Cognitive behavioral therapy (CBT) has been augmented for family members in the CBT-oriented family module for anorexia nervosa treatment. It has three components. First, families received educational sessions on the CBT model of EDs which view the problem as within the individual, resulting from overvaluations of food/shape/weight and excessive desire for control over such issues. Next, family members learn how to support patients during family mealtimes. Finally, family members are taught how to create an optimal home environment to facilitate healthy change

CBT-Oriented Family Module for Anorexia Nervosa Treatment

Systemic family therapy is based around the notion that interpersonal relationships, social interactions, and narratives around the issue contribute to anorexia nervosa, rather than the patient themselves being the source of the problem. No specific emphasis is placed on eating normalization or weight restoration in the model of treatment, but focus is instead placed on finding solutions to problems based on the family's existing strengths and resources. Family members are often provided with a manual to guide their support of their loved ones. 

Systemic Family Therapy for Anorexia Nervosa Treatment

The Maudsley model of family-based therapy (FBT) is a form of family treatment for anorexia nervosa, although it varies depending on how it is being practiced. While it originally made no claims as to knowledge about the causes of the disorder to avoid placing blame on families, other models address the ways in which families may worsen or enable anorexia nervosa by organizing and mobilizing around the disorder. It is often a first-line treatment for first-episode adolescent cases of anorexia nervosa, and focuses on addressing problems. As such, treatment targets include eating regularization, weight restoration, and reduction of eating disorder behaviors. Depending on the version, parents and children maybe seen separately or together, and there are augmentations to the model that can be made to address unresponsive parents and patients, specifically target treatment for emerging adults, etc. 

Maudsley Model of Family-Based Therapy (FBT) for Anorexia Nervosa Treatment

The New Maudsley Model for Collaborative Care (NMCC) was developed for caregivers of adults with anorexia nervosa or patients with treatment-resistant anorexia nervosa. The model is based on the cognitive-interpersonal maintenance model of anorexia nervosa, which addressing the intrapersonal and interpersonal factors that contribute to the disorder's persistence. Treatment targets include correcting isolating behaviors and fostering healthy connections. Caregivers are taught to care for patients while managing their own responses to avoid contributing to the illness's maintenance. This may include building skills for resilience, communication, and emotional regulation, in addition to addressing enabling behaviors and fragmentation within the support network. Caregivers and therapists are provided with manuals, videos, remote workshops, and group and individual support from other trained caregivers. 

New Maudsley Model for Collaborative Care (NMCC) for Anorexia Nervosa Treatment

While there are many benefits to family inclusion in anorexia nervosa treatment, there are also significant cons that must be considered when making treatment decisions for individual cases. One main con is that family inclusion can cause significant costs for family members and other social support network members. Family-based therapy (FBT) often requires intensive treatment that continues for years, so financial instability may be a barrier to FBT since some parents report concerns about losing their jobs or report having to leave their jobs to care for their children. There are also mental and emotional costs for caregivers: some caregivers report that the model for FBT indirectly places blame on them in cases where treatment is unsuccessful, contributing to guilt, anxiety, and feelings of failure. 

Cons of Family Inclusion in Anorexia Nervosa Treatment: Costs for Family

Resource use analyses of systemic family therapy and family-based therapy (FBT) indicate that inclusion of family members through FBT may help to reduce the necessary resources for successful treatment of anorexia nervosa. In adolescent inpatient treatment, FBT was associated with ~50% of the days in hospital and ~50% of the of re-admissions of systemic family therapy. Likewise, the Parents in Charge (PIC) approach inherent to FBT, in which parents take control of adolescents' meals, was associated with 50% fewer hospital admissions, shorter hospital stays, and reduced needs for nasogastric feeding when compared against non-specific expert-driven psychoeducational family therapy. NMCC was also associated with reduced dropout rates and rescue treatments, and reduced bed use. 

Pros of Family Inclusion in Anorexia Nervosa Treatment: Reduced Resource Use

Several models exist to include family members in anorexia nervosa treatment. These models strive to put theory-based strategies into action, either by addressing intra- and inter-personal factors that maintain the disorder, by addressing behaviors of the illness, or by focusing on improving the well-being of the family as a whole: 

- CBT-oriented family module
- Systemic family therapy
- Maudsley model of family-based therapy (FBT)
- New Maudsley Model for Collaborative Care (NMCC)

Kalamazoo College

This list includes different types of methods for treating and/or managing different feeding and eating disorders. These include, but are not limited to the following:
-	Mindfulness for Patients with Eating Disorders
-	Cognitive-Behavioral Therapy vs. Behavioral Weight Loss (BWL) as Treatment for Binge-Eating Disorder
-	Mindfulness-Based Interventions for Binge Eating Disorders
-	Dialectical Behavior Therapy for treating Bulimia Nervosa
-	Dialectical Behavior Therapy for treating Anorexia Nervosa
-	Subjective Experiences of Eating Disorder Treatments
-	Pharmacological Treatment for Binge Eating Disorders
-	Enhanced Cognitive Behavioral Therapy (CBT-E) for Eating Disorders
-	Family-Based Treatment of Eating Disorders in Adolescents

Treatment & Management Methods for Feeding and Eating Disorders

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

The Value of Including Families in the Treatment of Anorexia Nervosa

Mindfulness interventions have been shown to be beneficial for those suffering with eating disorders including anorexia nervosa, binge eating disorder, and bulimia nervosa.

