Status: Strong Research Support

Description

Family-Based Treatment (FBT) for anorexia nervosa is an outpatient intervention for adolescents designed to restore weight without hospitalization; however, if a patient is medically unstable, a brief stay in an inpatient unit to resolve the medical concerns may be warranted, followed by a course of FBT. While there are many types of family therapy, FBT specifically refers to a treatment modality developed at the Maudsley Hospital in London, England or its adaptations. FBT is typically conducted in 20 sessions over 12 months, although a shorter course is sufficient for many cases while additional sessions may be necessary for others. FBT consists of three phases. In the first phase, parents are placed in charge of the process of nutritional rehabilitation and weight restoration with the help of the therapist. The adolescent’s autonomy in other domains (friendships, school) is kept intact, at a level consistent with the patient’s stage of development. In the second phase of treatment, once the acute starvation is reversed, control over eating is returned to the adolescent. The third phase of treatment addresses termination and issues of family structure and normal adolescent development. FBT views the parents of adolescents with anorexia nervosa as a resource for resolving the problem, and corrects misperceptions of blame directed to the parents and to the ill adolescent. Siblings play a supportive role in treatment, and are protected from the job assigned to the parents. The focus of FBT is not on what caused the anorexia nervosa, but on what can be done to treat it with as little reliance on hospitalization as possible.

 

Key References (in reverse chronological order)

  • Lock, J., Le Grange, D., Agras, S., Moye, A., Bryson, S.W., & Jo, B. (2010). Randomized clinical trial comparing family-based treatment with adolescent-focused individual therapy for adolescents with Anorexia Nervosa. Archives of General Psychiatry, 67, 1025-1032.
  • Eisler, I., Simic, M., Russell, G.F.M., & Dare, C. (2007). A randomized controlled treatment trial of two forms of family therapy in adolescent anorexia nervosa: A five year follow-up. Journal of Child Psychology and Psychiatry, 48(6), 552-560.
  • Lock J, Couturier J, Agras WS. (2006). Comparison of long term outcomes in adolescents with anorexia nervosa treated with family therapy. J Am Acad Child Adolesc Psychiatry 45: 666-672
  • Lock J, Agras WS, Bryson S, Kraemer HC. (2005). A comparison of short- and long- term family therapy for adolescent anorexia nervosa. J Am Acad Child Adolesc Psychiatry44: 632-639
  • Eisler I, Dare C, Hodes M, Russell GFM, Dodge E, Le Grange D. (2000). Family therapy for adolescent anorexia nervosa: The results of a controlled comparison of two family interventions. J Child Psychol Psychiatry 41: 727-736
  • Eisler I, Dare, C, Russell GFM, Szmukler GI, Le Grange D, Dodge E. (1997). Family and individual therapy in anorexia nervosa: A five-year follow-up. Arch Gen Psychiatry 54: 1025-1030
  • Russell GFM, Szmukler GI, Dare C, Eisler I (1987), An evaluation of family therapy in anorexia nervosa and bulimia nervosa. Arch Gen Psychiatry 44: 1047-1056
  • Full reference list

 

Clinical Resources

  • Lock J, Le Grange D, Agras WS, Dare C (2001), Treatment Manual for Anorexia Nervosa: A Family-Based Approach. New York: Guilford Press

 

Training Opportunities

  • Daniel Le Grange, PhD (The University of Chicago) at legrange@uchicago.edu
  • James Lock, MD, PhD (Stanford University) at jimlock@stanford.edu
  • Katharine L. Loeb, PhD (Fairleigh Dickinson University and Mount Sinai School of Medicine) at katharine.loeb@mssm.edu