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Innovations and new directions in family-based treatment of eating disorders.
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Family-based treatment: Innovations and new directions
Renee Hoste, Ph.D.Assistant Professor of Psychiatry
Daniel Le Grange, Ph.D. Professor of Psychiatry
Anorexia NervosaAnorexia Nervosa
FBT = 1st line treatment
FBT = 1st line treatment
??
Where are we today after 25 years of research?
Where are we today after 25 years of research?
Young Adults with
AN
Young Adults with
AN
Bulimia Nervosa
Adolescent Overweight
Some signals in favor of FBT
and CBT
?
???
Adolescent Anorexia Nervosa(Lock & Le Grange, 2011)
Part 1
4
Family-Based Treatment for AN
Developed in London at the Maudsley Hospital (1980s), continued refinement there, the US, Canada, and Australia
First line treatment for medically stable children and adolescents with AN
Outpatient treatment to restore weight and return adolescent to developmental track
Team approach, i.e., parents, therapist, pediatrician and psychiatrist
Three Phases of FBT-AN
Anorexia NervosaAnorexia Nervosa
FBT = 1st line treatment
FBT = 1st line treatment
Non-responders?Non-responders?
Where are we today after 25 years of research for AN?
Where are we today after 25 years of research for AN?
Parent/Sibling Role?Parent/Sibling Role?
Role of Medication?Role of Medication?
More intensive FBTMore intensive FBT
MGFT, Reg FT, PFTMGFT, Reg FT, PFT
Olanzapine or other meds?Olanzapine or other meds?
Adolescent Bulimia Nervosa(Le Grange & Lock, 2007)
Part 2
Family-Based Treatment for BN
Adapted from AN treatment manual (Lock, Le Grange, et al., 2001)
Twenty sessions over six months
Concomitant management of medical and comorbidity needs
Three Phases of FBT-BN
Specific Challenges in FBT-BN
Developmental stage of BN adolescents
Secretiveness (shame and guilt) of BN
Bulimic symptoms can elicit criticism
Ego-dystonic nature of BN
Comorbidity and BN
Heterogeneity of BN
How is FBT different for BN?
Treatment is more collaborative (developmental stage + egodystonic)
Focus on bulimic symptoms can be a challenge (comorbidity)
Greater flexibility/creativity on the part of the therapist required (heterogeneity)
Emphasis on regulating food intake, and curtailing binge/purge behavior (secretiveness)
How is FBT different for BN?(continue)
Family meal in BN Help adolescent eat regular meal Include food that typically triggers
binge Explore adolescent’s feelings around
urges to binge and purge
FBT-Y for young adults with AN
Chicago Treatment Development(Le Grange & Chen)
Part 3
How does FBT-Y differ from FBT-AN?
Collaborative approach Family of choice Developmental issues Time with patient
Operational Mechanisms for FBT and FBT-Y
FBT-Young Adults
Case series (Chen, Le Grange et al., 2010)
Treatment development
Two iterations of 6 patients (N=12)
Open trial (N=20)
FBT for Pediatric Overweight
Chicago & Mt Sinai Treatment Development
(Loeb & Le Grange)
Part 4
Adolescent Anorexia Nervosa
Phase 1 Phase 2 Phase 3
Very underweight Healthy weight
All ages
Weight Status
ParentalControl
Very underweight Healthy weight
Pediatric Overweight
Child
Pre-Adolescent
Adolescent
WeightStatus
ParentControl
Overweight Healthy weight
Phase 1 Phase 2 Phase 3
Anorexia NervosaAnorexia Nervosa
FBT = 1st line treatment
FBT = 1st line treatment
Non-respondersNon-responders
Where are we today?Where are we today?
Young Adults with
AN
Young Adults with
AN
Bulimia Nervosa
Adolescent Overweight
Signals in favor of FBT and
CBT
Multi-Site Study
Treatment Dev Study
Treatment Dev StudyTreatment Dev Study
Parent/Sib RoleParent/Sib Role
MedicationMedication
Recruitment at Chicago
www.eatingdisorders.uchicago.edu
773-834-5677