Mindfulness for patients with eating disorders

- Dialectic Behavior Therapy
- Mindfulness-Based Eating Awareness Training

Mindfulness-Based Interventions for Binge Eating Disorder

Though cognitive behavior therapy is generally considered the treatment of choice for bulimia nervosa, dialectical behavior therapy (DBT) may be particularly effective in treating bulimia nervosa due to its targeting of emotional dysregulation problems, which often underlie the eating disorder. One study has shown a significant decrease in binge/purging behaviors in patients with bulimia nervosa who underwent DBT with a focus on emotional regulation, though more research into this area is necessary.

Dialectical Behavior Therapy for treating Bulimia Nervosa

Dialectical behavior therapy (DBT) has been shown to be effective in treating anorexia nervosa (AN), as patients with the disorder who underwent DBT saw low dropout rates and increased BMIs which were sustained 6 months later. While standard DBT has been shown to be effective, a DBT program that was augmented to focus on overcontrolled emotions and behaviors which contribute to AN was more helpful in encouraging long term results.

Dialectical Behavior Therapy as Treatment for Anorexia Nervosa

One study examined the current literature on the experiences and perspectives of those across healthcare interfaces for eating disorders, to include individuals with eating disorders, people close to or caring for those with eating disorders such as family and friends, and health professionals.

Subjective Experiences of Eating Disorder Treatments 

One study explored the different pharmacological treatments for BED. The study found that antidepressants, appetite suppressants, and anticonvulsants, specifically, desipramine, fluvoxamine, fluoxetine, sertraline, citalopram, dexfenfluramine, sibutramine, and topiramate can aid in BED treatment. 

Pharmacologic Treatment for Binge Eating Disorder

Enhanced cognitive behavior therapy (CBT-E) is a transdiagnostic approach that is designed to treat multiple clinical conditions, including the complete list of eating disorders identified in DSM-V, such as anorexia nervosa, bulimia nervosa, binge eating disorder (BED), among others. It is different from typical CBT in that it aims to treat the underlying pathological factors contributing to several disorders, rather than any one condition. 

CBT-E is comprised of four stages, yet the details of each stage differ based on the individual patient and their clinical circumstances.

The overarching goal of CBT-E is to assist the patient in first acknowledging their harmful eating patterns and body-image concerns so that they can eventually begin actively participating in therapeutic sessions targeted at addressing the emotions, beliefs/thoughts, and behaviors (e.g., body-image concerns, low self-esteem stressful life events, interpersonal relationship conflicts, etc.)  sustaining their condition. 

After the patient has begun to heal, CBT-E treatment provides them with coping mechanisms to manage challenges to their recovery so that they can maintain their progress.

Enhanced Cognitive Behavioral Therapy (CBT-E) for Eating Disorders 

The family-based treatment (FBT) method for eating disorders entails a clinician working with the adolescent patient and their family to establish a comprehensive care plan that extensively engages the patient's home/family life.

Comprised of three phases, FBT is characterized by granting the patient's family responsibility to monitor and oversee their child's eating behaviors in order to support the patient's sustainable adoption of healthy eating habits. As the patient progresses in their recovery, they are incrementally granted more autonomy over their dietary decisions and eating preferences.

Family-based Treatment of Eating Disorders in Adolescents

Research unfortunately indicates that anorexia nervosa treatment outcomes are not always ideal. Although oftentimes significant weight is restored by the end of treatment, psychological symptoms frequently go largely unaddressed, indicating a gap in current treatment procedures that may leave patients more vulnerable to relapse.

Anorexia Nervosa Treatment Outcomes

Depending on the severity of the case of bulimia nervosa, treatment methods may vary, but often include the following: 

- Purging cessation
- Nutritional support
- Monitoring 
- Medical treatment for complications
- Psychotherapy
- Psychiatric medication

Bulimia Nervosa Treatment

CBT is known as an effective treatment for binge-eating disorder (BED) in that it helps people to stop binge-eating, but it does not actually help people to lose weight (which is important because BED puts people at high risk for obesity and the health problems associated with that).  Because of this shortcoming, perhaps another treatment option is necessary to help people with BED to lose weight.

Cognitive-Behavioral Therapy vs. Behavioral Weight Loss (BWL) as Treatment for Binge-Eating Disorder

Multiple forms of treatment exist for binge eating disorder, each with different levels of efficacy in terms of prompting remission of binge-eating episodes, lessening psychological symptoms, and reducing body weight:

- Psychotherapy
- Structured self-help treatment
- Combined treatment
- Pharmacotherapy
- Behavioral weight loss treatment
- Self-help weight loss treatment
- Inpatient treatment 

Binge Eating Disorder Treatment Outcomes

In general, treatments for ARFID can be divided into two major groups: 

- Psychological treatment
- Adjunctive pharmacological treatment

Avoidant/Restrictive Food Intake Disorder (ARFID) Treatment

Family Inclusion in Anorexia Nervosa Treatment

Neuromodulatory techniques are also being studied to directly affect the brain to regulate food intake and reduce AN’s psychological symptoms. Multiple forms on neuromodulation have been studied or are being studied currently, including the following:
- Transcranial direct-current stimulation (tDCS) 
- High-frequency repetitive transcranial magnetic stimulation (rTMS) 
- Deep brain stimulation (DBS)

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