Family-Based Therapy: An Opportunity in Eating Disorder Treatment
According to the American Psychiatric Association, up to 5% of people have an eating disorder. In most cases, these disorders start in a person’s youth or young adulthood. During this time, an eating disorder can affect not only a child’s health but also their development and school or work performance. It’s a situation that can leave parents and loved ones feeling powerless.
Family-based treatment (FBT), or family-based therapy, is an evidence-based approach used to help young people with eating disorders on their path to recovery—and help their families become part of the recovery process.
“FBT is an outpatient behavioral approach focused on weight restoration and normalization of eating. It’s the treatment of choice for pediatric eating disorders,” explains Christina Tortolani, a psychologist and educator who specializes in eating disorders and family-based treatment.
Tortolani is by no means alone in her stance on FBT. For those interested in this approach, here is what to know about the disorders it can treat, the treatment process itself, and the research backing it.
Understanding Eating Disorders
Before learning how family-based therapy can support a child’s eating disorder recovery, it can be helpful to learn more about eating disorders themselves. Following are overviews of the different types of eating disorders, how they often present themselves, and some of the other issues that occur among people with an eating disorder.
Types of Eating Disorders
Broadly speaking, eating disorders are defined as unhealthy relationships people have with food. These relationships typically involve compulsive habits related to eating that negatively affect the person’s physical health, mental health, or life in general. Sometimes, an eating disorder is more about a person’s relationship with their body or weight than their relationship with food.
The broad term “eating disorder” encompasses many different but related disorders. Here are a few common examples.
Anorexia Nervosa
Anorexia nervosa, often referred to as simply anorexia, is a condition in which a person attempts to keep their body weight as low as possible, often by restricting their food intake. People with anorexia may also exercise compulsively or take laxatives to avoid weight gain.
Bulimia Nervosa
A person with bulimia typically eats large amounts of food all at once, then induces vomiting or takes laxatives to get rid of it. This cycle is called bingeing and purging and can cause many serious health problems.
Binge Eating Disorder
Like bulimia, a binge eating disorder (BED) is defined by periods of overeating. The main difference is that those experiencing BED do not necessarily purge afterward. Feelings of guilt, shame, and loss of control are common with BED, meaning it can be just as dangerous to a person’s mental and physical health as cycles of bingeing and purging.
Avoidant Restrictive Food Intake Disorder
Avoidant restrictive food intake disorder (ARFID) is similar to anorexia in that the person severely restricts their food intake. But instead of harboring compulsions about their weight or body, a person with ARFID is sensitive to the textures, tastes, or smells of certain foods; fears choking or vomiting; or is generally uninterested in food at all. This eating disorder often occurs among children and those with autism spectrum disorder. It goes beyond picky eating and can result in serious nutrient deficiencies.
Co-occurring Disorders
Eating disorders often occur alongside other mental health issues. These issues are called co-occurring disorders, and one disorder can make the other worse. For people with co-occurring disorders, both disorders need to be treated.
According to a 2024 study published in General Hospital Psychiatry, more than half of people with eating disorders have been previously diagnosed with a mental health disorder. Mental health issues that often occur alongside eating disorders include:
- Depression
- Anxiety
- Obsessive-compulsive disorder
- Body dysmorphia
- Substance use disorder
- Post-traumatic stress disorder (PTSD) and other trauma-related issues
Eating disorders can also cause a number of physical problems that may require an added layer of treatment. These include gastrointestinal problems, heart disease, diabetes, and chronic vitamin deficiency.
“Physiologically, eating disorders impact the body head to toe and can lead to dangerous medical complications such as a low heart rate and blood pressure shifts,” Tortolani says of the physical ailments that often afflict those with eating disorders. “These are signs of the effects of starvation on the brain and body.”
More Information About Eating Disorders
To learn more about eating disorders, co-occurring symptoms, and other topics, explore the information provided by these sources:
- National Association of Anorexia Nervosa and Associated Disorders, Eating Disorder Statistics: Data about eating disorders among children, men, women, and other groups
- National Association of Anorexia Nervosa and Associated Disorders, “The Link Between Eating Disorders and Substance Use”: An in-depth guide to how eating disorders and substance use interact
- National Eating Disorders Association, Warning Signs and Symptoms: Information about recognizing an eating disorder in a loved one
- National Eating Disorders Collaboration, Types of Eating Disorders and Related Experiences: Information about many types of eating disorders and other topics such as neurodivergence, co-occurring disorders, and fertility care
- Eating Disorder Foundation, About Eating Disorders: Health Consequences: Health issues associated with specific eating disorders
What Is Family-Based Therapy? The Why, What, and How
Family-based therapy is an outpatient approach to eating disorder treatment that takes place mostly in a child’s own home. While a mental health professional is involved at every stage of treatment, the child’s parents and caregivers play an active role in the child’s recovery. Over the years, FBT has become the gold standard for eating disorder treatment.
