An Integrated Treatment Approach for Adolescents

Merging FBT and DBT for adolescent patients.

  • There is a subset of adolescent eating disorder patients for whom first-line treatments in their pure form are not indicated. 
  • Research on an integrated treatment approach including dialectical behavior therapy (DBT) and family-based treatment (FBT) has produced support for these interventions.
  • FBT strategies are used for the normalization of eating/weight, and DBT brings in the necessary patient/parent skills for emotion regulation.

The majority of young people presenting with moderate to severe eating disorder symptoms can be expected to benefit from first-line outpatient treatments like family-based treatment and enhanced cognitive behavioral therapy. Early intervention and compliance with these treatment protocols can lead to strong outcomes in younger patients.

When first-line treatments are not the best fit

There is a subset of adolescent patients, however, for whom first-line treatments in their pure form are not indicated.

In these cases, specific adaptations to the treatments may be necessary to best address the full scope of the patient’s condition. An adapted treatment course should be considered when teens present to care with eating disorders and suicidal or self-injurious behaviors. Young people with other challenging co-occurring conditions like severe emotion dysregulation or oppositional behavior may also fall into this category of patients who will require a skillfully rendered, integrated treatment.

Research on dialectical behavior therapy (DBT) and family-based treatment (FBT) has produced an abundance of support for these interventions to address emotion dysregulation, self-injurious behavior, suicidality (DBT), and eating disorders (FBT) respectively. But when multiple complicating features occur together and alongside an eating disorder, these treatments on their own often prove inadequate. Patients with this combination of an eating disorder, emotion dysregulation, and/or self-injurious or suicidal behaviors have traditionally been considered “hard to treat.” They may cycle through multiple treatments, providers, and facilities with only aspects of their conditions addressed at any given time.

An integrated treatment approach of FBT and DBT

Innovation in the field of eating disorders has led to some highly specialized providers meeting the needs of these patients by integrating FBT and DBT. FBT strategies are used to effect normalization of eating/weight, while DBT brings in the necessary patient and parent skills for emotion regulation. Additionally—and very importantly—DBT is structured to both monitor and manage serious, potentially life-threatening factors like self-harm and suicidality; FBT is not.


Read the rest of this post on Psychology Today under Essential Reads about Eating Disorders or on Melissa’s blog, The Road to Recovery.