Young adults with anorexia: family-based treatment for 17-25 year olds

Last updated on April 27th, 2021

Are you wondering if family therapy is suitable for your young adult with anorexia?

We're in a crazy situation where the minute someone turns 18, the gold-standard treatment for eating disorders gets ditched.

That's because the family-based treatment model has not yet been put to much research in adults.

So I pounced on one bit of research on a variant of family-based treamtent (FBT) applied to 'Transition Age Adults (TAY)', defined as 17 to 25 years old.

This makes sense to me. There are plenty of accounts of older adults benefiting from support from their parents. I hope that one day, the involvement of family members will become a standard treatment option: suitable for many, whatever their age.

Currently the eating disorder treatment available to individuals aged 18+ is almost exclusively via individual therapy, with parents or partners kept firmly at bay. For some eating disorders, there is also group therapy, but again, parents or partners are excluded.

Through weekly appointments, the person is expected to find motivation and insight, which, the theory goes, will eventually enable them to nourish themselves, gain weight if required, stop purging, stop over-exercising, stop bingeing. When individuals don't manage all this and deteriorate, hopefully they get access to a higher level of care ( hospital / residential / day-hospital treatment etc). Upon discharge, the person may not be able to continue the recovery work, and the cycle starts all over again.

In this model, parents or partners can only watch and suffer.

Far from being empowered to support the person with the eating disorder, they have been instructed not to get involved, to let the person 'take ownership of their recovery', to 'take responsibility' for themselves. If they try and help, they may get branded as enmeshed, over-controlling, co-dependent…. just like parents of teens, before research showed that youngsters with an eating disorder can really benefit from their parents' involvement.

I believe people, whatever their age, need skilled support from people who love them. Parents and partners must be empowered by therapists, because they are facing someone whose illness creates ambivalence about getting help. And they need coaching because it's an extremely skilled task.

If you think you can't possibly take charge of your son or daughter's eating because they are older and are used to a high level of autonomy, then FBT-TAY (family-based treatment for transition-age youth) may be the answer. It's an adaptation of FBT, where with a therapist's help, the young person takes on a little more ownership of their treatment. This works if they agree, at least in principle, to have their parents' help. When they waver, the therapist helps renew the agreement.

For more on this, head over to my article on mirror-mirror here.

Mirror-Young adults anorexia family therapy

It summarises findings in a chapter of this excellent book (which all clinicians should have). More research from Gina Dimitropoulos, Kristen Anderson, James Lock and Daniel Le Grange is due to be published. Sign up for emails from me for news.

For more on supporting an adult with an eating disorder using a family-based approach

Head over to Tabitha Farrar's excellent resources for adults (podcast, YouTubes, blog, books).

Read Modified Family-Based Treatment for the Young Adult by therapist Sarah Wells

Read a fantastic first-hand account by 40-year old Helen, who got her parents to help her recover.

Check out @recovering_nomad on Instagram

For a review of the research on treatment for adults, see Glenn Waller (2016), ‘Recent advances in psychological therapies for eating disorders

I say a little more on the treatment of adults or 18+ here

4 Replies to “Young adults with anorexia: family-based treatment for 17-25 year olds”

  1. I did not like the comment referring to nurses helping people to gain weight just like the parents could have done much earlier at home. This is ignorant to the fact that parents have tried absolutely everything to get their child to eat and certainly would not want to put their child in hospital unless they were absolutely desperate to get their child nourishment in any way possible. My child became violent and threw every food item across the room that I offered, for over 2 weeks yet she would eat a banana at clinic appointments.I was at my wits end . Sometimes you need others to intervene as you could be too emotionally involved. It’s heart wrenching for parents to see their child starve themselves.

    1. Dear Jan, a quick reply before I take some time to re-word that sentence, and I'm glad you flagged it up. I agree with what you say, totally, and I believe I know much of the pain behind it. I had a similar experience, when we could not get our 10-year old to eat or drink. The hospital was absolutely necessary and saved her life (within an hour of admission she's accepted a packet of crisps/chips and a glass of milk from the nurses). So I'm with you. I need to reword the paragraph as my point is to do with the missed opportunities when parents are firmly told to back off when their child is 18+ I know it is painful to be judged for having a kid in hospital, and in some places, hospitals are wrongly labelled with being useless or harmful. So I want to be clear for readers here that even with all the parent skills and tips we can share (which is why I wrote my book) there are always some people who are hit so hard by an eating disorder that they do need a spell in hospital, and it's life-saving. Then the work at home resumes.
      Jan if you see anything else that is insensitively written please let me know!

  2. Oh dear, it sounds awful. It is really common for children who were very close to reject us big-time when an eating disorder is affecting so many of their thoughts and emotions. Often they seem to reject most the person they were the closest to, that they felt the safest with (who will not abandon them), maybe the person who normally puts food on the table and who has been asking them to eat. I wrote about this in detail in Chapter 14. The main thing is, as the eating disorder recedes, our children become very close again. Maybe this will give you hope.

  3. My daughter has been in hospital 4 3 months – prior to my getting her treated we got on well. Now she is going to live with my mother in law who has verbally abused me. She has totally withdrawn from me – is this anorexic or teenage behaviour? I live in Australia with no family support.

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