Family-Based Treatment (FBT) for Eating Disorders

Overview

Family-based treatment (FBT) is a leading treatment approach for adolescent eating disorders, including anorexia nervosa, bulimia nervosa, and other specified feeding or eating disorders (OSFED). It is a structured treatment delivered by trained professionals, typically provided in outpatient settings. Some residential and partial hospitalization (PHP) programs may also incorporate FBT.

Research and Effectiveness

Research has consistently demonstrated FBT's effectiveness and speed compared to other treatments, making it a first-line approach for children, adolescents, and some young adults with eating disorders.

Key Principles

FBT differs from traditional treatments by viewing the eating disorder as an external force controlling the child, while acknowledging the strong bond between parents and children. This approach empowers parents to use their love and influence to help their child recover.

Phases of FBT

FBT typically consists of three phases:

Phase 1: Full Parental Control: - Parents take charge of meals, helping the child reestablish regular eating patterns by providing regular meals and snacks planned with the treatment team. - Parents help interrupt problematic behaviors like excessive exercise or purging. - The goal is to achieve weight gain and address malnutrition.

Phase 2: Gradual Return of Control to the Adolescent: - Once weight is restored, meals become smoother, and behaviors are more under control, control is gradually transitioned back to the adolescent in an age-appropriate manner. - Adolescents are encouraged to take on more responsibility for their eating and learn to make healthy choices.

Phase 3: Establishing Healthy Independence: - When the adolescent can eat independently and maintain healthy behaviors, the focus shifts to developing a healthy identity, addressing other developmental issues, and helping the family reorganize. The aim is to facilitate the adolescent's transition to independence and prevent relapse.

Advantages of FBT

FBT offers several advantages, including:

• Efficacy in overcoming anosognosia (lack of insight) commonly seen in adolescents with eating disorders.
• Assigns behavioral change and nutrition responsibility to parents, reducing the risk of medical complications.
• Cost-effective with demonstrated high recovery rates and sustained abstinence in teens.

Suitability of FBT

FBT is most effective for families with an illness duration of less than three years and an early positive response to treatment. However, it is essential to note that FBT is not suitable for every family. It is not recommended for families with physical or sexual abuse, substance abuse, or excessive criticism. In such cases, separated FBT, where the therapist meets only with parents, can be an alternative option.

Family Involvement

Families who have undergone FBT often express enthusiasm and gratitude for being an integral part of the solution in their child's recovery.