Tag Archives: anorexia nervosa

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Treating Anorexia Nervosa in Teens: The 5 Tenets of FBT

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You may feel confused, scared, frustrated, and maybe even hopeless if your teen has an eating disorder like anorexia nervosa. You have seen your fun-loving and bright teen change drastically, becoming a shell of their usual self. 

There are many types of treatments for eating disorders that work for teens and their families. Cognitive behavior therapy (CBT), dialectical behavioral therapy (DBT), Family-Based Treatment  (FBT), and Acceptance and Commitment Therapy (ACT) are a few of the common treatment modalities that are used in eating disorder recovery. Additionally, there are different levels of care available for those with eating disorders, such as hospitalization, residential, partial hospitalization, or outpatient treatment.

Looking at all of the treatment options for anorexia nervosa in teens may feel daunting.

In this article, the focus is on family-based treatment (FBT), one type of treatment for eating disorders that is used for treating anorexia nervosa in teens. In particular, this article discusses the nuances of family-based treatment, which are referred to as the “Tenets of FBT”. 

The focus of FBT is to empower you, the parent, to provide nutrition rehabilitation and restore your child back to health with the guidance of a treatment team. FBT is an outpatient treatment that can be used in place of residential treatment or partial hospitalization if your teen is medically stable. That means your teen can stay at home during treatment. 

The tenets of Family-Based Therapy guide me as a clinician, and you as a parent, during eating disorder treatment and recovery. When working with families and teens throughout treatment I refer to these guiding principles frequently.

5 Tenets of Family-Based Treatment for Anorexia Nervosa in teens

Agnostic view of the eating disorder

In FBT, the focus shifts from why your teen developed the eating disorder to treating the eating disorder.

Eating disorders are complex disorders and can develop for a myriad of psychological, biological, social, and medical reasons, and beyond. The parents and the teen are not to blame for the eating disorder. I know it may feel like your teen is choosing their eating disorder because they are restricting food or purging, but they are not.

Additionally, parents don’t cause eating disorders-so let yourself off the hook.

How this is helpful:

It reduces blame, guilt, and shame for the teen, as well as their parents. It focuses on stopping the eating disorder in its tracks, restoring your teen’s health, shortening the length of illness, and preventing the eating disorder from becoming chronic. 

This is similar to if you found out you had cancer. You or your doctor initially wouldn’t spend a lot of time figuring out why you have cancer but rather focus on how to treat the cancer. Treatment for an eating disorder is similar, including for anorexia nervosa in teens.

Externalization of the illness

Externalization of the illness is a tool to understand that the eating disorder is separate from your teen. Although it may appear on the surface that your teen is refusing food, it is the anorexia that causes the food refusal. 

Externalization is commonly utilized in the treatment of OCD, schizophrenia, and other mental health conditions. 

How this is helpful:

This helps families understand how to separate their loved one from their eating disorder which can reduce blame and shame. The spirit of treatment feels more like us (family and teen) vs. the eating disorder, in contrast to parents vs. the teen. FBT helps you call on your years of parental experience and wisdom to help heal your child.  This can often increase parental empowerment leading to more successful nutrition rehabilitation.

An increase in connection between parents and teen is what I have observed when working with families during eating disorder treatment. Increased connection can contribute to improved physical and mental health for the whole family.

The therapist takes a non-authoritarian stance

In traditional adolescent-focused therapy, the therapist works predominantly with the teen, and the therapist is leading the treatment. In contrast, in FBT, the therapist acts more like a coach.

“The therapists are experts on eating disorders and parents are experts on their family and teen,” is something I learned during my training in FBT.  This lends itself to high amounts of collaboration between the therapist and family. Additionally, FBT utilizes the strengths of the teen to help aid in the healing process.

How this helps:

FBT is “not a one size fits all approach” to treating anorexia nervosa in teens. In Family-Based Treatment, the therapist activates the problem-solving skills of the family.

In other words, the therapist is there to help guide you and your child through recovery – but you know your child best and what has helped them with other struggles in the past. This knowledge is essential as you work together toward recovery.

