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Empowering Families: The Key to Effective Treatment for Adolescent Eating Disorders

The Family-Based Treatment (FBT), also known as the Maudsley method, is a well-established and highly effective approach for treating adolescent eating disorders such as anorexia nervosa, bulimia nervosa, and other specified feeding or eating disorders (OSFED). In this article, we will explore the concept of FBT and its effectiveness as a first-line approach for adolescents with eating disorders.

Additionally, we will debunk certain parental blame theories and discuss the weight of evidence in support of FBT.

Family-Based Treatment (FBT)

The Effective Approach of FBT

Family-Based Treatment (FBT) is a manualized treatment that involves trained professionals working with the families of adolescents with eating disorders. It typically takes place in outpatient settings, although it can also be utilized in residential programs or partial hospitalization.

FBT has been proven to be highly effective, making it the first-line approach recommended by leading experts in the field. One of the key principles of FBT is that parents are seen as valuable allies in the treatment process.

The focus is on empowering parents to take charge and assist their child in recovering from the eating disorder. Through targeted guidance and support, parents learn skills to effectively manage their child’s eating behaviors and gradually transfer control back to the adolescent.

The Effectiveness of FBT as a First-Line Approach

Numerous studies have shown the effectiveness of FBT as a first-line treatment for adolescent eating disorders. For example, a meta-analysis of 10 studies found that FBT led to higher rates of full remission and faster rates of weight restoration compared to individual therapy.

These positive outcomes were observed across various settings, including outpatient, inpatient, and day-hospital programs. The manualized nature of FBT ensures that trained professionals can deliver the treatment consistently, regardless of the treatment setting.

This allows for a streamlined and evidence-based approach to be implemented, increasing the likelihood of positive outcomes. FBT has been shown to have comparable effectiveness to other treatment modalities, such as cognitive-behavioral therapy (CBT), but with the added advantage of involving the family system in the recovery process.

Debunking Parental Blame Theories and Highlighting Parental Inclusion

Alternative Approach: Debunking Parental Causation Theories

In the past, some theories suggested that parents were to blame for their child’s eating disorder. However, over time, research has debunked these theories and highlighted the complex interplay of genetic factors, societal influences, and individual vulnerabilities.

It is crucial to overcome the notion of parental blame and instead focus on understanding the multifactorial nature of eating disorders, which involves more than just parental factors.

The Weight of Evidence in Favor of FBT

The weight of evidence supports the inclusion of parents in the treatment process for adolescent eating disorders. Numerous studies and position papers have endorsed the importance of parental involvement in promoting positive treatment outcomes.

For example, a position paper by the Society for Adolescent Health and Medicine stresses that excluding caregivers from treatment may result in suboptimal outcomes and therefore emphasizes the inclusion of families, particularly parents, in the recovery journey. Additionally, studies on starvation experiments emphasize the role of familial dynamics in the development and maintenance of eating disorders.

They highlight the need for early intervention and support in the form of FBT, which addresses both the individual and familial factors contributing to the illness.


In conclusion, Family-Based Treatment (FBT) is a highly effective and well-supported approach for treating adolescent eating disorders. It empowers parents and involves them as essential allies in their child’s recovery.

By overcoming parental blame theories and emphasizing the weight of evidence supporting the inclusion of parents in treatment, we can improve outcomes and provide the best care for adolescents with eating disorders. FBT’s manualized nature, trained professional involvement, and positive research findings make it a first-line approach for addressing these challenging conditions.

FBT vs. Family Therapy: Understanding the Differences

FBT vs.

Traditional Family Therapy

When discussing family-based treatment (FBT), it is important to differentiate it from traditional family therapy. While both approaches involve the family, they differ in their focus and goals.

Traditional family therapy aims to address broader family issues and improve family dynamics, while FBT focuses specifically on treating adolescent eating disorders. In traditional family therapy, the identified problem may be a family dysfunction or conflict unrelated to the eating disorder.

This approach may not directly target the eating disorder symptoms or provide the specialized techniques necessary for its successful treatment. On the other hand, FBT adopts a more targeted and structured approach, specifically tailoring interventions to address the eating disorder behaviors.

The Academy for Eating Disorders (AED) emphasizes the distinction between FBT and traditional family therapy in their position paper. They stress that FBT is the gold standard treatment for adolescents with eating disorders and caution against confusing it with other family-focused interventions that are not specifically designed for this population.

