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 General Psychiatry.
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 says.
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 says.