The Role of Family-Based Treatment For Adolescent Eating Disorders: Opportunities and Challenges

Family-Based Treatment
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Family-Based Treatment
There is a commonly held misconception that eating disorders are a lifestyle choice. However, this is not the case in reality. In reality, eating disorders are serious illnesses that could turn out fatal if not attended to. Eating disorders are illnesses that are associated with severe disturbances in people's eating behaviors and related thoughts and emotions ("Eating Disorder Statistics | General & Diversity Stats | ANAD," 2021). Family-Based Therapy (FBT) is a robust outpatient program that tries to keep away from hospitalization and rather effectively connects with guardians during the time spent reestablishing their kid to a solid load at home. 
Family-Based Treatment is also referred to as the Maudsley approach (Morris & Twaddle, 2007). The method was initially developed and tested in London, England, at Maudsley Hospital. This research was done on a population of adolescents and adults, which was found to be efficacious for patients that were eighteen years old and younger. The Maudsley approach has been primarily designed to provide an alternative treatment to Anorexia Nervosa. Although this treatment is for patients with Anorexia Nervosa, it is known to work best for patients diagnosed with the disorder for at most three years (Rienecke, 2017). With the help of FBT, parents have been able to get help with their diagnosed child and ultimately get through the remission from Anorexia Nervosa. The FBT aims at bringing back the child to their original state of mind and their authentic physical look, their chronologically appropriate stage of physical and psychosocial development (Brown et al., 2013). Family-Based treatment is a common form of treatment among children and teens to treat Anorexia Nervosa. However, FBT can also be effectively applied to treat Anorexia Nervosa in young adults and other adults.  
There exists evidence by a seminal study attributing to the effectiveness of FBT's utility in preventing relapse and facilitating continuous improvement following inpatient weight restoration. FBT for adolescent Anorexia Nervosa has been subjected to further study in additional RCTs, open trials, and clinical case series. Collectively, existing literature has demonstrated that FBT is adequate for an entire course of weight restoration (Caskey, 1985). This shows that Maudsley's approach can be very effective if used correctly and accurately. The patients continue to be healthier and healthier as time goes by. Previous studies have also shown that binge eating and dieting have determined that 10-50% of adolescent boys and girls engage in binge eating (Costa-Font & Jofre-Bonet, 2012). FBT treats Anorexia as a clinical ailment while using food as the remedial specialist.
Anorexia Nervosa
Anorexia Nervosa, on the other hand, is a mental/emotional disorder that is becoming more and more common in today's society. Mental illnesses are fragile because there are no many choices in medicine to find a cure. Anorexia Nervosa is the lack or loss of appetite for food with an obsessive objective of losing weight by not eating correctly. In addition, it is characterized as a dietary issue that is occasioned by the refusal of a starved individual to keep an ordinary bodyweight. It has been noted that about 30 million individuals across both gender battle with some dietary problem in the United States ("Eating Disorder Statistics | General & Diversity Stats | ANAD," 2021). Dietary problems do not segregate, and they can affect people of all races and identities. Eating disorders have been identified as being the fatal ones across all mental illnesses, with the Standardized Mortality Ratio (SMR) for Anorexia Nervosa being at 5.86 ("Eating Disorder Statistics | General & Diversity Stats | ANAD," 2021). The most common symptoms of an individual with dietary issues include an outrageous weight reduction, exhaustion, habitual working out, fixation on food and weight, reading about food, participating in scattered ceremonies involving food, lying about food admission, crabbiness, and loss of a menstrual cycle (Anorexia Signs and Symptoms). Anorexia is also synonymous with other psychological wellness problems like despair, tension, fanatical urgency issues, and Post Traumatic Stress and Disorder (PTSD) ((Jacquelyn, 2018)). Anorexia is psychological maladjustment because taking part in practices adjusts the mind design, and it interferes with the victim's considerations and thoughts, changing their psychological measure.
About Anorexia Nervosa
Mental sickness influences the individual's thinking. Anorexia Nervosa is classified as a mental illness based on its solid connections to neuroscience and its evident impacts on cerebrum structure. Studies that use Computer Tomography have shown improved ventricles and sulci in the cerebrums of those diagnosed with Anorexia Nervosa. However, patients during the study showed the ability to reverse this kind of damage on the brain once enrolled in a weight restoration plan (Dooley-Hash, 2013). An investigation utilizing attractive reverberation imaging exhibited that anorexia patients with incredibly low loads had a considerable decrease in amygdala and hippocampus arrangement. The pieces of the cerebrum that direct feelings found that anorexics showed hypo-perfusion in the average transient flap of the mind. The control members without Anorexia exhibited normal perfusion (Dooley-Hash, 2013).
A trademark quality of Anorexia is expanded thoughts concerning food and weight. As expressed earlier, Anorexia is a psychological disorder because of how much it reduces an individual's productivity. The victim has fanatical and relentless thoughts about things that keep crossing in his mind all day. This tends to regularly prompt dietary limitations. These considerations and ideas take up such a lot of kind space that the anorexic individual is left with a not precisely ideal capacity to decide what is more critical and needs to be focused on (Kornell, 2021). It is generally realized that psychological predispositions concerning how data is handled in an anorexic cerebrum are the standard keeping up factor in the continuation of the dietary problem (Brockmeyer et al., 2018). Survivors of an eating disorder issue, for the most part, decipher all criticism given about the state of their body as being negative. This unfavorable translation of criticism has likewise been displayed in other psychological ailments, for example, melancholy and anxiety (Brown et al., 2013). This point of view propagates a pattern of cognitive functioning that is broken and dysfunctional and points to cluttered practices that have been fruitless in modifying that view.
