Anorexia Nervosa (AN) is a potentially fatal, highly heritable, neuro-behavioral illness characterized by restriction of food intake, weight loss, and inability to perceive one’s body size and shape accurately. Many individuals with AN have an extreme fear of eating and weight. AN may lead to a variety of severe medical and psychiatric consequences, including cardiac complications, osteoporosis, hypothermia, depression, obsessive-compulsive behaviors, amenorrhea, kidney failure, infertility, and suicide. Scientific research has demonstrated that the risk of developing AN is largely genetic. Other variables, such as puberty, temperament, and experience, also play a role in the manifestation of this illness. For those who are predisposed to AN, an energy deficit (consuming fewer calories than the body requires to meet energy needs) caused by dieting, illness, stress, athletic training, or a simple decision to “eat healthy,” triggers a self-perpetuating cycle of decreased food intake and weight loss. Once AN is set into motion, it becomes extremely difficult for the person to break free from this cycle without significant support.
Anorexia has the highest mortality rate of any psychiatric disorder.
Although the disorder typically begins in adolescence, AN occurs in people of all genders, all ages, and all shapes and sizes. It is not possible to tell if someone has AN simply by looking at them. While many people with AN have a thin or “underweight” appearance, others appear to be “normal weight” or even “overweight.” In fact, recent research indicates that nearly 1/3 of individuals who are hospitalized for AN are not underweight. Further, given that nutritional and physical recovery usually precede psychological recovery, people who are recovering from AN may appear to be “healthy” and “normal” based on their body size, while still suffering tremendously from food anxiety, body dysmorphia, depression, or other mental symptoms.
In FBT for AN, parents are empowered to take control of their child’s eating habits to reverse the process of starvation, require the adolescent to eat 100% of all meals plated by parents/caregivers, and support the patient in restoring a healthy weight and healthy body functions. Once physical health is achieved and weight is fully restored, control over eating is gradually returned to the patient as he/she demonstrates an ability to maintain his/her weight and eat independently at an age-appropriate level (Phase 2). In the last phase of treatment, any lingering psycho-social issues are addressed, the family is supported in re-establishing a normal family life, and the patient and family collaborate with me to develop a written relapse prevention plan.
Again, the length of time required to complete FBT varies dramatically depending on individual and family variables. Some individuals – typically those with milder symptoms and no comorbid conditions – may complete FBT in as little as 6 months. Others – typically those with more severe forms of AN who have been ill for longer and also suffer from comorbid disorders – may take 2-3 years to complete their treatment.
Bulimia Nervosa (BN) is a serious, potentially life-threatening eating disorder involving repeated cycles of binge eating followed by compensatory behavior such as self-induced vomiting, laxative abuse, fasting, strict dieting, or compulsive exercise. In most cases, BN is initially triggered by dieting and weight suppression. Many individuals who suffer from BN also experience depression, anxiety, substance abuse, or other mental health disorders.
In Family-Based Treatment for BN, the restrict-binge-purge cycle is discussed openly among family members in an environment free of blame, guilt, and shame so that patterns and triggers can be identified. Parents are empowered to interrupt their child’s binge-purge cycle by requiring complete, balanced, structured meals and snacks at regular intervals, ensuring that their child is always well-nourished. Parents also learn to prevent episodes of binge eating and purging by providing emotional support, supervision, and distraction at their child’s most vulnerable times. When the patient has established a consistent pattern of balanced meals and snacks and has been abstinent from binge/purge symptoms for a period of time, control over eating is gradually handed back to the patient. Once the patient is able to eat healthfully with an age-appropriate level of independence, any lingering individual or family issues are addressed.
