Family Therapy Helps Teens With Bulimia
Method Allows Parents to Be Involved in a Child's Treatment
Sept. 4, 2007 -- A family-based approach showing promise to help treat
children and teens with anorexia may be an even more effective treatment for bulimia.
Family-based treatment involves close monitoring of an anorexic or bulimic
child's eating behavior by parents who are encouraged to intervene when they
see signs that the behavior is out of control.
The thinking is that parents and other family members are in the best
position to help a child with an eating disorder get well -- not by becoming
food cops, but by providing encouragement and support, Daniel le Grange, PhD,
of the University of Chicago tells WebMD.
"Instead of telling parents to back off, they become a big part of
treatment," he says. "They work together with their child to figure out the
best way to get a handle on eating binges."
Bulimia Treatment in Teens
In the study by le Grange and colleagues, the family-oriented approach was
compared with supportive psychotherapy for the treatment of teens with bulimia
or those who frequently binged and purged, but did not meet the strict criteria
for the disorder.
The goal of supportive psychotherapy was to identify underlying emotional
issues that might cause the bulimia. It included no behavioral therapy to
specifically address symptoms.
Between 2001 and 2006, 41 teens were randomly assigned to family-based
treatment and 39 to psychotherapy. Both interventions involved 20
outpatient-clinic-based visits over the course of six months.
Slightly more than twice as many patients in the family therapy group -- 39%
vs. 18% -- achieved remission by the end of treatment, meaning that they
reported no binging or purging during the previous four weeks.
Six months after treatment ended, 12 of the 41 patients (29%) who got the
family therapy remained in remission, compared with four of the 39
psychotherapy patients (10%). Partial remissions were seen in 41% of the family
therapy patients and 21% of the psychotherapy patients.
The findings are published in the September issue of the Archives of
Research on Bulimia in Teens
The study is one of only two randomized, controlled trials to examine
family-based therapy for the treatment of bulimia in adolescents.
Other therapies used to treat the eating disorder in children and teens,
such as antidepressants and cognitive behavioral therapy, have
not been studied in this age group at all, le Grange says.
Family-based treatment has been more thoroughly studied in adolescents with
anorexia nervosa, and it is now considered the first-choice treatment for
children and teens with the disorder in Great Britain.
Sanford University eating disorders specialist and researcher James Lock,
MD, PhD, tells WebMD that a key component of family-based treatment is
eliminating the secrecy that is a hallmark of bulimia.
Lock and le Grange are co-authors of the 2007 book, Treating Bulimia in
Adolescents: A Family-Based Approach.
"By bringing the disorder out in the open you reduce the shame and guilt
patients feel," Lock says.
Family members can then work with the bulimic child to help them normalize
eating behaviors and minimize the triggers that cause binging and purging, he
That may mean monitoring what the child eats as much as possible or spending
time with her after meals so that she has little opportunity to purge.
"The focus is on normalizing eating behaviors, not on placing blame," he