Transdiagnostic Theory and Application of Family-Based Treatment for Youth With Eating Disorders
Open accessAbstract
This paper describes the transdiagnostic theory and application of family-based treatment (FBT) for children and adolescents with eating disorders. We review the fundamentals of FBT, a transdiagnostic theoretical model of FBT and the literature supporting its clinical application, adaptations across developmental stages and the diagnostic spectrum of eating disorders, and the strengths and challenges of this approach, including its suitability for youth. Finally, we report a case study of an adolescent female with eating disorder not otherwise specified (EDNOS) for whom FBT was effective. We conclude that FBT is a promising outpatient treatment for anorexia nervosa, bulimia nervosa, and their EDNOS variants. The transdiagnostic model of FBT posits that while the etiology of an eating disorder is unknown, the pathology affects the family and home environment in ways that inadvertently allow for symptom maintenance and progression. FBT directly targets and resolves family level variables, including secrecy, blame, internalization of illness, and extreme active or passive parental responses to the eating disorder. Future research will test these mechanisms, which are currently theoretical.
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Cites
Diagnostic and Statistical Manual of Mental Disorders
Williams, J. B. W., & First, M. B. (2013) · Oxford University Press eBooks · doi:10.1093/acrefore/9780199975839.013.104 · Cited by 109,841 · see citing works
KAUFMAN, J., BIRMAHER, B., BRENT, D., RAO, U., FLYNN, C., MORECI, P., WILLIAMSON, D., & RYAN, N. (1997) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/00004583-199707000-00021 · Cited by 10,148 · cited 2× · see citing works
“M.’s assessment included a psychiatric intake, the Eating Disorder Examination, Version 16.0 (Fairburn, Cooper, & O’Conner, 2008) and the Kiddie Schedule of Affective Disorders (Kaufman et al., 1997), plus standardized questionnaires.”
BackgroundMethodInfluentialEmotional processing of fear: Exposure to corrective information.
Foa, E. B., & Kozak, M. J. (1986) · Psychological Bulletin · doi:10.1037/0033-2909.99.1.20 · Cited by 5,396 · see citing works
Cognitive behaviour therapy for eating disorders: a “transdiagnostic” theory and treatment
Fairburn, C. G., Cooper, Z., & Shafran, R. (2003) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(02)00088-8 · Cited by 3,374 · cited 5× · see citing works
“This core pathology is thought to underlie the majority of clinically significant eating disorder presentations - regardless of if and how they are formally codified in the DSM - and consists mainly of the cognitive features of overevaluation of shape and weight and their control, which are expressed in a range of dis…”
BackgroundInfluentialAn evaluation of family therapy in anorexia nervosa and bulimia nervosa.
Russell, G. F. M., Szmukler, G., Dare, C., & Eisler, I. (1987) · Archives of General Psychiatry · doi:10.1001/archpsyc.1987.01800240021004 · Cited by 848 · cited 5× · see citing works
“Only six randomized clinical trials with fewer than 400 adolescents studied in adolescent AN and two randomized clinical trials with a fewer than 200 subjects studied in adolescent BN have been published (Eisler et al., 2000; Eisler et al., 2007; Eisler et al., 1997; Le Grange et al., 1992; Russell et al., 1987; Lock…”
BackgroundResultInfluentialFairburn, C. G., Cooper, Z., Doll, H. A., O’Connor, M. E., Bohn, K., Hawker, D. M., Wales, J. A., & Palmer, R. L. (2009) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2008.08040608 · Cited by 829 · cited 2× · see citing works
“…trial comparing two versions of the transdiagnostic, “enhanced” cognitive-behavioral therapy (CBT-E) for BN and EDNOS (Body Mass Index > 17.5) (Fairburn et al., 2009) found that patients improved in both treatments and that DSM diagnosis did not moderate treatment effects, even at 60-week…”
BackgroundInfluentialBulimia nervosa treatment: a systematic review of randomized controlled trials.
Shapiro, J., Berkman, N., Brownley, K., Sedway, J., Lohr, K., & Bulik, C. (2007) · International Journal of Eating Disorders · doi:10.1002/eat.20372 · Cited by 593 · see citing works
50-year trends in the incidence of anorexia nervosa in Rochester, Minn.: a population-based study.
