FBT is a treatment method and manual developed by J Lock & D LeGrange. It has been tested and studied to prove success in adolescents under 19 years old. Currently, it is the most researched and effective treatment we have to treat Anorexia Nervosa in youth. Treatment can last from 6-to 12 months, though I have seen it last longer in enduring Anorexia Nervosa.

Treatment is divided into 3 phases which we will look into now:

Phase 1- Refeeding and Weight Restoration

This is the most important Phase of FBT, hence why it is first. Your child has been struggling with eating for a while and needs your help to restore their physical health. In order to do that, you (parents, caregivers) have to take full control of food. Parents need to have full control, without any input from the adolescent over the following things:

• Grocery Shopping

• Deciding what foods to buy without input from the Eating Disorder

• Cooking and Preparing all meals

• Choosing all meals and snacks for the adolescent

• Determining the portion and quantity of food for the child

• Supervising all meals and snacks (having eyes on your child while they eat)

This list may look like A LOT. IT IS! Your child is ill and they need full-time support to be able to get healthy again.

In addition, you need to monitor for extra energy spent/calories burnt and may need to implement 24/7 monitoring to make sure your child is not secretly exercising.

At this stage, your child will not have any insight into their illness. They likely believe that they are “fine” and “not sick” and “don’t need treatment”. Your child will likely be very resistant to the above supervision and may give a lot of pushback. This is normal. Continue anyway, because your child needs you.

Phase 2- Returning Control of Eating back to the Child

In Phase 2, hopefully, your child's Eating Disorder behaviors have become less frequent and less intense and they have developed some insight into their ED. They should begin eating a wide variety of foods and meals should be easier.

Your child will still have Eating Disorder thoughts and they may still be very loud.

Many parents In Phase 2 report an improvement in their child’s mood and more socialization with family and peers. Once we see all of these signs, we begin to slowly return some control of food choices to the child. They may pick foods or portion meals with supervision from parents. We want to make sure the child is able to make choices, not the eating disorder. Slowly, the child will make more and more food choices with less and less input from parents needed.

Phase 3- Identifying Adolescent Issues that may need to be Addressed

During this Phase, we have restored weight, eating is going well, and the child is returning to spending time with friends, going to school, and returning to hobbies. This phase is used to deal with any typical adolescent issues that had to be put on the back burner during weight restoration and addressing eating disorder behaviors. Anxiety, depression, OCD, family dynamics or social development issues will be addressed during Phase 3.

Key Points of FBT:

• Parents are in charge of restoring their child’s health. You are the expert on your child, I am the expert on eating disorders.

• We do not worry about what causes Anorexia Nervosa and no one is blamed.

• We externalize the Anorexia to remove feelings of blame and help the child to fight against the Eating Disorder

Let’s talk more about the separation of the illness from the child:

You know what your child was like before anorexia nervosa came in and you know what they are like with a strong eating disorder- and I am sure you will agree those are two different children. Anorexia has influenced your child’s behavior and personality and is likely out of character from the child you knew before. Children have a hard time with this concept and often resist it. We know your child would not be making these choices or acting in this way without the influence of the eating disorder. For example, if we can separate and say, “I see your eating disorder is telling you not to eat that sandwich, that must be very hard. I am not going to talk to the eating disorder right now, I’m going to talk to my child. This is exactly what your body needs right now”, this can help the child to come around to the idea of separating from the illness.

We can also pull examples for the child about the changes in their behavior. For example:

• Have they been isolated from their friends and skipping out on things they would have enjoyed before?

• Are they having difficulty focusing and paying attention in school, when they didn’t before?

• Are they lying and hiding things from their parents, when that wasn’t them before?

• Did they used to enjoy a walk in the neighborhood, but now the eating disorder only wants them to run to burn more calories?

If we can separate the Eating Disorder from your child, we can work to get your child on board with you and the treatment team to fight and work against the eating disorder towards recovery. We are all on one team against the Eating Disorder, not against the child.

Things to Remember:

• Your child does not believe they are ill. They will not have the motivation or want to change, at first.

• Your child does not want your help and will often see you as trying to make them “fat”.

• Your child will have the best chance at recovery if you can stick with it and stay consistent

If you have more questions about what FBT is or want to get started, please scheduled a FREE consultation call or visit my Info page on my website, eatingdisordertherapyohio.com

References:

Ganci, M. (2016). Survive FBT: Skills Manual for Parents Undertaking family based treatment (FBT) for child and adolescent anorexia nervosa. LMD Publishing.

Lock, J., & Grange, L. D. (2015). Treatment manual for anorexia nervosa: A family-based approach. Guilford.