The Role of the Maudsley Hospital and the Training Institute for Child and Adolescent Eating Disorders

The Maudsley Hospital, located in London, United Kingdom, is one of the pioneers in developing and refining the Family-Based Treatment (FBT) approach. Established in the 1980s, the Maudsley Hospital’s specialized treatment program has demonstrated impressive results in treating eating disorders in adolescents.

Its success has led to the dissemination of FBT across the globe. The Training Institute for Child and Adolescent Eating Disorders, affiliated with the Maudsley Hospital, provides education and training in FBT to mental health professionals.

Their mission is to equip professionals with the necessary skills and knowledge to effectively implement FBT in clinical practice. Through comprehensive training programs, they ensure that therapists can deliver FBT adhering to its core principles and techniques.

The Principles and Process of FBT

Key Principles of FBT

Family-Based Treatment (FBT) is grounded in several key principles that guide the treatment process. Firstly, FBT takes an agnostic view of the etiology of eating disorders, avoiding excessive focus on the underlying causes.

Instead, it focuses on parents’ empowerment and their central role in helping their child recover. FBT also views the eating disorder as an external force that has taken control of the adolescent, shifting the responsibility away from the child.

This perspective helps parents understand that the eating disorder is not their child’s choice or fault. By separating the child from the illness, FBT allows parents to address the behaviors and symptoms without blaming their child.

Additionally, FBT recognizes the critical role of nutrition. Restoring the adolescent’s weight to a healthy range is seen as the first necessary step in the treatment process.

Adequate nutrition provides the brain and body the energy needed for proper functioning and supports emotional and cognitive well-being. Family involvement is another crucial principle of FBT.

It recognizes that parents are uniquely positioned to provide support, structure, and accountability for their child. By involving the entire family, FBT promotes understanding, empathy, and shared responsibility for recovery.

The Three Phases of FBT

Family-Based Treatment (FBT) is typically divided into three distinct phases, each serving a specific purpose in the treatment process. In the first phase, also known as the “underweight-remission” phase, the goal is to restore the adolescent’s weight to a healthy range.

This phase involves intense medical monitoring, coaching parents on how to manage meals, and addressing any resistance or challenging behaviors surrounding food. FBT therapists may also utilize behavioral therapy techniques to reinforce positive eating behaviors.

The second phase, referred to as the “adolescent control” phase, focuses on gradually returning control over eating to the adolescent. It involves collaborative decision-making and increasing the adolescent’s autonomy in managing their own meals.

However, parents continue to provide support and supervision to ensure continued progress and prevent relapse. Finally, the third phase, called the “healthy independence” phase, helps the adolescent establish a healthy and independent relationship with food.

This phase aims to consolidate the gains made in earlier stages and equip the adolescent with the necessary skills to navigate their own eating behaviors and maintain long-term recovery. It emphasizes the development of healthy coping strategies and supports the adolescent’s transition to a more independent and self-sufficient life.

Throughout these three phases, FBT sessions typically involve family meals, allowing the therapist to observe mealtime behaviors and provide immediate guidance to parents. The therapist plays a crucial coaching role, helping parents navigate challenges, address resistance around meals, and provide emotional support to their child.


In this article expansion, we have delved into the differences between FBT and traditional family therapy, highlighted the role of the Maudsley Hospital, and discussed the principles and process of Family-Based Treatment. By understanding the unique nature of FBT and its evidence-supported approach, we can better appreciate its effectiveness in treating adolescent eating disorders.

Through empowering parents, involving the whole family, and following the structured three-phase treatment process, FBT offers hope for a brighter and healthier future for adolescents struggling with eating disorders.

The Advantages and Research of FBT

The Advantages of FBT

Family-Based Treatment (FBT) offers several advantages that contribute to its effectiveness as a treatment for adolescent eating disorders. Firstly, FBT recognizes the brain starvation that occurs due to the restriction of food intake.

By prioritizing weight restoration and adequate nutrition, FBT aims to reverse the effects of malnourishment and support the physical and cognitive well-being of the adolescent. Empowering parents is another crucial advantage of FBT.

Parents are actively involved in the treatment process, providing support, structure, and accountability for their child. By engaging parents as key allies, FBT promotes a collaborative approach to recovery.

