental health diagnoses other than eating disorders. For example, some mental health conditions, like anxiety, depression, or ADHD, can impact our appetite, or make preparing food difficult. 

Whether you are struggling with an eating disorder or disordered eating, we are happy to support you in building a healthy and fulfilling relationship with food.

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