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February 19, 2013

What Might Family-Based Treatment Suggest About Eating Disorder Treatment for Adults?

Re-posted from the Cleveland Center for Eating Disorders (CCED) blog archives and updated with additional Emily Program client thoughts. CCED and The Emily Program partnered in 2014. Contributions by Sarah Emerman.

In the field of eating disorders, multiple studies have shown that Family-Based Treatment (FBT) is the most effective method available to achieve successful weight restoration and maintenance after treatment is completed. Unfortunately, specific treatments for adults have not been shown to have the same long-term benefits as FBT. Clearly, there are many variables involved in this data, however, there are elements to FBT that may point us to a better understanding of what happens for adults.

FBT has 3 distinct phases: refeeding, transition of control from family back to the patient, and addressing normal adolescent issues. All of this happens while the adolescent is in the (hopefully) safe confines of their family. For adults, intensive treatment often stops after refeeding and cessation of behaviors, which would be considered only phase 1 of FBT. It often happens that an adult client is stepped down to a lower level of care from a hospital, residential facility, or partial hospitalization program once refeeding is complete. Step down may be indicated, as a lower level of care may provide more freedom and a chance for a more fulfilling life. The step-down may also be precipitated by insurance concerns or issues related to food, work, or family, as opposed to the completion of treatment. Unfortunately, a potential result of early step-down is that a slow transition to feeding oneself may not occur. Adult patients may find themselves having achieved a healthy weight and have strong motivation and commitment for recovery, but have decreased support around eating and have difficulty with their ability to generalize the skills they have learned in treatment.

FBT clinical experience suggests the treatment for an eating disorder may take years. After refeeding is done, significant external accountability, consultation, management, and therapy are necessary to maintain a healthy weight, motivation, and physical safety. Without a good treatment team and a supportive community maintaining recovery is very difficult. Our hope for any individual with an eating disorder is not only that they achieve goal weight, but that they achieve the ability to feed themselves and that they are able to fight against eating disorder thoughts and urges. There will be many bumps in the road and many obstacles that may emerge. However, if a long term plan, which will likely extend many years, is developed, that will help patients eat well, have a supportive community, feel better about themselves, their bodies, and their ability to live the life they are striving for, that health and recovery can be achieved.


Mark Warren, MD

Dr. Mark Warren is the Chief Medical Officer for The Emily Program and Veritas Collaborative. He is also one of the original founders of the Cleveland Center for Eating Disorders, which became The Emily Program – Cleveland in 2014. A Cleveland native, he is a graduate of the Johns Hopkins University Medical School and completed his residency at Harvard Medical School. He served as Chairman of the Department of Psychiatry at Mt. Sinai Hospital and Medical Director of University Hospital Health System’s Laurelwood Hospital. A past vice-chair for clinical affairs at the Case School of Medicine Department of Psychiatry, he continues on the Clinical Faculty of the Medical School, teaching in both the Departments of Psychiatry and Pediatrics. He is currently a faculty member and former chair of the Board of Governors at the Gestalt Institute of Cleveland. Dr. Warren is a Distinguished Fellow of the American Psychiatric Association, a two-time recipient of the Exemplary Psychiatrist Award of the National Alliance for the Mentally Ill, and a winner of the Woodruff Award. He leads the Males and Eating Disorders special interest group for the Academy of Eating Disorders.

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