Family-Based Treatment for Bulimia Nervosa

Status: Modest Research Support

Description

Family-Based Treatment (FBT) for bulimia nervosa is adapted from FBT for anorexia nervosa and like its predecessor, is designed for adolescents. While there are many types of family therapy, FBT specifically refers to a treatment modality originally developed at the Maudsley Hospital in London, England. FBT for bulimia nervosa is an outpatient intervention typically conducted in 20 sessions over 6 months, although a shorter course is sufficient for some cases while additional sessions may be necessary for others. FBT consists of three phases. In the first phase, parents are placed in charge of helping their child reestablish healthy eating patterns and prevent binge eating and purging episodes from occurring. While this process is collaborative in nature, parental authority is mobilized as necessary in response to the health crisis that the eating disorder poses. 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 symptoms have abated and a regular pattern of eating a variety of foods is established, 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 bulimia 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 bulimia nervosa, but on what can be done to resolve this serious disorder.

Key References (in reverse chronological order)

• Le Grange, D., Crosby, R.D., Rathouz, P.J., & Leventhal, B.L. A randomized controlled comparison of family-based treatment and supportive psychotherapy for adolescent bulimia nervosa. Archives of General Psychiatry, 64, 2007, 1049-1056.
• Schmidt, U., Lee, S., Beecham, J., Perkins, S., Treasure, J., Yi, I., Winn, S., Robinson, P., Murphy, R., Keville, S., Johnson-Sabine, E., Jenkins, M., Frost, S., Dodge, L. Berelowitz, M., & Eisler, I. (2007). A randomized controlled trial of family therapy and cognitive behavior therapy guided self-care for adolescents with bulimia nervosa and related disorders. American Journal of Psychiatry, 164, 591-598.

Clinical Resources

• Le Grange D & Lock J (2007), Treating Bulimia in Adolescents: A Family-Based Approach. New York: Guilford Press

Training Opportunities

• Contact Daniel Le Grange, PhD (The University of Chicago) at legrange@uchicago.edu
• James Lock, MD, PhD (Stanford University) at jimlock@stanford.edu