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Family Involvement in Treatment for Bulimia Nervosa
Contributor: Leigh Bell, BA, writer for Eating Disorder Hope
The most effective treatment for bulimia, in either adolescents or adults, remains somewhat elusive to researchers, professionals, and family members. The most common treatment for this eating disorder is cognitive-behavioral therapy and is often boosted by antidepressant medication. [1]
Yet, the outcome is unremarkable. Relapse rate remains high for those in recovery from bulimia – anywhere from 30-50%, depending on the source you’re citing. Those aren’t the best odds.
Family-based therapy (FBT) has been somewhat successful in the treatment of teenagers with anorexia. Very few studies have tested this therapeutic approach on teens with bulimia, and the sparse existent research is discrepant. One study resulted in superior outcomes from FBT when compared to cognitive-behavioral therapy, and another
showed no statistically significant differences between the two treatments. [2]
Little Evidence on Treating Bulimia in Adolescents
“We have very little information about how to best address bulimia in adolescents, and have been depending on what we know about the efficacy of treatment in adults,” said co lead author of the latter study, Dr. James Lock, professor of psychiatry and behavioral sciences at Stanford University.
But we have even less research-based information on the efficacy of FBT in treating adults with bulimia; and the main reason is “most researchers studying adults did not consider this (FBT) as an option for adults, whereas, for developmental reasons, including family members in treatment appears reasonable for younger patients,” wrote
Lock in an earlier study. [3]
Until the last decade, no randomized controlled trials of family therapy existed on the efficacy of FBT in those with bulimia, and professionals simply “considered” it for adolescents (Halmi, 2005).
Family-based Therapy New Concept for Eating Disorders
Family-based therapy remains a relatively new concept. Historically, eating disorder treatment purposefully excluded family members, especially parents, who were thought to exacerbate the eating disorder and impede treatment.
A paradigm shift originated with work at the Maudsley Hospital in London in the late 1970s, and the family began to be seen as a “potential resource in therapy, easing parents’ burden of guilt, and promoting an attitude of inclusion that is reflected today. in current treatment guidelines applied to the pediatric-age patient,” according to the “Academy for Eating Disorders Position Paper: The Role of the Family in Eating Disorders.” [4]
The paper avers that families should be routinely involved in the treatment of most young people with an eating disorder, but exactly how will vary from family to family.
Family Involvement Differs for Adults and Teens
Family involvement in the treatment of adults with bulimia will probably look different than in teens with the eating disorder. Involved family members may not be parents or siblings, rather it’s more likely to be a spouse, significant other, and/or children.
Family therapy can be used in addition to treatment for an adult with bulimia – it doesn’t have to be the foundation. In fact, many therapists recommend family involvement to a certain extent. When a family member suffers from an eating disorder, their loved suffer along with them, often feeling helpless, confused, guilty, and scared. Family therapy, where the entire immediate family participates, as an adjunct to treatment, can provide family and loved ones education, support, communication skills, and conflict resolution. [5] It’s also a space where family can set health boundaries and learn how to maintain them.
Who is involved and how deeply in the treatment of an adult with bulimia will likely be up to that adult, if he or she is emotionally and physically stable. The decision should depend on how the inclusion of family will help start, support, and maintain recovery.
Community Discussion – Share your thoughts here!
What has been your experience with the treatment of an adult with Bulimia?
About the Author: Leigh Bell holds a Bachelor of Arts in English with minors in Creative Writing and French from Loyola Marymount University in Los Angeles. She is a published author, journalist with 15 years of experience, and a recipient of the Rosalynn Carter Fellowship for Mental Health Journalism. Leigh is recovered from a near-fatal, decade-long battle with anorexia and the mother of three young, rambunctious children.
References
[1]: Halmi, K. (2005). The multimodal treatment of eating disorders. World Psychiatry, 4(2), 69-73.[2]: Le Grange, D., Lock, J., Agras, W.S., Bryson, S., Jo, B. (2015). Randomized clinical trial of family-based treatment and cognitive-behavioral therapy for adolescent bulimia nervosa. Journal of the American Academy of Child & Adolescent Psychiatry, (54)11, 886-894.
[3]: Lock, J. (2011). Evaluation of family treatment models for eating disorders. Current Opinion in Psychiatry, 24(4), 274-279.
[4]: Le Grange, D., Lock, J., Loeb, K., & Nicholls, D. (2010). Academy for Eating Disorders position paper: The role of the family in eating disorders. International Journal of Eating Disorders, 43(1), 1-5.
[5]: Engel, B., Staats Reis, N., & Dombeck, M. (2007, February 2). Eating Disorder Professional Treatment – Family Therapy. Retrieved November 18, 2015, from https://www.mentalhelp.net/articles/eating-disorder-professional-treatment-family-therapy/
The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer discussion of various issues by different concerned individuals.
We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.
Last Updated & Reviewed By: Jacquelyn Ekern, MS, LPC on January 3, 2015
Published on EatingDisorderHope.com
The EatingDisorderHope.com editorial team comprises experienced writers, editors, and medical reviewers specializing in eating disorders, treatment, and mental and behavioral health.
