Family Based Treatment: Effects and Experiences of Outpatient Treatment

In recent years, eating disorders have become a more increased topic of
discussion in our society. Anorexia is the mental disorder with the highest
mortality rate; 5 to 10% of clients die from this serious disease. Together
with the increase of interest on the topic, there has also been an increase in
the prevalence of eating disorders amongst adolescents. This results in longer
waiting lists at specialized eating disorder centers for (clinical) treatment.
The national Ketenaanpak EETstoornissen (K-EET) has identified several
bottlenecks regarding the care for eating disorders, including: 1) insufficient
options for combined treatment in the case of comorbidity (which results in
inconsistent care), 2) too little possibility of scaling down after clinical
admission, 3) professionals do not always feel equipped to treat the
'complicated' problems of eating disorders, 4) insufficient application of the
basic standard of care, and 5) in the treatment of eating disorders, the most
recent knowledge and the available family oriented therapy treatments
(including Family Based Treatment (FBT)) are not used efficiently. The main
challenge within the mental health care, which is also identified as one of the
bottlenecks by K-EET, is how to implement the basic standard of care
efficiently for children and adolescents with eating disorders and to offer
them an integrated care plan and effective treatment tailored to their needs.
This research protocol describes a research design that provides for this.

The primary question in this study is: what is the weight development for
adolescents with an eating disorder during FBT? The secondary objectives are
about the course of eating disorder symptomatology, as well as anxiety and mood
complaints. And in addition what the experience of the treatment is for
adolescents, parents and practitioners, both during and after treatment and
what changes take place within the family relationships.

To assess the effectiveness of FBT, we designed a mixed-method strategy
consisting of two elements: a single-case design and a qualitative study.
Different objectives have been formulated for both components.

Within FBT, the family is seen as an essential component of the treatment. FBT
is aimed at re-empowering families, who often experience impaired functioning
due to the eating disorder. The parent is used as a co-therapist and plays an
active and positive role in the treatment of the eating disorder. FBT consists
of three phases. In the first phase, the adolescent is treated as someone who
has no control over his or her own behavior, because it is the eating disorder
that has control over the adolescent. At the start of FBT, parents learn to
take control of eating and gaining weight of the adolescents. When sufficient
weight recovery has been achieved, control is gradually transferred to the
young person again in the second phase.

By means of this mixed-method study, researchers want to evaluate whether FBT
leads to weight gain, a decrease in eating disorder-related complaints, what
influence the treatment has on family relationships and how the treatment is
experienced.