Research has shown that FBT leads to faster recovery rates compared to other treatment modalities. Adolescents who undergo FBT have been found to achieve weight restoration at a faster pace, reducing the risk of medical repercussions associated with prolonged malnutrition.

The early and intense intervention of FBT contributes to better outcomes and can prevent the development of severe physical complications. FBT is also considered cost-effective.

By utilizing outpatient settings and involving parents as primary agents, FBT minimizes the need for costly inpatient or residential treatment. FBT’s focus on weight restoration and symptom reduction helps limit treatment duration, further reducing the financial burden on families.

Research on FBT

Extensive research supports the effectiveness of Family-Based Treatment (FBT) for adolescent eating disorders. Studies consistently report higher rates of full recovery and weight restoration in patients who undergo FBT compared to other treatments.

A study by Lock et al. compared FBT with cognitive-behavioral therapy (CBT) and found that FBT led to higher rates of full remission from anorexia nervosa and bulimia nervosa.

FBT has also demonstrated success in weight restoration even in young adults, challenging the notion that it is only effective for adolescent populations. Interestingly, research has indicated that FBT is particularly effective for adolescents with a shorter duration of illness.

This suggests that early intervention is crucial, and FBT may be most beneficial when implemented at the earliest signs of an eating disorder. However, it is important to note that FBT can still be effective for individuals with a longer duration of illness, as FBT aims to address the illness holistically, not just weight restoration.

These studies and research findings highlight the robust evidence supporting the effectiveness of FBT as a treatment approach for adolescent eating disorders.

The Limitations and Variations of FBT

FBT is Not for Every Family

While FBT has been shown to be highly effective, it may not be suitable for every family. Some families may face unique challenges or barriers that can limit the successful execution of FBT.

For example, families with significant psychopathology or dysfunction unrelated to the eating disorder may require additional therapeutic support beyond FBT. Exceptions to the standard FBT approach are also recognized in certain cases.

For instance, if parental involvement is not feasible or if parents are part of the problem rather than being supportive caregivers, adaptations to the treatment approach may be necessary. These exceptional cases require careful assessment and consideration to ensure that the most appropriate treatment approach is chosen.

Variation of FBT and Tailoring to Individual Families

Recognizing the diverse needs and complexities of families, variations of FBT have been developed to accommodate different circumstances. For example, separated FBT involves working with parents separately to address any conflicts or challenges that may hinder the successful implementation of FBT.

Through individual therapy or support groups, separated FBT allows parents to work on their own issues while still receiving support and guidance in helping their child with an eating disorder. With certain families, variations of FBT may involve working with critical parents who struggle to support their child effectively.

Therapist involvement in meal planning or intensive coaching may be necessary to help these parents develop a more supportive and constructive approach. Medical monitoring is another essential component of FBT.

In cases where there are severe medical complications or concerns, close collaboration between the FBT therapist, the medical team, and the family is necessary to ensure the safety and well-being of the adolescent. Despite potential challenges, many families have positive experiences with FBT.

By actively engaging in their child’s treatment, families become an integral part of the recovery journey. This active role enables them to build stronger relationships and develop insights and skills that extend beyond the treatment of the eating disorder.


In this expanded article, we have explored the advantages and research supporting Family-Based Treatment (FBT) for adolescent eating disorders. The brain starvation perspective, the empowerment of parents, faster recovery rates, and cost-effectiveness all contribute to the effectiveness of FBT.

Additionally, we discussed the variations of FBT and its adaptability to individual families’ circumstances, acknowledging that FBT may not be suitable for every family and highlighting the importance of tailoring the treatment approach when necessary. FBT remains a highly effective and evidence-based treatment option for adolescent eating disorders, providing hope and support to families on the path to recovery.

In conclusion, Family-Based Treatment (FBT) is a highly effective approach for treating adolescent eating disorders, such as anorexia nervosa, bulimia nervosa, and other specified feeding or eating disorders (OSFED). FBT’s focus on the empowerment of parents, its successful track record in weight restoration and faster recovery rates, and its cost-effectiveness make it a first-line approach recommended by experts in the field.

Research consistently supports the effectiveness of FBT, highlighting its advantages in comparison to other treatment modalities and its applicability even for young adults with shorter illness durations. While FBT may not be suitable for every family, variations and adaptations have been developed to address specific challenges.

Overall, FBT offers hope for families, emphasizing the importance of early intervention, family involvement, and personalized treatment approaches for successful recovery from adolescent eating disorders.

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