Family-Based Treatment (FBT) for Eating Disorders

Table of ContentsView AllTable of ContentsAlternative ApproachResearchFBT vs. Family TherapyPrinciples of FBTThree Phases of FBTAdvantages of FBTResearch on FBTFBT Is Not for Every Family

Table of ContentsView All

View All

Table of Contents

Alternative Approach

Research

FBT vs. Family Therapy

Principles of FBT

Three Phases of FBT

Advantages of FBT

Research on FBT

FBT Is Not for Every Family

Family-based treatment (FBT, also sometimes referred to as the Maudsley method) is a leading treatment for adolescent eating disorders includinganorexia nervosa,bulimia nervosa, and other specified feeding or eating disorder(OSFED).

While FBT may not be for every family, research shows that it is highly effective and faster to act than many other treatments.

It should therefore usually be considered as a first-line approach to treatment forchildren, adolescents, and some young adults with eating disorders.

The typical treatment instructed parents to step aside and turn their children with anorexia over to individual treatment or residential treatment centers—an approach we now know to have been, in many cases, detrimental to both the families and the patients.

Recent research has debunked the theory of parental causation of eating disorders, just as it has for schizophrenia and autism.

Genetic studies indicate that approximately 50% to 80% of a person’s risk of an eating disorder isdue to genetic factors.

The literature has rediscovered older starvation studies demonstrating that a number of characteristic behaviors of anorexia are actually the result of malnutrition that accompanies anorexia.

It is also believed that many clinicians made a basic selection bias error: observing the dynamics of families as they were seeking treatment, clinicians naturally saw families locked in a life-and-death struggle over food. This struggle is, however, a symptom of the disorder, not a cause—in the years preceding the eating disorder, their dynamics likely looked no different than other families.

Acknowledging that the weight of evidence had shifted, in 2010, the Academy for Eating Disorders published a position paper specifically refuting the idea that family factors are a primary mechanism in the development of an eating disorder. This is a positive shift because it has resulted in the greater inclusion of parents in treatment in general and greater acceptance of and demand for FBT.

FBT should not be confused with the similarly-named but potentially fundamentally different approaches under the umbrella of family therapy. Traditional family therapy often takes the view that the child with an eating disorder is expressing a family problem.

In the 1970s and early 1980s, the clinicians at the Maudsley Hospital in London, England, conceived a very different form of family therapy, treating parents as a resource, not a source of harm. The Maudsley team has continued to develop and teach the approach, which they do not refer to as the Maudsley approach, but as anorexia-focused family therapy.

Meanwhile Drs. Daniel Le Grange and James Lock further developed the model in a manual (published in 2002 and updated in 2013), naming their manualized version Family-Based Treatment (FBT).

The FBT approach is rooted in aspects of behavioral therapy, narrative therapy, and structural family therapy. Lock and Le Grange have established the Training Institute for Child and Adolescent Eating Disorders, an organization that trains therapists in this treatment and maintains a list of certified therapists and therapists in training.

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.

Anorexia Nervosa Recovery: Meal Plans to Restore Nutritional Health

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.

FBT has three phases:

Brain starvationcan causeanosognosia, 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.

Because it tends to work faster than other treatments, FBT reduces medical repercussions and increases the chances of a complete recovery. It allows the child to remain at home with their parents and is often more cost-effective thanresidential treatment.

Research has shown that adolescents who receive FBT recover at higher rates than adolescents who receive individual therapy:

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.

FBT may not be recommended for families in which the parents are overly critical.

A Word From Verywell

The above exceptions represent only a minority of cases. Families who have used this approach are generally very enthusiastic and grateful to have been a part of the solution. Helping to play an active role in your child’s recovery can be a very rewarding experience.

