Family Based Treatment For Eating Disorder

Family-Based Treatment (FBT) for Eating Disorders
Family-based treatment (FBT, also sometimes referred to as the Maudsley method) is a leading treatment
for adolescent eating disorders including anorexia nervosa, bulimia nervosa, and other specified feeding or
eating disorder (OSFED).
It is a manualized treatment delivered by trained professionals. It is primarily delivered in outpatient

settings, although there are some residential and partial hospitalization (PHP) programs that incorporate
FBT.
It should therefore usually be considered as a first-line approach to treatment for children, adolescents,
and some young adults with eating disorders.
Principles of FBT
FBT takes an agnostic view of the eating disorder, meaning therapists do not try to analyze why the eating
disorder developed. FBT does not blame families for the disorder. On the contrary, it presumes the
powerful bond between parents and children and empowers the parents to use their love to help their
child.
In FBT, parents are viewed as experts on their child, an essential part of the solution, and members of the
treatment team.
In FBT, the eating disorder is viewed as an external force that is possessing the child. Parents are asked to
join with the healthy part of the child against the eating disorder which is threatening to take their child
away. Full nutrition is viewed as a critical first step in recovery; the role of parents is to provide this
nutrition by actively feeding their child.
FBT sessions usually involve the entire family and include at least one family meal in the therapist’s office.
This gives the therapist an opportunity to observe the behaviors of different family members during a meal
and to coach the parents to help their child eat.
Three Phases of FBT
Phase 1: Full parental control.
Parents are usually in complete charge of meals as they help their child to reestablish regular
patterns of eating and interrupt problematic eating disorder behaviors such as bingeing, purging, and
overexercise. If weight gain is indicated, the goal is 1 to 2 pounds per week.
Phase 2: A gradual return of control to the adolescent.
This phase typically begins once weight is mostly restored, when meals are going more smoothly,
and when behaviors are more under control. Control is gradually handed back to the adolescent in an age-
appropriate manner.
Phase 3: Establishing healthy independence.
When the adolescent is able to eat with an age-appropriate level of independence and does not
exhibit eating disorder behaviors, the focus of treatment shifts to helping them develop a healthy identity
and catch up on other developmental issues. Other comorbid problems may be addressed.
Advantages of FBT
Brain starvation can cause anosognosia, a lack of awareness that one is ill. As a result, there can be a long
time lag before the minds of adolescents in recovery are capable of the motivation or insight to maintain
their own recovery.
FBT assigns the work of behavioral change and full nutrition to the parents and gives them skills and
coaching to meet these goals. As a result, it helps the child to recover even before they have the capacity
to do so on their own.
Research on FBT
Research has shown that adolescents who receive FBT recover at higher rates than adolescents who
receive individual therapy:
 A study out of the University of Chicago and Stanford 7 shows that at the end of a course of FBT,
two-thirds of adolescents with anorexia nervosa have recovered; 75 percent to 90 percent are
weight-recovered at a five-year follow-up.
 A recent study compared FBT for bulimia nervosa with CBT for bulimia nervosa. The findings
indicated that FBT led to faster and sustained abstinence rates for teens.
 Preliminary research and case studies also indicate that FBT is an acceptable approach for young
adults.
FBT Is Not for Every Family
Parents often believe that FBT will not work for them. “My child is too old.” “My child is too independent.”
“I’m not strong enough.” “We are too busy.” Yet none of these issues have shown to necessarily be a
barrier for a successful FBT treatment execution. Research and clinical experience demonstrate that many
diverse families are able to successfully implement FBT.
However, it is not for every family. It is rigorous and requires a strong commitment by the family members.
It is not recommended for families in which the parents are physically or sexually abusive or are abusing
substances.
FBT may not be recommended for families in which the parents are overly critical.
For families where parents tend to be critical, a variation of FBT, called separated FBT, can be a great
option.

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Family Based Treatment For Eating Disorder

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Family-Based Treatment (FBT) for Eating Disorders

It is a manualized treatment delivered by trained professionals. It is primarily delivered in outpatient

Phase 1: Full parental control.

FBT Is Not for Every Family

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