Lucas, A. R., Beard, C., O'Fallon, W., & Kurland, L. (1991) · American Journal of Psychiatry · doi:10.1176/ajp.148.7.917 · Cited by 593 · see citing works
Eisler, I., Dare, C., Hodes, M., Russell, G. F. M., Dodge, E., & Grange, D. L. (2000) · Journal of Child Psychology and Psychiatry and Allied Disciplines · doi:10.1176/foc.3.4.629 · Cited by 560 · cited 5×
“However, separated FBT appears to be more effective for families with high levels of expressed emotion, particularly criticism (Eisler et al., 2000; Le Grange et al., 1992).”
BackgroundInfluentialDiagnostic Crossover in Anorexia Nervosa and Bulimia Nervosa: Implications for DSM-V
Eddy, K. T., Dorer, D. J., Franko, D. L., Tahilani, K., Thompson-Brenner, H., & Herzog, D. B. (2008) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2007.07060951 · Cited by 535 · cited 4× · see citing works
“First, the bounds that distinguish AN, BN, and EDNOS from one another are blurred, both in the manner that DSM-IV criteria capture present state, as well as temporally in the migration between diagnostic categories over the course of illness (Eddy et al., 2008; Fichter & Quadflieg, 2007; Milos, Spindler, Schnyder, & F…”
BackgroundInfluentialFamily and Individual Therapy in Anorexia Nervosa: A 5-Year Follow-up
Eisler, I. (1997) · Archives of General Psychiatry · doi:10.1001/archpsyc.1997.01830230063008 · Cited by 522 · cited 2× · see citing works
“…randomized clinical trials with a fewer than 200 subjects studied in adolescent BN have been published (Eisler et al., 2000; Eisler et al., 2007; Eisler et al., 1997; Le Grange et al., 1992; Russell et al., 1987; Lock et al., 2005; Gowers et al., 2007; Schmidt et al., 2007; Le Grange et al.,…”
BackgroundLewinsohn, P., Striegel-Moore, R., & Seeley, J. (2000) · Journal of the American Academy of Child and Adolescent Psychiatry · doi:10.1097/00004583-200010000-00016 · Cited by 487 · cited 1× · see citing works
“Third, eating disorders typically onset in adolescence (Lewinsohn, Striegel-Moore, and Seeley, 2001; Lucas, Beard, & O’Fallon, 1991), with initial presentations frequently appearing subthreshold or atypical relative to DSM-defined AN or BN (WCEDCA, 2007).”
BackgroundA Comparison of Short- and Long-Term Family Therapy for Adolescent Anorexia Nervosa
Lock, J., Agras, W. S., Bryson, S., & Kraemer, H. C. (2005) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/01.chi.0000161647.82775.0a · Cited by 452 · cited 10× · see citing works
“…Grange & Lock, 2007), which have both been tested in studies that included subthreshold and atypical (i.e., EDNOS) cases (Le Grange et al., 2007; Lock et al., 2005; Lock et al., 2006; Loeb et al., 2007); for the prevention of AN in symptomatic children and adolescents at high risk for…”
BackgroundMethodInfluentialSelf-citationAnorexia nervosa treatment: A systematic review of randomized controlled trials
Bulik, C. M., Berkman, N. D., Brownley, K. A., Sedway, J. A., & Lohr, K. N. (2007) · International Journal of Eating Disorders · doi:10.1002/eat.20367 · Cited by 427 · see citing works
Twelve-year course and outcome predictors of anorexia nervosa.
Fichter, M., Quadflieg, N., & Hedlund, S. (2006) · International Journal of Eating Disorders · doi:10.1002/eat.20215 · Cited by 398 · see citing works
A controlled comparison of family versus individual therapy for adolescents with anorexia nervosa.
