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Eating Disorders Advanced Treatment (Family-Based Therapy)

Comprehensive multidisciplinary treatment for adolescent anorexia, bulimia, and binge eating disorder

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Psikiyatri department. Book Appointment →

What is Eating Disorders Advanced Treatment (Family-Based Therapy)?

Eating disorders include anorexia nervosa (restricting and binge-purge subtypes), bulimia nervosa, binge eating disorder, avoidant/restrictive food intake disorder (ARFID), and other specified feeding or eating disorders. They have the highest mortality rate of any mental illness, with combined medical and psychiatric complications. Comprehensive multidisciplinary treatment is essential, integrating medical stabilization, nutritional rehabilitation, psychotherapy, family involvement, and treatment of comorbidities.

Family-Based Therapy (FBT, Maudsley method), developed at Maudsley Hospital, is the evidence-based first-line treatment for adolescents with anorexia nervosa within 3 years of illness onset. FBT empowers parents to take charge of refeeding and weight restoration in their child, with three phases: (1) parental control of eating with weight restoration as primary goal, (2) gradual transfer of control back to adolescent as weight is restored, and (3) addressing developmental issues and termination of treatment.

Other evidence-based treatments include cognitive behavioral therapy enhanced (CBT-E) for older adolescents and adults with all eating disorder diagnoses, interpersonal psychotherapy (IPT) for binge eating disorder, dialectical behavior therapy (DBT) for emotion regulation difficulties, and adolescent-focused therapy. Pharmacotherapy includes fluoxetine for bulimia nervosa, lisdexamfetamine for binge eating disorder, and treatment of comorbid mood, anxiety, and trauma disorders. Olanzapine in low doses may help in anorexia. Inpatient or partial hospitalization is reserved for medical instability, severe behavioral dyscontrol, or treatment failure.

Symptoms

Significant weight loss or low body weight (anorexia nervosa)
Intense fear of weight gain
Distorted body image
Restriction of food intake
Excessive exercise
Binge eating episodes
Compensatory behaviors (purging, laxatives, diuretics, fasting)
Amenorrhea (anorexia)
Bradycardia, hypotension, hypothermia
Lanugo hair, hair loss
Russell sign (callus on knuckles from purging)
Dental erosion
Salivary gland enlargement
Constipation, abdominal pain
Refeeding syndrome risk on initial nutrition
Electrolyte abnormalities (especially hypokalemia)
Cardiac arrhythmias
Osteoporosis (especially anorexia)
Endocrine abnormalities (low LH/FSH, low T3, hypercortisolism)
Comorbid depression, anxiety, OCD, trauma, substance use

Risk Factors

Female sex (especially anorexia, bulimia)
Adolescence and young adulthood
Family history of eating disorders or mood disorders
Genetic predisposition
Perfectionism, anxiety traits
Trauma exposure (sexual abuse association)
Athletes (gymnastics, ballet, wrestling, distance running)
Models, dancers
Type 1 diabetes mellitus (insulin omission)
LGBTQ+ individuals (some increased risk)
Bariatric surgery history
Critical comments about weight or eating
Dieting initiation
Cultural emphasis on thinness
Social media exposure
ADHD (binge eating disorder)
Obesity (binge eating disorder)
Obsessive-compulsive personality traits
Autism spectrum (ARFID)
Pediatric food selectivity history (ARFID)

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Significant weight loss or restrictive eating
  • Binge eating episodes
  • Purging behaviors
  • Body image distress
  • Excessive exercise with weight loss
  • Amenorrhea in adolescent
  • Failure to gain weight in growing adolescent
  • Cardiac symptoms (palpitations, fatigue, syncope)
  • Electrolyte abnormalities
  • Type 1 diabetes with insulin omission
  • Severe distress about eating or weight
  • Family concerns
  • Comorbid depression, anxiety, self-harm with eating concerns
  • Failed prior treatment

Treatment Methods

01
Comprehensive multidisciplinary evaluation: psychiatry, pediatrics or internal medicine, nutrition, psychology, family therapy
02
Detailed history including eating behaviors, weight history, exercise, purging, comorbidities
03
Physical examination including vital signs, BMI, growth chart in pediatric patients
04
Laboratory workup: CBC, comprehensive metabolic panel including phosphorus and magnesium, ECG, urinalysis, TSH, vitamin D, B12
05
DEXA scan for bone density (anorexia)
06
Pregnancy test in females
07
Suicide risk assessment
08
Determine level of care: outpatient, intensive outpatient, partial hospitalization, residential, inpatient
09
Medical stabilization (fluid, electrolyte correction, nutritional rehabilitation, refeeding syndrome prevention)
10
Family-Based Therapy (FBT, Maudsley method) for adolescents with anorexia or bulimia within 3 years of onset — first-line
11
Cognitive behavioral therapy enhanced (CBT-E) for older adolescents and adults with all eating disorders
12
Interpersonal psychotherapy (IPT) alternative for binge eating disorder
13
Dialectical behavior therapy (DBT) for emotion regulation
14
Adolescent-focused therapy (AFT) alternative for anorexia
15
Specialist supportive clinical management (SSCM)
16
Body image work, mirror exposure
17
Nutritional rehabilitation with weight restoration goals
18
Refeeding syndrome prevention with phosphorus, thiamine, careful caloric increase
19
Hospitalization for medical instability (heart rate <40, hypotension, hypothermia, electrolyte derangement, BMI <15, rapid weight loss)
20
Fluoxetine 60 mg daily for bulimia nervosa
21
Lisdexamfetamine 30-70 mg daily for binge eating disorder
22
Olanzapine 2.5-10 mg for anorexia (limited evidence)
23
Treatment of comorbid depression, anxiety, OCD, PTSD
24
Avoid bupropion in eating disorders (seizure risk)
25
Cautious medication management in low BMI
26
Bone health: calcium, vitamin D, weight restoration; bisphosphonates only in adults with established osteoporosis
27
Estrogen replacement controversial in adolescent anorexia (does not improve bone health independent of weight)
28
Hospitalization for severe behavioral dyscontrol or treatment failure
29
Long-term follow-up: high recurrence risk
30
Specialty eating disorder programs (residential, partial hospital) for treatment-resistant cases
31
Multidisciplinary care: psychiatry, nutrition, primary care, family therapy, peer support

Which Department to Visit?

You can visit our Psikiyatri department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

Learn About Psikiyatri Department

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.