Family-based treatment for adolescent eating disorders

Eating disorders, including Anorexia Nervosa and Bulimia Nervosa, are affecting greater numbers of adolescents and even children and early intervention is critical. If not identified or treated early, eating disorders can become chronic and cause serious or even life-threatening medical problems. Anorexia Nervosa is the most dangerous, with the highest death rate, of any mental illness: between 5% and 20% of people who develop the disease eventually die from it.

Although eating disorders can be notoriously hard to treat, recent research studies have demonstrated some highly successful treatments. For adolescents with anorexia, the treatment of choice is Family-Based Treatment (FBT). It is also referred to as the Maudsley approach (after the hospital in the UK where it was first applied).

Traditionally, parents of children with anorexia were viewed by mental health professionals as intrusive and were instructed to place their children into individual treatment or residential treatment centers. FBT, in contrast, respects the powerful bond between parents and child and empowers the parents to use their love to help their child. It allows the adolescent to remain at home and enlists the support of the family as a resource in helping them battle their eating disorder. The entire family attends every treatment session.

FBT treatment first focuses on helping the child to return to a healthy weight because the more time spent in starvation, the worse the outcome. The parents take responsibility for providing adequate nutrition for their adolescent during family meals. The therapist supports the parents in this challenging task and also creates a climate where there is no blame: the eating disorder is an outside force that must be fought off by the entire family working together. In the second phase of treatment, the parents gradually give the child more control over her (or his) own eating. The final phase of treatment addresses issues of adolescent identity within the family context.

FBT offers a promising alternative to costly inpatient or day hospital programs. Research out of the University of Chicago and Stanford University shows that at the end of a course of FBT, two-thirds of adolescents with anorexia have recovered; 75% to 90% are weight-recovered at a five-year follow-up. This approach has also been successful with adolescents with bulimia and with college students with anorexia and is most effective for families in which the length of illness is less than three years.

In my clinical practice, I provide treatment based on the most recent scientific research available. I provide FBT to adolescents with eating disorders in a course that usually consists of 20 treatment sessions over 6 to 12 months. Family-based therapy is not appropriate for all families. It is rigorous and requires a strong commitment by the family members. However, I find that the partnerships with families who have this commitment to their child’s recovery are very rewarding to me as a therapist. Families who have used this approach are generally very enthusiastic and grateful to have been a part of the solution.

For more information about Maudsley Family-Based Treatment for adolescent eating disorders and/or to find a treatment professional visit:

Drs. Lock and Le Grange who brought this treatment to the U.S. have also written a manual for parents based on this approach:

Help Your Teenager Beat an Eating Disorder, by James Lock, MD, PhD and Daniel le Grange, PhD.

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