Treatment of Eating Disorders in Children and Adolescents
Are Eating Disorders Treatable?
Eating disorders can be successfully treated by clinicians with specialized knowledge and training. Children and adolescents, in particular, often have excellent responses to the evidence based treatments identified below.
What Are the Types of Psychotherapies Used to Treat Eating Disorders in Children and Adolescents?
Family Based Treatment
Family Based Treatment (FBT) was specifically developed for use in children and adolescents and has a remarkable body of evidence to support its use. FBT is an approach that empowers the parents and/or caregivers to reclaim control of a young person’s eating habits in order to prevent the eating disorder from causing the young person to starve, binge, or purge. While this requires immense efforts on the part of the family, a skilled clinician will coach the family members to find ways of harnessing the power of their unparalleled commitment to and knowledge of the young person. Families learn to treat the eating disorder much the same way they would treat cancer, diabetes, or any other high risk illness: treatment is non-negotiable and takes top priority, with each family member playing an important role. By restoring physical health and normalizing eating behaviors, the young person also begins to improve psychologically and can ultimately resume the process of moving towards adulthood and greater independence. The efficacy of FBT makes it first line treatment for most young people with eating disorders, but is particularly indicated for anorexia nervosa, for which other treatments are less effective.
Cognitive Behavioral Therapy
Cognitive Behavioral Therapy (CBT) refers to a wide range of protocols that treat various mental disorders through a combination of behavioral and cognitive interventions. CBT is based on the insight that thoughts, feelings and behaviors all impact one another. Therefore, a successful treatment needs to target each one in order to achieve lasting change. In CBT protocols for eating disorders, the eating disorder behaviors (excessive exercise, restricting, starving, binging, etc) are targeted alongside the cognitive core of the illness, which usually involves placing excessive importance on one’s appearance. In CBT treatment for ￼ARFID, the treatment focuses on addressing the restrictive eating behaviors alongside whatever beliefs and/or worries might be driving the young person to avoid certain foods, textures, or eating experiences. Since low weight and/or nutritional deprivation usually worsen anxiety, rigidity, obsessional thinking, and preoccupation with food, CBT protocols first stabilize physical health and eating habits. This allows the young person to achieve more cognitive flexibility before the cognitive interventions become a central focus of treatment. CBT has been proven as effective for eating disorders and often appeals to young people with the maturity and motivation to engage in this highly collaborative approach. Between session assignments guide patients in changing their behavior and undermine the thoughts and beliefs that would otherwise maintain the eating disorder’s influence and power.
Dialectical Behavior Therapy and Acceptance and Commitment Therapy
Dialectical Behavior Therapy (DBT) and Acceptance and Commitment Therapy (ACT) are both newer interventions that developed out of the CBT tradition but incorporate significant attention to ideas like acceptance and present moment awareness. These treatments have often been referred to as the “third wave” of behavioral therapy. DBT is specifically geared towards the development of skills that allow individuals to be mindful, interpersonally effective, emotionally regulated, and able to tolerate intense emotion. ACT works to help individuals clarify their values and align their behavior with these values in spite of discomfort and pain.
Research regarding the efficacy of ACT and DBT for eating disorders is still limited but promising. Additionally, ACT is an evidence based treatment for depression, anxiety, pain, and OCD, while DBT is an evidence based treatment for Borderline Personality Disorder. They are, therefore, proven treatments for some of the most common disorders that co-occur with eating disorders. For individuals dealing with eating disorders and these common comorbidities, an ACT or DBT based approach can be a powerful way to approach change. DBT and ACT have both been carefully adapted for use with children and adolescents.
How Long Will My Child or Adolescent Need to be in Therapy?
One of the unique challenges with eating disorder treatment and recovery is that once eating behaviors start to improve there is typically a delay in relief from some of the psychological symptoms such as preoccupation with appearance, fear of weight gain, and obsessive thinking about food. Therefore, therapy is most successful when a patient remains in treatment long enough to experience improvements not only in their eating habits and physical health but also in the severity of their psychological symptoms. The timeframe for psychological improvements is often related to the duration of the illness, with children and adolescents who have only recently become ill typically making the fastest progress. Nevertheless, sometimes even children and adolescents with anorexia nervosa, for example, need 6 to 12 months before their thoughts and feelings start to “catch up” and normalize alongside their improved weight and behavior. A skilled clinician will make an individualized recommendation for when to end treatment and how to maintain the progress a child or adolescent has made.
What are Lifestyle Strategies That Can be Used to Treat Eating Disorders in Children and Adolescents?
In addition to specific therapeutic interventions, some general lifestyle guidelines may help families as they work to help a child or adolescent recover from an eating disorder. The more flexibility parents and caregivers can model the better. Adults must remember that while most children and adolescents might experiment with dieting without significant consequences, for those with eating disorders even small restrictions often lead to more extreme behaviors and become self reinforcing. Additionally, just as a parent might hope that his or her children would see themselves as successful due to a range of qualities, that same parent can make an effort to praise his or her children for their character, their determination, or their kindness, rather than focusing on appearance. This can help young people refrain from placing additional emphasis on fitness, size or shape, which are already so heavily attended to in this culture. Other specific lifestyle recommendations often include limiting the frequency of weight checking and choosing exercise that is social and focused on pleasure and health rather than changing body shape or weight. While some of these guidelines may become more flexible over time, it is often important to bring these principles into everyday life during the initial phase of treatment.