Additionally, FBT appreciates the uniqueness of each family and their teen including culture, gender, abilities, exceptionalities, neurodiversity, religion, and family values to name a few.

Parental empowerment

Simply put, parental empowerment means that parents feel confident about taking care of their children. Some parents have some experience with feeling empowered with things like setting a curfew, boundaries around school work, and expectations around chores, while others might second-guess their parenting choices. FBT is an opportunity for growth in this area.

One of the tasks of the FBT therapist is to help you harness the skills and confidence that you already have as a parent, and apply them to renourishing your teen. 

How this helps:

Empowered parents can be more effective at renourishing their teen. Since you, as the parent, are in charge of feeding your teen, it reduces distress and second-guessing about what and how much to feed your teen. 

Furthermore, empowered parents provide structure, consistency and boundaries that help children and teens thrive. 

Pragmatic approach

The initial focus of FBT is symptom reduction rather than focusing on why the eating disorder developed. In the case of anorexia nervosa in teens, parents are tasked with the nutrition rehabilitation of their child, similar to the staff at a residential treatment center. This allows the family to stay together during treatment.

How this is helpful:

This approach stops the eating disorder from getting worse, which can lead to medical complications or potentially death. Stopping the eating disorder behaviors will help keep them from becoming habitual for your teen.

One hypothesis for why eating disorders develop is that eating disorders have a function. That is, they are helpful in some way, despite causing physical harm. For example, if someone smokes a cigarette, although the cigarette is physically harmful, it reduces stress for the smoker in the short term. Eating disorders are thought to function in the same way.

In my work, I have witnessed families rally around their teens, and through connection and compassion help their teen develop new skills to manage life stressors so the eating disorder is no longer needed.

Do you have a teen who is struggling with anorexia nervosa? Working with a dietitian  who is experienced in Family-Based Treatment can help. If you are in Texas and interested in working with me, click here to fill out a contact form.

"When Your Loved One Doesn’t Want to Get Better Understanding Anosognosia in Anorexia Nervosa" in white text on a light purple background in the bottom left corner of the graphic. The rest is a stock photo of a white woman sitting on a couch next to a teenage girl, looking concerned. White text in the top left corner reads "www.alisonpelz.com Helping people make peace with food & their bodies."

When Your Loved One Doesn’t Want to Get Better: Understanding Anosognosia in Anorexia Nervosa

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Anorexia nervosa is an eating disorder characterized by severe food restriction, an intense fear of weight gain, and body image disturbance. Anorexia nervosa affects many individuals of all genders, ages, and identities worldwide. 

The consequences of anorexia nervosa can be devastating, both physically and psychologically. However, one of the most challenging aspects of this disorder, particularly for family members and caregivers (and even clinicians!), is the phenomenon known as anosognosia.

What is Anosognosia?

Anosognosia, stemming from the Greek words “nosos” (disease) and “gnosis” (knowledge), refers to a lack of awareness of one’s illness. Anosognosia often can feel and look like denial. 

Denial is a defense mechanism and psychological response to avoid dealing with anxiety or other uncomfortable feelings. In contrast, anosognosia in mental health conditions is better described as a lack of awareness of their own condition.

Anosognosia can affect individuals struggling with bipolar, schizophrenia, eating disorders, and other psychological disorders. 

In anorexia nervosa, individuals may minimize the severity of their condition. They may adamantly believe they are not sick, or that their behaviors are justified, making it incredibly difficult for them to recognize the need for treatment. It can feel like your loved one is being “difficult” and in teenagers it can be especially confusing because during adolescence it is normal for teens to be contrary or contradictory. 

Anosognosia causes a person to be unable to achieve one or more of the following:

  • Accept that they have an illness or disorder.
  • See the signs and symptoms of their condition.
  • Connect their feelings and personal experiences back to that condition. 
  • Understand and agree that the condition is serious and needs treatment.

One of the most dangerous aspects of anosognosia in anorexia nervosa is the individual struggling with insight when the condition becomes life-threatening.

This lack of awareness around a loved one’s illness can further complicate the treatment plan and, many times, prevent treatment from occurring altogether. 

Parents frequently ask me if they should wait for their child to want to recover.

