Bulimia Family Therapy | Support Through Recovery 

Bulimia nervosa (BN) is a serious mental health condition with potentially dangerous consequences, but thankfully, it’s also one of the most treatable eating disorders.

Several types of therapy have been found to help people with BN reduce their eating disorder behaviors, so specialists may choose from several techniques when treating these patients.

Author | Danielle Mauldin
Reviewed By | Bridget Clerkin

2 sources cited

TABLE OF CONTENTS | What is FBT? | Tenets | How it Works | Help for Bulimia

Several types of therapy have been found to help people with BN reduce their eating disorder behaviors, so specialists may choose from several techniques when treating these patients.

And when it comes to treatment for younger people with BN—including adolescents, teens, and people even younger—family-based treatment (FBT) is a common choice, as this approach encourages and empowers all members of a household to participate in someone’s eating disorder recovery.

What is Family-Based Treatment?

Family-based treatment was originally developed with the intention of helping patients with anorexia nervosa (AN), but the method has proven effective for helping people with all types of eating disorders, including bulimia nervosa. [1]

The concept hinges on the fact that many eating disorders develop during adolescence when most people are still living with their parents or caretakers. As such, it works to incorporate parents, caretakers, and sometimes other family members in therapy sessions, where the family, as a unit, learns more about the condition and how to help.

Essentially, parents, caretakers, and sometimes extended family members are given agency over the food-based decisions of the person in the family with the eating disorder. As therapy goes on, the person will slowly be given more autonomy over their food and meal choices.

Family members are given support and education throughout the process, with the therapist helping them decide when and how to give the child more food-based freedom.

Tenets of Family-Based Treatment

While involving more people in someone’s eating disorder treatment can work to help create better conditions for recovery at home, it also adds to the number of people and perspectives involved, which could create complications.

To help keep preexisting dynamics and other family factors from potentially derailing treatment, FBT follows several major beliefs. [2]

It’s established early on in FBT that the purpose of therapy is not to focus on the cause of the eating disorder but to help create solutions and reinforce healthy eating patterns.

This helps keep sessions productive and keep the group away from blaming anyone for the situation, or having to work through guilt, defensiveness, or other unhelpful reactions that might come from these sensitive conversations.

Essentially, this tenant makes clear everyone’s role in family-based treatment.

The therapist is considered a subject matter expert on BN and psychology. Family members are encouraged to view them as expert consultants, there to provide education and guidance.

Meanwhile, parents or caretakers are designated as experts on their child and/or their family unit, and treated as such.

Parents or caretakers, in FBT, are given authority over what, when, and how their child will eat at home, with the child only regaining freedom over those choices slowly, as therapy goes on.

Still, the job is difficult and often stressful. So a major aspect of FBT is instilling the confidence and education in parents to take on this challenging responsibility.

This tenant of FBT also works to help remove the distractions of blame, guilt, or defensiveness from therapy sessions. By externalizing the eating disorder, parents, caretakers, and other family members are encouraged to see the disorder as an entity in its own right and a separate entity from the child.

This can also help parents understand that if a child is being difficult about eating, it’s not the child deciding to act that way but rather the result of the disorder. This hopefully helps parents resist the temptation to direct any anger, frustration, or worries on their child during the recovery process.

The final tenant of FBT helps remind family members to stay on task. It reinforces the idea that therapy sessions are symptom- and solution-focused, intended only to address and reduce eating disorder behavior.

The idea behind this pragmatism is twofold. It helps prevent sessions from trailing into secondary issues, and also helps target disordered behavior as quickly as possible. This is particularly important for adolescents with bulimia nervosa, as the illness can easily be entrenched in their sense of identity or personality at that age, at which point it becomes much more difficult to treat.

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How Does Family-Based Treatment Work?

Family-based treatment empowers parents or caretakers to take on the responsibility of making all food-based decisions for their child, with the child eventually gaining more autonomy over those choices.

Generally speaking, sessions are broken into three distinct phases, each with its own goals for parents, children, and other family members. [1]

Phase I focuses on reestablishing the patient’s physical health.

The goal of this phase is steady weight gain and ensuring the child’s nutritional needs are being met, with parents having nearly all control of a child’s eating routine. Parents work together with their therapist to help develop a healthy, sustainable eating plan.

Sometimes, this phase involves the family bringing a meal into the therapist’s office. The therapist will then walk the family through ways to effectively address the eating disorder and support their child during mealtimes.

Once the child starts trending toward a healthier weight and showing the ability to eat better on their own, the family will enter Phase II. This middle phase marks the transition of autonomy back to the child.

While a patient’s guardians are still involved in some decisions during this time, they’re advised on how to gradually give the child more control or choice over what they eat, so long as the level of autonomy is age-appropriate and normal for their family. Guardians may eventually only intervene if they think the child’s nutritional needs aren’t being met. 

Another important goal of this phase is to help establish the idea of the family as a support system for the child. By helping their child become more autonomous in their recovery effort, parents or caretakers will hopefully be seen as a trusted source of care and support, which can help guard against backsliding.

In this final phase of a family-based approach, the goal is primarily to help the family unit, as a whole, return to normal, healthy patterns of family life.

The therapist will review the adolescent’s development and work with the family to identify potential developmental challenges. They will also teach the family how to help the patient get through those challenges without being at significant risk of reverting to disordered eating behaviors. 

Ultimately, the goal of Phase III is to establish a sustainable recovery pattern that can persist even after the family leaves therapy. Even if the patient sometimes thinks about their body or food in an unhealthy way in the future, they, and their family, can handle these challenges without reverting to previous patterns or behaviors.

Finding Help for Bulimia Nervosa

Bulimia nervosa is a serious, dangerous, and potentially deadly eating disorder. If someone is struggling with BN, it’s crucial for them to seek out help.

Family-based therapy is particularly helpful at stopping disordered eating behaviors before they’ve made too deep of an impact on an adolescent with bulimia nervosa. But some patients may also benefit from individualized treatment or a group therapy setting.

A therapist, psychiatrist, primary care physician, or other trusted medical professional can be a great resource for learning more about treatment options and available programs. A number of eating disorder hotlines can also provide additional information and resources for those seeking help on an anonymous basis.

Regardless, the most important aspect of any type of therapy is starting. Bulimia nervosa may feel like an impossible disorder to overcome, but with the right kind of help and support, recovery is always possible.

Within Health offers personalized remote eating disorder treatment backed by years of experience.

Within’s IOP and PHP programs offer meal kit deliveries, a numberless scale, a convenient app to attend therapy sessions and view your schedule, and so much more.

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  1. Rienecke RD. (2017). Family-based treatment of eating disorders in adolescents: current insights. Adolescent Health, Medicine and Therapeutics, 8:69–79.
  2. Rienecke R, Le Grange D. (2022). The five tenets of family-based treatment for adolescent eating disorders. Journal of Eating Disorders, 10(60).

Last Update | 05 - 1 - 2023

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