Anorexia Nervosa affects about 2% of young ladies and about 1% of juvenile guys. The disorder significantly modifies patients' existences with development advancement and richness and is usually associated with substance use, temperament, and nervousness. The death rate—an expected 20 percent—is the most elevated of any mental sickness ("Mental illness - Symptoms and causes," 2021). Anorexia is a dangerous psychological instability that totally assumes control over the cerebrum. It incorporates outrageous passion and conduct issues encompassing food and body shape. The individual managing the ailment self regulates food consumption in such a prohibitive manner that the body goes through ailing severe health. Anorexia influences physical and enthusiastic wellbeing, usually seen in other psychological maladjustments. 
Why FBT is a leading choice in treating adolescent eating disorders (anorexia nervosa) than other family treatment
The Family-Based Treatment is anchored on five principles (Slim, 2014): 
1 Agnostic view of illness
2 Initial symptom focus
3 Family Responsible for refeeding/addressing behaviors
4 Non-authoritarian stance
5 Externalization of illness
The Agnostic view of illness
This principle is pegged on the fast reactionary response by the Family-Based Treatment approach. Unlike other traditional treatment measures, FBT is not focused on establishing the child's cause(s) of an eating disorder. It is instead focused on how to handle the eating disorder.
Initial symptom focus
The initial symptom focus principle sets as a priority full nutrition as a prevention tool for eating disorders. This principle is anchored on prevention is better than cure—the FBT advocates for complete food for both those with eating disorders and those without. Full nutrition, in this case, works as a remedy for those already diagnosed with Anorexia Nervosa while preventing the rest from developing an eating disorder.
The family is responsible for refeeding/addressing behaviors.
Under this principle, the family to which the child belongs is responsible for their children's meals. The parents are tasked with providing full nutrition for their children. Through this principle, the parent's role in the child's health is reinforced. As the primary caregivers, the parents are also brought into focus for their child's health, thereby easing the burden on the medical practitioners.
Non-authoritarian stance.
Under this principle, a medical practitioner is brought into the treatment of the Anorexia Nervosa patient. The therapist attached to the child or adolescent under this principle must collaborate with the patient's parents actively. The therapists, together with the parents, make up the child's full treatment team  
Externalization of illness.
Under this principle, the eating disorder is not viewed as one that emanates from within the body. Instead, the illness is considered as an external force that attacks the child. Not only does the force attack the child physically, but it also attacks their health. Therefore, the illness is viewed as an opponent in the form of a force. The opponent, therefore, needs to be countered, and thereby, a team is formed to fight the enemy. The team formed comprises the child, the parents or guardian(s), and providers who jointly combine forces. The team's main objective is to restore health and completely do away with an eating disorder in the child or teen.
FBT Structure
The Family-Based Treatment is structured in phases. The treatment structure contains three broad phases. As mentioned earlier, FBT is not focused on establishing the cause of the disorder but rather aims at avoiding higher levels of care through the restoration of physical health and elimination of eating disorder behaviors. The treatment is therefore focused more on the behavioral aspects of the child or teen.
Phase I – Full Parental Control
The first phase is usually where the bulk of the work is embedded. The first phase usually comprises about 10 to 12 sessions (RUSSELL & GROSS, 2000). The first phase of the Family-Based Treatment is primarily focused on rapid weight gain. The phase features approaches are aimed at stopping behaviors that lead to weight loss. During this first phase, the clinician examines the seriousness of the eating disorder. They additionally give schooling, training, and strengthening methodologies to the child's parents or guardian(s). At the beginning of each session, the patients are weighed. The weighing-in sets the tone for the session. This data assists them with dealing with their kid's refeeding interaction. 
In this phase, the parents or guardian(s) gradually assume responsibility for the child's eating habits. The parents and guardian(s) begin taking responsibility for their child's eating and physical exercise design. The parents and guardians are fully focused on all aspects of how the child eats. They choose when the kid eats, eat, and ensure they do not put away or cleanse food. During this phase, the parents and guardians aim to restore regular eating patterns and correct the eating habits associated with the eating disorder. Usually, the aim is to gain about one or two pounds each week (Sheldon, n.d.). During this phase, parents and guardians begin to reincorporate food varieties that they had dropped in their collection. However, during this first phase, the carers are still completely liable for the refeeding interaction. The parents and guardians are also required to secretly monitor their kids for the kind of exercises they engage in and their eating behavior. 
The new routine may seem exhausting for the parents and guardians. However, it is undoubtedly worth all the effort. The Family-Based Treatment assumes the child or teen suffering from Anorexia Vernosa cannot perceive how unhealthy they are and cannot be allowed under whichever circumstance to live by their own decisions. During the first phase of the Family-Based Treatment, the first principle of Family-Based Treatment comes into play. During this phase, the family's doctor or the attached medical personnel externalizes the dietary problem. They make it known to the parents or guardians that the kid and the dietary problem are two different entities from the onset. The disease is considered an external force and should only be treated as such. As a matter of fact, they are supposed to offer protection to the child against the opponent, which is Anorexia Verona. The kid needs to be protected against constraints by the eating disorder. Specifically, they need to be protected against maladaptive practices which are due to the eating disorder. Externalizing the disease makes it simpler for guardians to be firm when going about the when and how the young adult will eat. It gives everybody in the family a shared adversary to rise against. Furthermore, in situations where contentions break out, it assists the parents and guardians in understanding why their child, who usually is 'good,' turns out to be rebellious.
Phase II - A gradual return of control to the adolescent
The second phase of the Family-Based Treatment is usually when a significant proportion of the child's weight has been restored. The ...