Family Based Treatment (FBT) is one of the most effective treatments for adolescents with anorexia nervosa and preliminary research also suggests that it may be helpful for adolescents with bulimia nervosa. We have written previously about what FBT involves and the insider experience from the child’s and parent’s perspective. Below we describe some indicators that FBT might not be the right fit – or the right fit right now – for your child or family, and provide some information on other options worth pursuing.
There are concerns about your child’s medical stability.
As part of the initial evaluation of an eating disorder, your child needs to be evaluated by a pediatrician, adolescent medicine specialist, or other primary care provider. The results of this medical workup will in part dictate what comes next; if your health care provider has concerns about medical stability, a medical hospitalization may be necessary prior to beginning FBT to help keep your child out of harm’s way.
During the medical workup, your clinician will check for the effects of inadequate nourishment. This includes checking height and weight, which is necessary to evaluate how your child is progressing on their growth curve. The medical provider will be assessing signs that your child’s body is in a starved state. This can include slowed heart rate, low blood pressure, low body temperature and other physical signs. Bloodwork will help evaluate signs of malnutrition, electrolyte imbalances that can occur if there is purging behavior, and changes in hormone levels. Additional assessment may be completed to assess heart or bone health.
There is no identified medical provider.
In this treatment, therapists and medical professionals work together closely to continuously assess risk, progress, and recommended targets for weight restoration.
Anorexia nervosa is a serious and complex eating disorder. Because people with this particular eating disorder are by definition at a weight that is below what’s recommended for optimal health, it is a diagnosis that carries with it a heightened risk of medical problems. Purging behaviors, which may be a part of clinical pictures for adolescents with anorexia or bulimia nervosa, also impact the body in potentially dangerous ways. For these reasons, it is essential that adolescents participating in FBT have an established medical provider who can follow them regularly to provide medical monitoring and collaborate with the FBT therapist.
Family participation in treatment – attending sessions and providing close, consistent mealtime supervision – is not feasible.
FBT requires teamwork, and anyone who is part of the fabric of your family’s daily rhythms – parents, grandparents, babysitters, siblings – is considered to be “on the team.” Multiple family members may be asked to regularly attend sessions. If parents or guardians live separately, the FBT therapist may ask them to come together to develop consistent strategies and goals for the patient at various points along the way. Firm and consistent parental involvement is an essential feature of the treatment.
Early in FBT, parental figures are charged with taking control of areas of life that may be impacted by the illness, specifically eating and exercise, and prepare, serve and supervise all meals and snacks. Often, supervision is required after meals to help your child manage whatever urges arise after the experience of eating. This may require taking time away from work, putting other familial needs/issues on hold, and forgoing other activities (such as family vacations or summer camp) in the early phases of treatment. This kind of sacrifice may not be doable for all families. It’s important to identify and discuss possible limitations of your circumstance when deciding on FBT. Possible alternatives include inpatient or residential treatment, or intensive outpatient options that offer nutrition adequate for renourishment and close, consistent supervision during and after meals. Individual CBT may be appropriate to complete weight restoration, help prevent relapse, or target the interruption of a binge-purge cycle.
There are safety concerns for your child at home.
If your child is experiencing escalating thoughts or behaviors about self-harm or suicide, then FBT may not be the appropriate place to start. Safety is paramount and takes precedence. In these cases, a structured treatment setting in which your child’s safety can be monitored while they do the hard work of recovering from an eating disorder is likely the most appropriate place to start. As the eating disorder symptoms stabilize and improve, treatment options can be reassessed.
The Bottom Line
FBT is one of the most useful treatments for adolescents with anorexia and bulimia nervosa, and there may be steps you can take to make it the right treatment for your family. There are also other treatments that can help, and the most important next step is any step which keeps your child make progress towards health.
Where else can I learn more about eating disorders treatment for adolescents and young adults?
- Maudsley Parents
- Families Empowered and Supporting Treatment of Eating Disorders (FEAST)
- National Eating Disorders Association
- Help Your Teenager Beat an Eating Disorder by James Lock & Daniel le Grange
- Eating Disorders: What Everyone Needs to Know by B. Timothy Walsh, Evelyn Attia, and Deborah R. Glasofer
- If Your Adolescent Has an Eating Disorder: An Essential Resource for Parents by B. Timothy Walsh and Deborah R. Glasofer
- When Your Teen Has an Eating Disorder: Practical Strategies to Help Your Teen Recover from Anorexia, Bulimia, and Binge Eating by Lauren Muhlheim, PsyD
- Decoding Anorexia by Carrie Arnold
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