Integrating Family-Based Treatment Principles in the Acute Inpatient Treatment of Adolescents with Restrictive Eating Disorders

Figures & data

Figure 1 Flowchart of patients’ medical hospitalization.

Table 1 Phases and Related Goals of Family-Based Treatment (FBT) Outpatient Treatment

	FBT Core Principles and Treatment Progression: Outpatient
	Initial Symptom Focus	Agnostic View of Illness	Family Responsible for Weight Restoration and Cessation of Behaviors	Non-Authoritarian Stance	Externalization of Illness
Phase I Sessions 1–10	Weight restoration and behavioral change Weekly sessions	Etiology not discussed Individual not blamed for ED	Family is the expert of their child and will restore their child to health	Parents remain agnostic, non-blaming and supportive	Parents learn the ED is in control of their child’s behaviors
Phase 2 Sessions 11–16	Stabilization or continued weight restoration Bi-weekly sessions	Causality not the focus of treatment	Individual is 90–95% weight restored	Gradual control of eating is returned to the individual	Individual may return to activities: ED behaviors are eliminated
Phase 3 Sessions 17–20	Maintenance Monthly sessions	Other comorbid problems may be discussed	Individual can eat without engaging in ED behaviors	Identify relapse prevention strategies	Individual can navigate age-appropriate challenges

Table 2 Phases and Related Goals of Family-Based Treatment (FBT) Inpatient Treatment

FBT Core Principles Applied to the Inpatient Admission
Agnostic View of Illness	Initial Symptom Focus	Increase Parental Self-Efficacy and Empowerment	Non-Authoritarian Stance	Externalization of Illness
Treatment team models a non-blaming stance Etiology of illness is not discussed EDs are viewed as complex multifactorial illnesses - psychoeducation is offered Staff minimizes parent guilt and shame	Daily weight restoration is the focus ED behaviors are targeted Team models limit setting Medical stability is achieved	Parents are encouraged and validated by staff Parents choose meals Parents sit with their child during meals and learn meal coaching from staff Parents identify supports during meals: eg siblings	Treatment team works in close collaboration with parents Parents are seen as experts of their child Treatment team problem solves with parents re: upcoming challenges	Treatment team models externalization strategies – child and ED are separate Staff supports family with these strategies to reduce conflict Parents learn to minimize emotional reactions to behaviors during meals