The Five Main Principles of Family-Based Therapy for Eating Disorders
FPT is often personalized to treat a specific patient’s unique circumstances, but the process is grounded in five main principles. These principles address how eating disorders are approached and give families a framework for helping their loved ones recover.
1. An Impartial Perspective on the Causes of an Eating Disorder
In family-based treatment, parents and mental health professionals do not attempt to investigate the underlying causes of the child’s eating disorder. This isn’t because those causes are not important, but because getting a child healthy can help them become an informed advocate for their own health later in the process.
2. A Focus on Initial Symptoms and Behaviors
With the focus taken off underlying causes, it is instead directed at the disorder-related symptoms and behaviors currently being exhibited by the child. The goal of the treatment is to reduce and eliminate these two things and replace them with behaviors focused on health restoration and full nutrition.
3. Family Responsibility for Addressing Behaviors and Symptoms (Family Empowerment)
In most types of treatment, a mental health professional is responsible for helping the patient eliminate their maladaptive behaviors. However, in the context of FBT for eating disorders, the family is empowered to provide nutritious food and help ensure the child does not restrict their food intake, binge, or purge. This might also include setting goals for healthy weight gain or loss.
4. Nonauthoritarian Stance of the Therapist
In FBT, the parents and caregivers are seen as the experts on their child. A mental health professional such as a therapist is typically involved, but, instead of leading the process, they act as a consultant. They provide input, support, and guidance as needed.
5. The Separation of the Child and the Eating Disorder (Externalization of the Illness)
Eating disorders often come with stigma and judgment—from family members, the world at large, and even the child themself. To circumvent this issue, family-based treatment emphasizes that the disorder is an outside force, not a part of the child or their character.
The Three Stages of Family-Based Therapy for Eating Disorders
While family-based therapy plans can vary based on the situation, the process itself is divided into three main parts: parent-led eating interventions, the handing of control back to the child, and ongoing developmental and recovery support.
“Something about FBT immediately resonated with me,” Tortolani says about learning of the process. “It just made sense to think about food as medicine, to separate the illness from the person, and to empower parents to help renourish their child’s body and brain.”
This process is often carried out over the course of six months to a year. In that time, the family and child meet with their consulting mental health professional regularly, typically once a week or more as needed.
Stage 1. Parent-Led Weight Restoration
During this time, parents and caregivers are in full control of their child’s eating routine, so behaviors such as binging and purging can begin to be removed from the child’s routine. A mental health professional can help families decide what rules, restrictions, and goals (such as weight gain or loss) are appropriate.
Stage 2. Handing Control Back to the Child
Once a child has eliminated their disorder-related behaviors and become more healthy and receptive to the changes, parents can begin giving them more control over their eating routines. For example, a child might be allowed to eat outside of the regularly scheduled times or eat out with friends. Families may have to retain some authority at different points, and setbacks are an expected part of the process at this stage.
Stage 3. Ongoing Developmental and Recovery Support
When a child has successfully gained independence over their eating habits and become healthier, the family, child, and mental health professional can work together on other issues such as co-occurring disorders and family relationships. At this point, the child is empowered to take an active part in their recovery and focus on their development and relapse prevention.
The Research Behind Family-Based Therapy
According to an overview of family-based therapy research published in Frontiers in Child and Adolescent Psychiatry in 2026, this approach has roots in similar treatments created in the early 1970s. Since then, researchers have conducted numerous studies on FBT and found it to be one of the most effective forms of eating disorder treatments among adolescents and young adults.
In their analysis of FBT research, the authors found that 80% of adolescents who engaged in this approach reached clinically healthy weights in a year or less. They also found that about half of the adolescents saw the full elimination of all signs and symptoms of their eating disorders.
More Research on Family-Based Therapy for Eating Disorders
To learn more about what current research says about family-based therapy for eating disorders, read these studies and, if possible, discuss them with a mental health or eating disorder treatment professional:
Plan for Long-Term Success in Eating Disorder Recovery
For many people, family-based therapy is only one aspect of their eating disorder recovery. Before an individual starts FBT, it may be helpful for them to enroll in an inpatient or partial hospitalization program. After they complete the therapy, joining a support group, seeking individual counseling, or enlisting the help of a nutrition professional can support their long-term success.
Here are a few resources to help families affected by eating disorders learn more about recovery, create a treatment plan, and connect with informed professionals who can help along the way:
While an eating disorder is a complex issue, the right support structure and family-based treatment can provide a path to a healthier, happier future.