9 SourcesVerywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Jewell T, Blessitt E, Stewart C, Simic M, Eisler I.Family Therapy for Child and Adolescent Eating Disorders: A Critical Review.Fam Process.2016;55(3):577-594. doi:10.1111/famp.12242Treasure J, Cardi V.Anorexia Nervosa, Theory and Treatment: Where Are We 35 Years on from Hilde Bruch’s Foundation Lecture?.Eur Eat Disord Rev.2017;25(3):139-147. doi:10.1002/erv.2511Le Grange D, Lock J, Loeb K, Nicholls D.Academy for Eating Disorders Position Paper: The role of the family in eating disorders.Int J Eat Disord.2010;43(1):1-5. doi:10.1002/eat.20751Lock J, Le Grange D.Can family-based treatment of anorexia nervosa be manualized?.J Psychother Pract Res. 2001;10(4):253–261.Training Institute for Child and Adolescent Eating Disorders.Mission. Upcoming Workshops.San Francisco: Training Institute for Child and Adolescent Eating Disorders 2020 http://train2treat4ed.comEpstein LH, Paluch RA, Wrotniak BH, et al.Cost-effectiveness of family-based group treatment for child and parental obesity.Child Obes. 2014;10(2):114-121. doi:1.1089/chi.2013.0123Lock J, Le Grange D, Agras WS, Moye A, Bryson SW, Jo B.Randomized clinical trial comparing family-based treatment with adolescent-focused individual therapy for adolescents with anorexia nervosa.Arch Gen Psychiatry. 2010;67(10):1025–1032. doi:10.1001/archgenpsychiatry.2010.128Le Grange DL, Lock J, Agras WS, Bryson SW, Jo B.Randomized Clinical Trial of Family-Based Treatment and Cognitive-Behavioral Therapy for Adolescent Bulimia Nervosa.Journal of the American Academy of Child and Adolescent Psychiatry.2015;54(11):886–894.e2. doi:10.1016/j.jaac.2015.08.008Timko CA, Zucker NL, Herbert JD, Rodriguez D, Merwin RM.An open trial of Acceptance-based Separated Family Treatment (ASFT) for adolescents with anorexia nervosa.Behav Res Ther.2015;69:63-74. doi:10.1016/j.brat.2015.03.011Additional ReadingDimitropoulos G, Lock J, LeGrange D, Anderson K. Chapter 11. Family therapy for transition youth. In: Loeb KL, ed.Family Therapy for Adolescent Eating and Weight Disorders: New Applications.New York and East Sussex, England: Routledge; 2015:230-256.Thornton LM, Mazzeo SE, Bulik CM.The Heritability of Eating Disorders: Methods and Current Findings.Current Topics in Behavioral Neurosciences. 2011;6:141–156. doi:10.1007/7854_2010_91

9 Sources

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Jewell T, Blessitt E, Stewart C, Simic M, Eisler I.Family Therapy for Child and Adolescent Eating Disorders: A Critical Review.Fam Process.2016;55(3):577-594. doi:10.1111/famp.12242Treasure J, Cardi V.Anorexia Nervosa, Theory and Treatment: Where Are We 35 Years on from Hilde Bruch’s Foundation Lecture?.Eur Eat Disord Rev.2017;25(3):139-147. doi:10.1002/erv.2511Le Grange D, Lock J, Loeb K, Nicholls D.Academy for Eating Disorders Position Paper: The role of the family in eating disorders.Int J Eat Disord.2010;43(1):1-5. doi:10.1002/eat.20751Lock J, Le Grange D.Can family-based treatment of anorexia nervosa be manualized?.J Psychother Pract Res. 2001;10(4):253–261.Training Institute for Child and Adolescent Eating Disorders.Mission. Upcoming Workshops.San Francisco: Training Institute for Child and Adolescent Eating Disorders 2020 http://train2treat4ed.comEpstein LH, Paluch RA, Wrotniak BH, et al.Cost-effectiveness of family-based group treatment for child and parental obesity.Child Obes. 2014;10(2):114-121. doi:1.1089/chi.2013.0123Lock J, Le Grange D, Agras WS, Moye A, Bryson SW, Jo B.Randomized clinical trial comparing family-based treatment with adolescent-focused individual therapy for adolescents with anorexia nervosa.Arch Gen Psychiatry. 2010;67(10):1025–1032. doi:10.1001/archgenpsychiatry.2010.128Le Grange DL, Lock J, Agras WS, Bryson SW, Jo B.Randomized Clinical Trial of Family-Based Treatment and Cognitive-Behavioral Therapy for Adolescent Bulimia Nervosa.Journal of the American Academy of Child and Adolescent Psychiatry.2015;54(11):886–894.e2. doi:10.1016/j.jaac.2015.08.008Timko CA, Zucker NL, Herbert JD, Rodriguez D, Merwin RM.An open trial of Acceptance-based Separated Family Treatment (ASFT) for adolescents with anorexia nervosa.Behav Res Ther.2015;69:63-74. doi:10.1016/j.brat.2015.03.011Additional ReadingDimitropoulos G, Lock J, LeGrange D, Anderson K. Chapter 11. Family therapy for transition youth. In: Loeb KL, ed.Family Therapy for Adolescent Eating and Weight Disorders: New Applications.New York and East Sussex, England: Routledge; 2015:230-256.Thornton LM, Mazzeo SE, Bulik CM.The Heritability of Eating Disorders: Methods and Current Findings.Current Topics in Behavioral Neurosciences. 2011;6:141–156. doi:10.1007/7854_2010_91

