Eating disorders can be one of the most challenging and heartbreaking mental health problems to treat. These conditions typically start between age 12 and 25, and parents struggle to help their child overcome their disorders and get enough nourishment.
Eating disorders are more common in females, but 10% are diagnosed in males. Most people with eating disorders also have another mental health disorder, such as an anxiety disorder or depressive disorder. “Eating disorders have a negative impact on quality of life, and they are very tricky to treat,” said Yazhini Srivathsal, MD, a psychiatrist with Banner Behavioral Health Hospital in Scottsdale, AZ.
Some of the most common types of eating disorders are:
- Anorexia, where people have low body weight, an intense fear of weight gain and body image issues.
- Bulimia, where people eat large amounts of and compensate inappropriately, such as by vomiting, taking laxatives or diet pills, or overexercising.
- Binge eating disorder, where people eat much more than normal, can’t control their eating and feel distressed.
- Avoidant restrictive food intake disorder (ARFID), where people have issues like a strong sensory aversion to foods, so they aren’t meeting their nutritional needs, and they may have developmental delays.
In the past, experts believed that problems within the family caused eating disorders. “So, the plan was to take the person away from their family, put them in a residential facility, try to make them eat better, help them learn better life skills and then bring them back to the family. But it did not work,” Dr. Srivathsal said. “It added so much stress on the family, and most of the time, the family was not to blame.”
Family-based therapy takes a different approach
Today, experts realize that family-based therapy is a better option for treating eating disorders such as anorexia nervosa and bulimia nervosa. “The goal is to provide support, education and encouragement to family members, so they feel empowered and understand how to help,” Dr. Srivathsal said.
With family-based therapy, there’s no blame. “We don’t worry about why this is happening. We focus on getting the person better. The clinician who is helping the family has a non-judgmental approach,” Dr. Srivathsal said. “The eating disorder is viewed as an external force, and the family is trying to help the child get away from the clutches of this external force.”
Family-based therapy helps people feel more empowered. “Parents often think, ‘Maybe I should have done things better.’ But that’s not helpful. So, we focus on how to make things better,” Dr. Srivathsal said.
Here’s how the process works
With family-based therapy, at least one meal is eaten in the therapist’s office at first, so the therapist can see what kind of dynamics happen and how they can help change behaviors. Typically, a family starts with weekly sessions with a therapist, and over time sessions decrease. Adolescents may not necessarily want to participate initially, but the treatment is centered around the family.
There are three phases of treatment:
1. Full control by the parents or loved ones. In this phase, the parents decide what to do based on nutritional needs. “It eases the responsibilities and stress for the child,” Dr. Srivathsal said. “They don’t have to worry about what they are going to eat. The parents or caregivers are going to take care of it.”
This stage is crucial, because when the brain is nutritionally deprived, people can’t think clearly. “They can’t understand that something bad is going on. It could be like a delusion,” Dr. Srivathsal said. “They may look in the mirror and feel like they are fat when that’s not the case. But they cannot understand or believe it.”
Parents need to supervise all meals and may need to supervise their child after meals if there’s a risk of purging or overexercising. The level of supervision is similar to inpatient treatment, but outside of meals, the child can participate in everyday activities as much as possible.
2. Gradual return of control to the adolescent. Once the child’s weight and health are improving, meals are going more smoothly, and behaviors are better controlled, they can start to make food choices on their own. “Once people start feeling better, they have a little more insight into what’s going on,” Dr. Srivathsal said. In this phase, the child may eat with other people and in different settings. If they have trouble with their eating, families can return to phase one and try again.
3. Healthy independence. In this phase, the child can make food choices on their own. They learn how to prevent relapses and can focus on treating any other behavioral health problems.
“Family-based therapy is a lot of work. It needs a very strong commitment from the family, but it can be done by any family unless there’s abuse or a safety concern,” Dr. Srivathsal said. “It’s one of the go-to ways to help a person who is struggling. It works faster than other options, and it has better long-term results. Plus, families can remain together.”
The bottom line
Treating eating disorders in adolescents can be challenging, and it’s painful for parents to see their child struggle. Family-based therapy can help. With it, families work together with a therapist to fight the eating disorder so the child can make their own healthy food choices. To connect with a behavioral health specialist who can help treat eating disorders and other mental health conditions, reach out to Banner Health.