Given the robust evidence supporting Family Based Treatment (FBT) as superior to other approaches to treating eating disorders in children, youth, and transition age youth, I offer FBT as the first line approach.
Typically, the eating disorder starts and goes unnoticed for some time while the sufferer becomes malnourished and more entrenched in eating disorder behaviours, thoughts, and emotions.
Once the eating disorder is identified the treatment process can begin.
Treatment will involve the family joining the young person in efforts to fight the eating disorder. This is in part due to the immense difficulty individuals have recovering from an eating disorder on their own. In addition, the ego-syntonic nature of eating disorders makes it difficult for sufferers to be fully committed to recovery in the early stages. This is where caregivers can bridge the gap.
FBT is a phased treatment.
Phase 1: Initially treatment will focus on reversing malnourishment and may involve weight restoration, normalization of eating, and cessation of purging behaviours. Caregivers will be responsible for weight restoration and symptoms interruption during Phase 1 of FBT treatment.
An eating disorder specific medical assessment and frequent monitoring is recommended throughout treatment.
Phase 2: Once physical health is restored and there is indication that the ED thoughts and emotions have reduced, developmentally appropriate control will be returned slowly and methodically to the young person. Return to movement and other life activities will be a focus of this phase as well.
Phase 3: Once the young person is no longer needing support to engage in recovery behaviours the focus will shift to improving overall mental health. This phase will have a focus on returning the young person and family to developmentally normal functioning without using the ED to cope. Themes include body image, emotional regulation, and interpersonal skills. In addition, options for support with other mental heath conditions is discussed.
It is worth noting that there is evidence supporting Parent-Focused Therapy (PFT), meaning FBT with only parents attending counselling session, is equal, and in some cases more effective than family sessions.
Full recovery from an eating disorder is possible! We can hold so much hope that with the help of family members young people can go on to live a full and thriving life free from an eating disorder!
