Expert Telehealth Care for Eating Disorders in New York
Eating disorders affect an estimated 28.8 million Americans — approximately 9% of the population — at some point in their lives, according to the National Eating Disorders Association (NEDA). They affect people of all genders, ages, ethnicities, and body sizes, and they carry one of the highest mortality rates of any psychiatric condition. Despite their severity, eating disorders are among the most treatable mental health conditions when comprehensive care is accessed early.
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At Strong Enough Mental Health, Salvatore Marchica, PMHNP-BC, provides psychiatric evaluation, diagnosis, and medication management as part of a coordinated, compassionate treatment approach for eating disorders — available through telehealth for adolescents and adults across New York State.
What Are Eating Disorders?
Eating disorders are serious, complex psychiatric conditions characterized by persistent disturbances in eating behavior, thought patterns around food and weight, and perceptions of one's body. They are not lifestyle choices or phases — they are medical conditions with biological, psychological, and sociocultural components that require expert, multidisciplinary care.
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Eating disorders treated at Strong Enough Mental Health include:
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Anorexia Nervosa: Restriction of food intake leading to significantly low body weight, driven by intense fear of weight gain and distorted body image
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Bulimia Nervosa: Recurrent cycles of binge eating followed by compensatory behaviors — purging, excessive exercise, fasting, or laxative use
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Binge Eating Disorder (BED): Recurrent episodes of consuming large amounts of food in a short time with feelings of shame and loss of control, without compensatory behaviors
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Avoidant/Restrictive Food Intake Disorder (ARFID): Severely limited food intake not driven by weight concerns, often related to sensory sensitivities or fear of choking
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Other Specified Feeding or Eating Disorders (OSFED): Clinically significant eating disorder presentations that do not meet full criteria for the above disorders
What Are The Signs And Symptoms of Eating Disorders?
Behavioral Signs
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Severe restriction of food intake or frequent skipping of meals
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Recurrent episodes of eating unusually large amounts of food in a short period
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Evidence of purging behaviors — trips to the bathroom after meals, use of laxatives or diuretics
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Excessive or compulsive exercise, especially after eating
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Food rituals — cutting food into tiny pieces, rearranging food, refusing to eat with others
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Avoidance of eating in public or social situations involving food
Emotional and Cognitive Signs
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Intense preoccupation with food, calories, weight, or body shape
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Distorted body image — perceiving oneself as larger than one actually is
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Intense fear of weight gain or becoming fat
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Significant guilt, shame, or distress after eating
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Rigid all-or-nothing thinking around food — foods categorized as strictly 'good' or 'bad'
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Self-worth heavily tied to body image, weight, or appearance
Physical Signs
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Significant weight loss or unexplained weight fluctuations
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Fatigue, dizziness, or fainting
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Thinning hair or hair loss
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Dental erosion or swollen jaw (associated with purging)
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Gastrointestinal problems — bloating, constipation, acid reflux
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Menstrual irregularities or loss of period
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Electrolyte imbalances — which can cause dangerous cardiac complications
How Are Eating Disorders Diagnosed?
Eating disorders are diagnosed through a comprehensive clinical evaluation assessing eating behaviors, beliefs about food and body image, physical health, and psychological wellbeing. At Strong Enough Mental Health, Salvatore approaches this evaluation with sensitivity, patience, and zero judgment. Coordination with a primary care provider is often recommended to assess physical health parameters that require medical monitoring.
What Are Possible Treatments For Eating Disorders?
Medication for Eating Disorders
While therapy — particularly Family-Based Treatment (FBT) for younger patients and CBT-E for adults — is the primary treatment for most eating disorders, medications play an important supportive role, especially in treating co-occurring depression, anxiety, and OCD.
Selective Serotonin Reuptake Inhibitors (SSRIs)
SSRIs are the most commonly used medications in eating disorder treatment and have the strongest evidence for bulimia nervosa and binge eating disorder.
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Fluoxetine (Prozac) — The only FDA-approved medication for bulimia nervosa, at a higher dose (60mg) than typically used for depression. Also used for co-occurring depression and anxiety in anorexia.
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Sertraline (Zoloft) — Frequently used for co-occurring depression and anxiety
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Escitalopram (Lexapro)
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Note: SSRIs are not FDA-approved for anorexia nervosa, and their direct effectiveness on restrictive eating symptoms is limited. Their primary role in anorexia treatment is addressing co-occurring conditions.
Lisdexamfetamine (Vyvanse) — For Binge Eating Disorder
Lisdexamfetamine is the only FDA-approved medication specifically for moderate-to-severe Binge Eating Disorder (BED) in adults. It significantly reduces the frequency of binge episodes. As a stimulant, it is prescribed with careful evaluation of each patient's history and health profile.
Topiramate (Topamax)
Topiramate is used off-label for bulimia nervosa and binge eating disorder to reduce the frequency of binge and purge episodes. Requires monitoring for cognitive side effects including word-finding difficulties and slowed thinking.
Medications for Co-occurring Conditions
Many individuals with eating disorders also experience significant depression, anxiety, OCD, or trauma-related conditions. Treating these co-occurring conditions with appropriate medications can substantially support overall recovery. Every medication decision is individualized and made with full transparency.