Diminishing the Eating Disorder: Restoring Your Child’s Health with Family-Based Therapy

Mar 29, 2024

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Just as eating disorders are multifaceted, so is recovery. There are social, emotional, and physical components of your child’s health, and nutrition impacts each of those aspects. 

Your child can’t effectively navigate the social and emotional aspects of their recovery if they’re undernourished. In your child’s recovery, restoring their health with nutritional rehabilitation comes first. 

That involves assisting with planning, preparing, portioning, and supervising food and fluid intake.

Here’s what you need to know about how to help a child with an eating disorder in their recovery.

Taking Away Control From the Eating Disorder

Whether your child starts their recovery journey in an outpatient setting or a higher level of care, all the changes — including nutritional rehabilitation — are a direct threat to your child’s eating disorder and most likely won’t be received well initially.

As the eating disorder is challenged, it will almost certainly push back — and it may happen in the form of your child becoming irritable, upset, vocal, and even aggressive. ¹

Pushing back against those eating disorder urges and behaviors, having a plan to respond to these things, and being persistent in not giving in to the eating disorder are crucial to helping your child recover.

What Is Family-Based Therapy?

Family-based treatment, or FBT, is a form of eating disorder treatment where parents take much of the responsibility in helping their child recover from an eating disorder. ² You may also hear some people refer to it as “family-based therapy.”

Research shows that long-term — 6 to 12 months after treatment is initially completed — FBT is more effective for adolescents when compared to individual treatment. ³ Research has also shown that FBT may be helpful for older adults, as was seen in one study of adults ages 18-26. ⁴

Family-based treatment has parents take responsibility in removing control from the eating disorder.

This includes:

  • Eliminating the opportunity for the eating disorder to call the shots, as a parent controls what the child eats
  • Challenging eating disorder thoughts, behaviors, and rules created by the eating disorder

As a parent, you are removed from the eating disorder that’s overpowering many of your child’s thoughts and behaviors. Parents can help identify eating disorder strongholds because they can point to how things were before the eating disorder.

Family-Based Treatment Principles

Family-based treatment focuses on a few core principles: ⁵

  • There is no single cause of the eating disorder, and they are complex. It is not your or your child’s fault that the eating disorder developed.
  • Your child is not their eating disorder — they are separate from it. When you are fighting with your child about what they’re going to eat, you’re not fighting them — you’re fighting the eating disorder.
  • The therapist will help parents get empowered to make decisions that are best for their child.

The Three Phases of Family-Based Treatment

FBT is broken down into three phases. You will take more responsibility in the beginning, and as they move through the three phases, you’ll gradually give your child more responsibility and autonomy over what they’re eating.

The three phases include: ⁶

Phase 1

This may be the most difficult phase, as you will help your child rehabilitate and work to restore their health. It may take around 10 weeks but can fluctuate depending on your child’s individual journey.

Rather than focusing on any causes of the eating disorder, you focus solely on working to get your child to eat and restore their health — knowing food is medicine, and the eating disorder is the illness — and lovingly fight against the eating disorder. You take a very hands-on approach and learn to navigate meals and what to give your child with guidance from the therapist, health professional, dietitian, and, if necessary, psychiatrist.

A dietitian can provide guidance on how to structure your child’s meals. Parents are encouraged to feed children meals that they think would be best for their recovery — in line with things children ate before behaviors arose.

You’ll be challenging many of the eating disorder thoughts, and the eating disorder may cause your child to lash out. It can be an overwhelming phase, but it’s important to push through. Remember: Compromising with the eating disorder will not get your child back to being healthy.

However, being persistent in what’s best for your child’s recovery will.

Phase 2

In this phase, you begin to give your child some more autonomy back as they are ready. You’ll continue to help them develop a more normal relationship with food. Your child may decide on some elements of their meals or choose a snack. ⁷ However, they’re not ready to fully decide what to have for a meal, or often to portion food for themselves, and they’re still working to fully restore their health.

If necessary, structure is re-introduced to help your child stay on track with their recovery.

It’s totally normal for your child to need more structure at times or be ready for more autonomy at others. It’s all a part of the process of helping your child get back to their regular eating habits.

Phase 3 

When your child reaches phase 3 of FBT, they’re ready to transition back to what’s more “normal.” You also shift from a position of fighting the eating disorder to supporting your child in their recovery journey. ⁸

Instead of deciding your child’s full meals, you’ll make small but mindful changes that help their recovery. Children regain more autonomy in this phase, and you’ll see your child appear more and more like themselves each day.

The eating disorder thoughts may still be present but will have much less of a hold on your child than before. They may reach for challenge foods that the eating disorder would never have wanted them to eat while they were in earlier stages of recovery, but will probably still need support in navigating meals and snacks.

Diminishing Your Child’s Eating Disorder with a Loving Approach

Taking a loving but firm approach can help your child walk the road to recovery — something they almost certainly can’t do on their own.

It may feel challenging and unnatural to decide what your child eats for every meal and seemingly fight with them, especially if your child is older. However, remember you’re really fighting the eating disorder, and everything you’re doing is to help your child recover.

Don’t get defeated if your child needs more structure or support. Just as every child is unique, so is their recovery journey. It may just take a little time.

Citations

  1. Muhlheim, Lauren. 2018. In When Your Teen Has an Eating Disorder: Practical Strategies to Help Your Teen Recover from Anorexia, Bulimia, and Binge Eating, 103. Oakland, California: New Harbinger Publications.
  2. Crosbie, Casey, and Wendy Sterling. Essay. In How to Nourish Your Child through an Eating Disorder: A Simple, Plate-by-Plate Approach to Rebuilding a Healthy Relationship with Food, 28. New York: The Experiment, 2018.
  3. Couturier, Jennifer, Melissa Kimber, and Peter Szatmari. 2012. “Efficacy of family-based treatment for adolescents with eating disorders: A systematic review and meta-analysis.” International Journal of Eating Disorders 46, no. 1 (July): 3-11. https://doi.org/10.1002/eat.22042.
  4. Rienecke, Renee D. 2022. “Family-based treatment of eating disorders in adolescents: current insights.” Adolescent Health, Medicine and Therapeutics 8 (December): 69-79. https://doi.org/10.2147/AHMT.S115775.
  5. Ibid.
  6. Crosbie and Sterling, How to Nourish, 34-35.
  7. Crosbie and Sterling, How to Nourish, 45-46.
  8. Crosbie and Sterling, How to Nourish, 46-48.

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