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Family Based Therapy
Eating disorders are complex mental illnesses. Eating disorders not only have a big impact on someone’s emotional well-being, they are also one of the deadliest mental illnesses.
Eating disorders can impact people from all different walks of life. In fact, about 9% of the US population is believed to have an eating disorder in their lifetime . While anyone can develop one, these disorders tend to come about during adolescence and young adulthood.
Given how important it is for people with eating disorders to get effective treatment, certain treatment protocols have been developed. One treatment approach is called Family-Based Treatment (FBT), which is also known as the Maudsley approach. FBT is used for adolescents with anorexia.
Anorexia Nervosa is an eating disorder characterized by severe food restriction and intense fear of gaining weight. Anorexia is less common than bulimia or binge eating disorder, but it is deadlier. The signs and symptoms are:
Here are the signs and symptoms of anorexia:
- Extreme food restricting
- Extreme thinness
- Belief that they are overweight or fat despite being severely underweight
- Intense fear of gaining weight
- Self-esteem that is significantly linked with body shape or size
- Despite low body weight, continual desire to lose weight
- Inability to maintain a healthy weight 
FBT seeks to help restore healthy eating patterns in teens with anorexia. The next section of this post will go over what to expect in family-based treatment.
Family Therapy for Eating Disorders and What to Expect
FBT is different from other treatment methods because the teens’ family is heavily relied on and takes a lot of control during the treatment process. FBT is done in three phases. The three phases are:
Step One: Family Helps Restore the Child’s Weight
During this step, a FBT therapist or coach will guide a family on how to help their child restore weight. The coach or therapist may first observe a family to see their unique family dynamics.
From there, the FBT practitioner may give specific recommendations for the parents to regain control and set certain boundaries with their teen with a goal of getting them to eat. It’s important to note that the family takes back control from their teen with an attitude of compassion and support, rather than judgment.
Step Two: Returning Control Over Eating
At this point, families begin returning control back to their teen. For example, a teen may start having more choice over what they eat rather than the parents picking meals and snacks. Close monitoring is provided to check for disordered eating behaviors.
During this phase, the FBT clinician may start working with the family on unhelpful family dynamics that contributed to the eating disorder. For example, maybe a teen’s parents fight a lot and this creates stress within the house. A teen may use disordered eating behaviors to cope with the stress. During family therapy, this could be worked through.
Step Three: Creating a Healthy Adolescent Identity
Adolescence is a time when people start becoming way more independent from their parents. This can be complicated during eating disorder recovery because the normal need for independence must be balanced with support from family in order to reach recovery. Step three helps teens and their parents work through this process.
Benefits and Limitations of Family Therapy for Eating Disorders
Another benefit is that FBT doesn’t require a teen to go to residential or inpatient treatment. Family can stay with their loved one during the treatment process.
One limitation of this approach is that it’s not easily used in situations where someone needs a higher level-of-care, such as hospitalization or residential treatment. The next section will go over other challenges of this approach.
Challenges of Family Based Therapy for Anorexia Nervosa
Research shows that there are some challenges of FBT. These are:
- Time commitment required of therapists and families
- Lack of having a dietitian on the team
- FBT does not allow for treatment to be individualized for each family. There are strict protocols that must be followed. Similarly, depending on how severe someone’s anorexia is, they may require other treatment approaches 
Family Based Therapy for Bulimia Nervosa
While FBT was designed to treatment anorexia, it has also been adapted to treat bulimia. People with bulimia struggle with cycles of binging and purging.
Purging includes any behavior that is used to avoid the “consequences” of binging. Purging can include self-induced vomiting, laxative misuse, compulsive exercise, and fasting. The approach becomes tailored to stop the binge-purge cycle.
Who Can Benefit from Family Based Therapy Treatment?
Even though FBT may not work for every person in treatment, FBT is designed for children and adolescents with anorexia. The protocol has been expanded to support this same age group who is struggling with bulimia.
Citations National Association of Anorexia Nervosa and Associated Disorders. (n.d). Eating Disorder Statistics. Retrieved December 3rd, 2021 from https://anad.org/eating-disorders-statistics/  Rienecke, R.D. (2017). Family-based treatment of eating disorders in adolescents: Current insights. Adolescent Health, Medicine and Therapeutics, 8. 69-79.
Author: Samantha Bothwell, LMFT
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