Not all family contexts thrive with traditional FBT. For example, family dynamics with high maternal criticism may benefit from separated, rather than conjoint, forms of family therapy. Likewise, in patients with high OCD psychopathology levels, systemic family therapy was found to be more effective for weight-restoration, while FBT was more effective for patients with low OCD psychopathology levels. Thus, levels of family involvement and models of inclusion should be augmented based on each patient's family context and individual traits.

Kalamazoo College

Other caregivers report simply needing more information to better support their loved ones: for example, models of FBT often do not address comorbidities and environmental exposures until Phase 3 of treatment, leading to issues in supporting patients with premorbid temperamental and developmental issues or difficulties alleviating patient distress, sometimes contributing to familial trauma. Patients similarly report some issues with adjusting to new behaviors from caregivers, and report concerns about blurred boundaries between family and clinical support groups, and worry about the need for ongoing support and training for caregivers. 

Cons of Family Inclusion in Anorexia Nervosa Treatment: Concerns from Patients and Caregivers

Treasure, J., Parker, S., Oyeleye, O., & Harrison, A. (2020). The value of including families in the treatment of anorexia nervosa. European Eating Disorders Review, 29(3), 393-401. https://doi.org/10.1002/erv.2816

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