My answer is always no, because I know that anosognosia is most likely operating, and because the devastating effects eating disorders have.

Let’s face it – no teen really wants the devastating effects of an eating disorder. Contrary to popular belief, no one chooses to have an eating disorder.

How Anosognosia May be Affecting You

It’s already difficult enough to observe as a family member or loved one suffers from Anorexia nervosa, but anosognosia can make it incredibly distressing and frustrating. Despite your pleas, watching as your loved one deteriorates physically and emotionally, while they remain unaware of the severity of their condition, can evoke feelings of helplessness and despair.

To best help your loved one, you must recognize that anosognosia is not a choice but rather a symptom of the disorder. 

It is deeply rooted in neurological and psychological mechanisms impairing the individual’s ability to perceive reality accurately. This is completely out of their control, and without professional help,they may be unable to leave behind their problematic and highly dangerous behaviors.

The Role of Brain Connection in Anosognosia

Research suggests that anosognosia in anorexia nervosa may have an anatomical basis. 

Brain imaging studies indicate abnormalities in brain structure and function. According to a study published in the European Eating Disorder Review, up to 80% of individuals with anorexia exhibit some degree of anosognosia.

Malnutrition, a hallmark of anorexia, can lead to significant changes in brain chemistry and structure. This potentially contributes to the development of anosognosia. These neurological alterations can impair the individual’s ability to recognize their illness and hinder their motivation to seek help. This perpetuates the cycle of disordered eating behaviors.

The good news is with nutrition rehabilitation, anosognosia diminishes. 

Navigating Treatment and Recovery

Supporting a loved one with anorexia nervosa requires patience, empathy, and a comprehensive understanding of the disorder. Here are some ways you can help your loved one on their journey to recovery:

Show Compassion and Understanding

When you are speaking to your loved one about their eating disorder, it’s important to approach the conversation with compassion. You want to validate their experiences and avoid judgments, criticism, and shaming.

Encourage Professional Help

Although it may be difficult for someone with an eating disorder to want to receive treatment, it is still important for you to encourage it. Most success is found in early intervention. When the illness is treated, early on, there are often better outcomes than for those struggling without help for years.

Educate Yourself

One of the best things you can do to support your loved one if they are struggling with anorexia and/or anosognosia is to educate yourself on the facts. This should include the common signs and symptoms, possible treatment options, and debunked myths. This information is powerful in helping you better advocate for your loved one and their well-being.

Foster Open Communication

Create a safe and supportive environment where your loved one feels comfortable discussing their thoughts and feelings. Encourage open communication and active listening, allowing them to express themselves without fear of judgment or criticism.

Practice Self-Care

Supporting a loved one with an eating disorder can be emotionally and physically draining. Take care of yourself and prioritize your own well-being, seeking support from friends, family, or mental health professionals if needed.

Be Aware of Triggers

One of the most important things to keep in mind is that even those deep into recovery can and will experience triggers. You can avoid adding to these by educating yourself on avoiding phrases and conversations, such as calorie counts or weight loss.

Expert Eating Disorder Treatment

If you think that a family member, child, or friend of yours is struggling with an eating disorder, it is important to consult a professional. With proper treatment, individuals can overcome their eating disorder and live a healthier life, both physically and mentally.

I am Alison Pelz, a psychotherapist and registered dietitian with over 16 years of experience. I specialize in treating eating disorders in Austin, TX. 

If you or someone you care about is struggling with an eating disorder, don’t hesitate to reach out for help. To learn more about expert eating disorder treatment and schedule a consultation with me today. I am here to help you and your loved ones reclaim their lives and break through the chains of disordered eating.

Are you a clinician? Sign up for my mailing list and CE course!

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4 tips to cope with weight gain in recovery from anorexia nervosa

4 Tips to Cope with Weight Gain in Recovery from Anorexia Nervosa

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Let’s face it – our society gives us strong messages from social media, print media, our schools, and the health care system that weight gain is bad.   Wherever we turn we are given the message that weight gain is a death sentence. (Which, by the way, is not true! If you want to learn more on this subject I highly recommend reading Health at Every Size).

