Why FBT Could Be The Answer For Your Teen’s Eating Disorder
Family Based Treatment (FBT) is the most evidence-based approach for the treatment of Anorexia Nervosa and other restrictive eating disorders in adolescents. It is particularly suitable for those with a duration of illness of less than 3 years, which thankfully appears to be the case for a lot of teenagers. It is sometimes called the Maudsley Method due to originating at the Maudsley Hospital in London; and is a treatment which is often misunderstood.
When parents seek help for their teenager with an eating disorder, they are often feeling helpless, overwhelmed, frustrated, and utterly terrified! Often, they’ve been facing daily battles to get their child to eat. Eating disorders are serious mental illnesses, and Anorexia has the highest mortality rate of all. It often results in such a grip on the sufferer that it drives them away from their family and friends through rigid rules, social withdrawal, and challenging behaviours such as refusing to eat certain foods, exercising compulsively, bingeing, purging, or other secretive or deceptive behaviours. This means parents are often desperate for professionals to “cure” their child, and are often feeling powerless to know what to do themselves. It can therefore come as a surprise to many when the idea of a family-based approach is suggested. Many parents are quite reluctant at first, and I often hear things like “I really think they need individual treatment” and “We’ve tried to help and they won’t listen to us” and “We need you to get to the bottom of why they developed it in the first place”. All of these things make sense if you’re feeling like nothing you say or do is making a difference, or if you’re faced with a combative teen fighting your every move! However, if we think of Anorexia as being a serious illness that has hijacked their brain, the chance of them being able to independently make the changes required is often slim.
Research generally shows that when a teenager has a serious eating disorder, it’s not that they “won’t” eat normally, it’s that they “can’t”. They are so overwhelmed with the anxiety and distress the Anorexia creates, so terrified of getting fat, so fearful of foods, so caught up in the obsessionality or ridged rules, that they are literally paralysed. Their fight/flight/freeze response is kicked into action, their brain is starving, and their cognitive capacity to think logically and reasonably has shut down. This results in extreme distress, avoidance, or outbursts to the point where they literally cannot do it alone!
One underlying philosophy of FBT is that no one is to blame for the eating disorder developing, but families do need to step in and take responsibility for helping their loved one get well. We don’t ask families to be involved because we think they’re part of the problem, but because they are a critical part of the solution. They are the best resource in their child’s recovery due to the investment in love they have for their child! The simple truth is that in most cases, no one will fight harder to keep a child alive than their parents. It may sound dramatic, but this is a life-or-death situation. Anorexia kills. Whether it is due to the acute medical complications that can arise, a more chronic destruction of the body over time, or sometimes suicide, it is not something that can be brushed off. And even if the sufferer doesn’t actually die, their quality of life is often greatly reduced. Hopes and dreams, and even normal everyday functioning all fall by the wayside. And the longer it goes on, the harder it becomes to treat. It requires enormous courage and commitment to stop an eating disorder in its tracks. Enormous strength and resilience, and it often requires an entire family to come together to fight it.
Framed another way, if the child or teen were to attend weekly individual therapy sessions, that’s one hour per week that they have support, and 167 hours per week they are fighting a deadly illness alone. If the family all attends, that’s one hour a week the family has the support of the therapist, but 168 hours a week the young person has their family forming a team to support them through challenging meals and triggering situations in real-time. Which of these likely has the greatest power to get them well?
We don’t really know what causes one child to develop Anorexia and not another, but it is likely a combination of genetics, temperament, and life experiences. Another key part of FBT is that we cannot afford to spend time trying to figure that out when the child is facing serious medical and psychological consequences of the illness. Instead, we need to understand and break the patterns which are keeping it going and get them physically restored to health as soon as possible. There is a frequently used metaphor in FBT that focusing on the underlying cause of the illness, is like the child being in a sinking ship, and the parents swimming out and examining the boat’s engine to figure out what went wrong, whilst in the meanwhile their child is literally drowning!
The other reason it’s often critical to have the whole family involved is that eating disorders don’t just affect the individual, they affect the whole family system. Often the parents experience significant anxiety, stress, worry or anger due to the impacts of the Anorexia or the changes they observe in their child. Siblings feel helpless at their brother or sister becoming so unwell, or they miss out on the attention and connection they need because everyone is focused on the illness and all its manifestations. Often the whole family accommodates the illness by buying or cooking different foods to try to keep the peace, or they spend vast amounts of time trying to negotiate or cajole the sufferer to eat something. All the while the anorexia is gaining power over the whole family and the way they function. Often mealtimes are no longer fun times of connection but are a battleground which is stressful for all!
By having the whole family involved, everyone can share their experiences with each other, everyone can collaborate in helping their loved one get well, and everyone can feel confident they are playing a part in their loved one’s recovery rather than watching helplessly from the sidelines. Parents, siblings, families - your loved one needs you! You can be part of the solution for them! There is hope!
Just like any type of therapy, FBT won’t necessarily work for everyone. But if your child or teen is experiencing an eating disorder, it may be worth discussing with your treatment provider whether FBT could be the answer!
For more information the following resources may be helpful:
https://butterfly.org.au – The Butterfly Foundation
https://insideoutinstitute.org.au – The Inside Out Institute
