Eating disorders most often onset during adolescence and are associated with serious medical complications, psychiatric comorbidity, and psychosocial impairment. Anorexia nervosa (AN) is characterized by low body weight and restrictive eating patterns, while bulimia nervosa (BN) is characterized by episodes of binge eating alternating with compensatory behaviors, such as self-induced vomiting. Both disorders involve an over-valuation of weight and shape and distorted cognitions about food and appearance.
Family-based treatment (FBT) takes an agnostic view of the etiology of eating disorders, and sees families not as a cause of the disorder, but rather as a resource in helping the adolescent recover. FBT has been found to be more effective than individual therapy in helping adolescents with AN to gain weight, and follow-up studies have found that these gains are maintained after five years. The treatment consists of three phases.
In the first phase, parents are put in charge of their adolescent's weight restoration. With the therapist's guidance, parents choose what their adolescent will eat, when he or she will eat, and the amount to be eaten. Parents are encouraged to monitor all meals and snacks and limit physical activity. During the second phase, as the adolescent nears a healthy weight and the eating disorder-related cognitions have lessened, control over eating and physical activity is handed back to the adolescent to whatever extent is age-appropriate.
The third phase of treatment involves a review of the developmental tasks of adolescence and a discussion of ways parents can help the adolescent get back on track. FBT for BN is similar, but instead of putting parents in charge of weight restoration, parents take on the responsibility of helping their adolescent regulate disordered patterns of eating and reduce binge eating and associated compensatory behaviors.
Resources & Recommended Readings
Herzog, D. B., Franko, D. L., & Cable, P. (2008). Unlocking the Mysteries of Eating Disorders: A Life-Saving Guide to Your Child's Treatment and Recovery. New York: McGraw-Hill.
Le Grange, D., & Lock, J. (2007). Treating Bulimia in Adolescents: A Family-Based Approach. New York: Guilford Press.
Lock, J., & Le Grange, D. (2005). Help Your Teenager Beat an Eating Disorder. New York: Guilford Press.
Lock, J., Le Grange, D., Agras, W. S., & Dare, C. (2001). Treatment Manual for Anorexia Nervosa: A Family-Based Approach. New York: Guilford Press.