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Jewell T, Blessitt E, Stewart C, Simic M, Eisler I.Family Therapy for Child and Adolescent Eating Disorders: A Critical Review.Fam Process.2016;55(3):577-594. doi:10.1111/famp.12242Treasure J, Cardi V.Anorexia Nervosa, Theory and Treatment: Where Are We 35 Years on from Hilde Bruch’s Foundation Lecture?.Eur Eat Disord Rev.2017;25(3):139-147. doi:10.1002/erv.2511Le Grange D, Lock J, Loeb K, Nicholls D.Academy for Eating Disorders Position Paper: The role of the family in eating disorders.Int J Eat Disord.2010;43(1):1-5. doi:10.1002/eat.20751Lock J, Le Grange D.Can family-based treatment of anorexia nervosa be manualized?.J Psychother Pract Res. 2001;10(4):253–261.Training Institute for Child and Adolescent Eating Disorders.Mission. Upcoming Workshops.San Francisco: Training Institute for Child and Adolescent Eating Disorders 2020 http://train2treat4ed.comEpstein LH, Paluch RA, Wrotniak BH, et al.Cost-effectiveness of family-based group treatment for child and parental obesity.Child Obes. 2014;10(2):114-121. doi:1.1089/chi.2013.0123Lock J, Le Grange D, Agras WS, Moye A, Bryson SW, Jo B.Randomized clinical trial comparing family-based treatment with adolescent-focused individual therapy for adolescents with anorexia nervosa.Arch Gen Psychiatry. 2010;67(10):1025–1032. doi:10.1001/archgenpsychiatry.2010.128Le Grange DL, Lock J, Agras WS, Bryson SW, Jo B.Randomized Clinical Trial of Family-Based Treatment and Cognitive-Behavioral Therapy for Adolescent Bulimia Nervosa.Journal of the American Academy of Child and Adolescent Psychiatry.2015;54(11):886–894.e2. doi:10.1016/j.jaac.2015.08.008Timko CA, Zucker NL, Herbert JD, Rodriguez D, Merwin RM.An open trial of Acceptance-based Separated Family Treatment (ASFT) for adolescents with anorexia nervosa.Behav Res Ther.2015;69:63-74. doi:10.1016/j.brat.2015.03.011

Jewell T, Blessitt E, Stewart C, Simic M, Eisler I.Family Therapy for Child and Adolescent Eating Disorders: A Critical Review.Fam Process.2016;55(3):577-594. doi:10.1111/famp.12242

Treasure J, Cardi V.Anorexia Nervosa, Theory and Treatment: Where Are We 35 Years on from Hilde Bruch’s Foundation Lecture?.Eur Eat Disord Rev.2017;25(3):139-147. doi:10.1002/erv.2511

Le Grange D, Lock J, Loeb K, Nicholls D.Academy for Eating Disorders Position Paper: The role of the family in eating disorders.Int J Eat Disord.2010;43(1):1-5. doi:10.1002/eat.20751

Lock J, Le Grange D.Can family-based treatment of anorexia nervosa be manualized?.J Psychother Pract Res. 2001;10(4):253–261.

Training Institute for Child and Adolescent Eating Disorders.Mission. Upcoming Workshops.San Francisco: Training Institute for Child and Adolescent Eating Disorders 2020 http://train2treat4ed.com

Epstein LH, Paluch RA, Wrotniak BH, et al.Cost-effectiveness of family-based group treatment for child and parental obesity.Child Obes. 2014;10(2):114-121. doi:1.1089/chi.2013.0123

Lock J, Le Grange D, Agras WS, Moye A, Bryson SW, Jo B.Randomized clinical trial comparing family-based treatment with adolescent-focused individual therapy for adolescents with anorexia nervosa.Arch Gen Psychiatry. 2010;67(10):1025–1032. doi:10.1001/archgenpsychiatry.2010.128

Le Grange DL, Lock J, Agras WS, Bryson SW, Jo B.Randomized Clinical Trial of Family-Based Treatment and Cognitive-Behavioral Therapy for Adolescent Bulimia Nervosa.Journal of the American Academy of Child and Adolescent Psychiatry.2015;54(11):886–894.e2. doi:10.1016/j.jaac.2015.08.008

Timko CA, Zucker NL, Herbert JD, Rodriguez D, Merwin RM.An open trial of Acceptance-based Separated Family Treatment (ASFT) for adolescents with anorexia nervosa.Behav Res Ther.2015;69:63-74. doi:10.1016/j.brat.2015.03.011

Dimitropoulos G, Lock J, LeGrange D, Anderson K. Chapter 11. Family therapy for transition youth. In: Loeb KL, ed.Family Therapy for Adolescent Eating and Weight Disorders: New Applications.New York and East Sussex, England: Routledge; 2015:230-256.Thornton LM, Mazzeo SE, Bulik CM.The Heritability of Eating Disorders: Methods and Current Findings.Current Topics in Behavioral Neurosciences. 2011;6:141–156. doi:10.1007/7854_2010_91

Dimitropoulos G, Lock J, LeGrange D, Anderson K. Chapter 11. Family therapy for transition youth. In: Loeb KL, ed.Family Therapy for Adolescent Eating and Weight Disorders: New Applications.New York and East Sussex, England: Routledge; 2015:230-256.

Thornton LM, Mazzeo SE, Bulik CM.The Heritability of Eating Disorders: Methods and Current Findings.Current Topics in Behavioral Neurosciences. 2011;6:141–156. doi:10.1007/7854_2010_91

Meet Our Review Board

Share Feedback

Was this page helpful?Thanks for your feedback!What is your feedback?HelpfulReport an ErrorOtherSubmit

Was this page helpful?

Thanks for your feedback!

What is your feedback?HelpfulReport an ErrorOtherSubmit

What is your feedback?