Anorexia Nervosa in Adolescents: FBT, Support and Recovery

Having worked within the multidisciplinary team in CAMHS Grampian, I’ve witnessed firsthand the devastating impact of Anorexia Nervosa on young people and their families. As part of my role, I supported adolescents undergoing Family-Based Therapy (FBT), helping them navigate the overwhelming reality of refeeding, hospital admissions, and the weekly monitoring of vitals—often a stark reminder of just how fragile their bodies had become. I’ve sat with parents as they struggled to recognise their own child beneath the illness, watched as Anorexia chipped away at personalities, turning bright, loving young people into withdrawn, distressed shadows of themselves. I’ve seen how it tests everything—family bonds, patience, resilience, and hope.

Beyond the medical aspects, I’ve also worked closely with both young people and parents on a psychological level. I’ve provided meal support during some of the hardest moments of FBT, offered counselling to those grappling with the intense emotions of the process, and helped families understand how to respond to the outbursts, fear, and anger that Anorexia provokes. One of the most important strategies I encouraged was externalising the illness—helping young people and their families see Anorexia as a separate entity, an unwelcome intruder that must be challenged rather than a flaw within the person themselves. Giving it a name, a character, something to fight against, can be a powerful tool in reclaiming autonomy from the disorder.

I am writing this blog post not just as a professional, but as someone who has stood beside families in the trenches of this battle. I have witnessed the horrors of Anorexia, but I also know that recovery is possible. My hope is to share insight into how FBT works, why it is effective, and how additional support—through counseling and a strong medical team—can make a profound difference in the journey to healing.

Let's have a look together at the peer-reviewed research that's out there!

Understanding Anorexia Nervosa and Family-Based Therapy (FBT)

Anorexia Nervosa is a severe psychiatric disorder that is life threatening and disabling [1]. It is characterised by self-imposed starvation and excessive weight loss. It significantly impacts physical health, leading to complications such as cardiovascular issues, bone density loss, severe malnutrition and cognitive impairments due to brain starvation. These cognitive deficits can affect memory, attention, and decision-making abilities, further entrenching the individual in disordered eating behaviours. The mortality rate associated with Anorexia Nervosa is notably high among psychiatric disorders, underscoring the critical need for effective intervention [2]. Research has shown that early intervention is crucial, as untreated Anorexia can lead to irreversible health complications, including osteoporosis, organ failure, and long-term cognitive deficits due to prolonged brain starvation [3].

Family-Based Therapy (FBT), also known as the Maudsley Approach, has been established as a leading treatment for adolescents with Anorexia Nervosa. FBT involves three distinct phases:

1. Weight Restoration: Parents assume responsibility for feeding their child to restore weight.

2. Returning Control to the Adolescent: Gradual transfer of eating control back to the adolescent.

3. Establishing Healthy Adolescent Identity: Addressing broader issues of adolescent development and identity.

   
   

Multiple studies have demonstrated the effectiveness of FBT in treating adolescent Anorexia Nervosa. Research indicates that weight restoration was achieved by 75% of patients within 12 months, with 46% attaining both normalisation of body weight and behavioural symptoms of Anorexia Nervosa. [4, 5]

When immediate weight gain is paramount, research indicates that FBT is more effective than any other therapy in promoting weight gain and reducing anorexic behaviours in adolescents [6]. However, the process can be challenging for families and young people. Adolescents may experience resistance due to the loss of autonomy over food choices, and families often face emotional and logistical difficulties in managing the intensive demands of the therapy.

The Complementary Role of Counselling and Comprehensive Medical Care

The journey through FBT can be arduous for adolescents [7]. The intensive involvement of parents in meal supervision and the loss of autonomy over food choices can lead to feelings of frustration, resentment, and isolation. Moreover, the nature of Anorexia Nervosa often includes a strong denial of the illness and an aversion to weight gain, making the demands of FBT particularly challenging.

While FBT focuses on the family's role in refeeding and behaviour modification, integrating counselling and medical oversight can be helpful for holistic treatment [8]. Counselling provides a platform for adolescents to explore underlying emotional issues, develop coping strategies, and address comorbid conditions such as anxiety or depression [5]. However, due to the cognitive impairments caused by malnutrition, initiating counselling too early may be less effective. It is often beneficial to introduce therapeutic interventions after some weight restoration has occurred, allowing for improved cognitive function and receptivity to psychological treatment.

Comprehensive medical care is vital throughout the treatment process. A multidisciplinary team—including nurse specialists, psychiatrists, and dietitians—should monitor the adolescent's physical health, manage medical complications, and ensure nutritional needs are met. This integrated approach addresses both the physiological and psychological aspects of Anorexia Nervosa, providing a more robust framework for recovery.

The intensive nature of FBT can also place significant emotional and psychological strain on parents, siblings, and other caregivers [7]. Individual counselling for family members can offer essential support, helping them process their emotions, develop effective coping strategies, and maintain resilience throughout the treatment journey. This support system is crucial, as a well-supported family can better contribute to the adolescent's recovery process.

Conclusion: Embracing a Holistic Approach for Recovery

Anorexia nervosa profoundly affects both the mind and body of young individuals. While Family-Based Therapy offers a solid foundation for treatment by involving the family unit, the incorporation of counselling and comprehensive medical care can enhance the effectiveness of the intervention. A holistic approach that combines these elements provides the best chance for recovery, addressing the complex interplay of physical health, cognitive function, and emotional well-being in adolescents battling Anorexia Nervosa.

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I am open to new clients! 

I specialise in supporting individuals who suffer from eating issues as well as their loved ones. Get in touch to book a free phone consultation or an initial session.

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References

[1] Treasure, J., Duarte, T. A. and Schmidt, U., (2020). Eating Disorders. The Lancet, 3959(10227), 899–9.

[2] Arcelus, J., Mitchell, A. J., Wales, J. and Nielsen, S., (2011). Mortality rates in patients with anorexia nervosa and other eating disorders: a meta-analysis of 36 studies. Archives of general psychiatry, 68(7), 724-731.

[3] Westmoreland, P., Krantz, M. J., and Mehler, P. S., (2016). Medical complications of anorexia nervosa and bulimia. The American journal of medicine, 129(1), 30-37.

[4] Bentz, M., Pedersen, S.H. and Moslet, U., (2021). An evaluation of family-based treatment for restrictive-type eating disorders, delivered as standard care in a public mental health service. J Eat Disord, 9, 141.

[5] Oshukova, S., Suokas, J., Nordberg, M. and Algars, M. (2023). Effects of family-based treatment on adolescent outpatients treated for anorexia nervosa in the Eating Disorder Unit of Helsinki University Hospital. J Eat Disord 11, 154.

[6] Austin, A., Anderson, A. G., Lee, J., Steen, H. V., ..., Dimitropoulos, D., (2025). Efficacy of Eating Disorder Focused Family Therapy for Adolescents With Anorexia Nervosa: A Systematic Review and Meta-Analysis. International Journal of Eating Disorders, 58, 3–36.

[7] Medway, M and Rhodes, P., (2016). Young people’s experience of family therapy for anorexia nervosa: a qualitative meta-synthesis. Adv Eat Disorders, 4(2),189–207.

[8] Lock, J., Le Grange, D., Agras, W. S., Moye, A., Bryson, S. W., and Jo, B., (2010). Randomized Clinical Trial Comparing Family-Based Treatment With Adolescent-Focused Individual Therapy for Adolescents With Anorexia Nervosa. Arch Gen Psychiatry, 67(10), 1025–1032.