Folks who are in recovery from an eating disorder have a double whammy to contend with.  One of the key features of anorexia nervosa (or really any eating disorder) is the fear of gaining weight. This fear plus societal pressure to look a certain way can make recovery from an eating disorder feel like an uphill battle.

Therefore, if you are in recovery from an eating disorder, it would make sense that you have an intense fear of gaining weight.  However, weight restoration is a must in recovery in order to maintain your physical and mental health.

Helping clients improve body image while restoring weight, nutrition, and health can be the hardest part of the recovery.  But it is possible with perseverance, patience, and hope.

I have gathered some wisdom from around the web from other treatment professionals and those in recovery to help you along with the process.

1. You are gaining weight that you shouldn’t have lost in the first place.

The weight gained in eating disorder recovery isn’t just regular weight gain–it’s weight restoration. You are healing through the weight gain – giving back what you shouldn’t have taken from your body in the first place.

Weight restoration can be complicated and difficult, and shouldn’t be a journey you embark on alone. To better understand the process, read this article on what weight restoration is, what it’s comprised of, and what you should expect when going through it.  It also includes a discussion of particulars you might not be familiar with, like refeeding syndrome (the complication of increasing food intake too quickly) and hypermetabolism (the increased rate of metabolic activity that often comes along with an eating disorder).

It also covers how difficult the process of weight restoration can be in recovery–and why it is critical to not only have a meal plan for weight restoration but a therapist to help throughout the journey.

Read the whole thing here: Working Through the Weight Restoration Phase of Anorexia Nervosa

2.  Accepting weight gain as part of recovery takes time (and lots of it!).

Accepting your body takes time.  In fact, it can be one of the slowest parts of recovery.  The author of this article provides several useful ways to cope with weight gain, including thanking your body!  It is a must read.

Some of the tips covered are:

  • remembering our bodies changes are never as visible as we fear
  • keeping perspective & remembering that the alternative is worse

Read the whole thing here:

5 Ways To Deal With Weight Gain When You Are In Recovery From An Eating Disorder

3.  Fear of weight gain usually reduces as your eating normalizes.

I have seen this in my clinical practice. As clients start to feel better physically because they are feeding themselves more regularly throughout the day, the fear of weight gain can lessen.

As weight gain also naturally redistributes after the initial gain, the prospect of weight gain becomes less overwhelming. Once your body has come out of life-saving mode, the weight you’ve gained back won’t just sit in one place. It will spread across your body, and will not be nearly as visible as someone in recovery might worry about when starting the process.

“Will I gain weight forever?”: What we know about weight trajectory during recovery from an eating disorder

Yes, Weight Gain Is Hard. Thankfully, We Have 8 Ways to Cope With Weight Gain For You

What this article shows us is that the odds of perpetual weight gain after the initial restoration, are actually pretty low. Your body will adjust back to a stable, healthy weight, and for the most part, stay stabilized.

4.  Weight restoration allows you to enjoy life more fully.

“Going to concerts has always been one of my favorite things to do. The atmosphere, the music — I can go on about it for hours. Ever since my eating disorder came to peak, I’d lost this love.”

Dietary restriction and malnutrition often occur pretty slowly, and sufferers from eating disorders may often not notice that their sense of joy and zest for life is blunted and dulled. Without proper nourishment, your body just isn’t able to sustain you through life as well.

With proper nutrition, you will begin to get feel more like your old self. Your body will have the nourishment it needs to keep healthy, to keep energy sustained, and you will be able to once again be an active participant in your life & hobbies.

How I’m Learning to Love Weight Gain in Eating Disorder Recovery

 

With your renewed energy, your emotions will feel full and vibrant again–allowing you to enjoy life in a way you may have not even realized you were missing out on. With weight gain comes this capacity to feel full and alert and restored.

Accepting weight gain in eating disorder recovery can be a long and difficult journey. It isn’t something that happens overnight. Work and support are necessary components to the journey. Keeping these four key things in mind can help you on your journey to recovery and weight restoration.

Please call for a free 15-minute phone consultation to learn how I work with clients with eating disorders.

4 tips to cope with weight gain in recovery from anorexia nervosa
4 tips to cope with weight gain in recovery from anorexia nervosa