Robin, A., Siegel, P., Moye, A., Gilroy, M., Dennis, A., & Sikand, A. (1999) · Journal of the American Academy of Child and Adolescent Psychiatry · doi:10.1097/00004583-199912000-00008 · Cited by 379 · cited 5× · see citing works
“Only six randomized clinical trials with fewer than 400 adolescents studied in adolescent AN and two randomized clinical trials with a fewer than 200 subjects studied in adolescent BN have been published (Eisler et al., 2000; Eisler et al., 2007; Eisler et al., 1997; Le Grange et al., 1992; Russell et al., 1987; Lock…”
BackgroundResultInfluentialAnorexia nervosa: outcome and prognostic factors after 20 years
Ratnasuriya, R. H., Eisler, I., Szmukler, G. I., & Russell, G. F. M. (1991) · British Journal of Psychiatry · doi:10.1192/bjp.158.4.495 · Cited by 369 · see citing works
Grange, D. L., Crosby, R., Rathouz, P., & Leventhal, B. (2007) · Archives of General Psychiatry · doi:10.1001/archpsyc.64.9.1049 · Cited by 339 · cited 6× · see citing works
“…Dare, 2001) and BN (Le Grange & Lock, 2007), which have both been tested in studies that included subthreshold and atypical (i.e., EDNOS) cases (Le Grange et al., 2007; Lock et al., 2005; Lock et al., 2006; Loeb et al., 2007); for the prevention of AN in symptomatic children and adolescents at…”
BackgroundInfluentialSymptom fluctuation in eating disorders: correlates of diagnostic crossover
Tozzi, F., Thornton, L. M., Klump, K. L., Fichter, M. M., Halmi, K. A., Kaplan, A. S., Strober, M., Woodside, D. B., Crow, S., Mitchell, J., et al. (2005) · American Journal of Psychiatry · doi:10.1176/appi.ajp.162.4.732 · Cited by 317 · cited 2× · see citing works
“…type (AN-BP), and from AN-BP to BN (Eddy et al., 2008; Fichter & Quadflieg, 2007; Fichter, Quadflieg, & Hedlund, 2006; Milos et al., 2005; Tozzi et al., 2005; Wentz, Gillberg, Gillberg, & Rastam, 2001), with only time, weight status, and clinical judgment determining the point at which…”
BackgroundEisler, I., Simic, M., Russell, G., & Dare, C. (2007) · Journal of Child Psychology and Psychiatry and Allied Disciplines · doi:10.1111/j.1469-7610.2007.01726.x · Cited by 300 · cited 2× · see citing works
“…adolescent AN and two randomized clinical trials with a fewer than 200 subjects studied in adolescent BN have been published (Eisler et al., 2000; Eisler et al., 2007; Eisler et al., 1997; Le Grange et al., 1992; Russell et al., 1987; Lock et al., 2005; Gowers et al., 2007; Schmidt et al., 2007;…”
BackgroundSchmidt, U., Lee, S., Beecham, J., Perkins, S., Treasure, J., Yi, I., Winn, S., Robinson, P., Murphy, R., Keville, S., et al. (2009) · American Journal of Psychiatry · doi:10.1176/foc.7.4.foc512 · Cited by 298 · cited 10× · see citing works
“…& Leventhal, 2007; Lock, Agras, Bryson, & Kraemer, 2005; Lock, Couturier, & Agras, 2006; Loeb, Walsh, Lock, Le Grange, Jones, Marcus, Weaver, & Dobrow, 2007; Robin, Siegel, Moye, Gilroy, Dennis, & Sikand, 1999; Schmidt et al., 2007), and is now being adapted for a more transdiagnostic spectrum.”
BackgroundMethodInfluentialInstability of eating disorder diagnoses: prospective study
Milos, G., Spindler, A., Schnyder, U., & Fairburn, C. (2005) · British Journal of Psychiatry · doi:10.1192/bjp.187.6.573 · Cited by 295 · cited 2× · see citing works
“…type (AN-R) to AN binge/purge type (AN-BP), and from AN-BP to BN (Eddy et al., 2008; Fichter & Quadflieg, 2007; Fichter, Quadflieg, & Hedlund, 2006; Milos et al., 2005; Tozzi et al., 2005; Wentz, Gillberg, Gillberg, & Rastam, 2001), with only time, weight status, and clinical judgment determining…”
BackgroundThe severity and status of eating disorder NOS: Implications for DSM-V
Fairburn, C., Cooper, Z., Bohn, K., O'Connor, M. E., Doll, H., & Palmer, R. L. (2007) · Behaviour Research and Therapy · doi:10.1016/j.brat.2007.01.010 · Cited by 273 · cited 2× · see citing works
“…the two combined (Ricca et al., 2001; Turner & Bryant-Waugh, 2004), and there has been much debate in the field as to how to best parse this broad but clinically compelling category (Crow, 2007; Fairburn & Cooper, 2007; Fairburn et al., 2007; Waller, 2008; Wilfley, Bishop, Wilson, & Agras, 2007).”
BackgroundOutcome in patients with eating disorders: a 5-year study
Ben-Tovim, D. I., Walker, K., Gilchrist, P. N., Freeman, R. K., Kalucy, R., & Esterman, A. (2001) · The Lancet · doi:10.1016/s0140-6736(00)04406-8 · Cited by 262 · see citing works
Clinical effectiveness of treatments for anorexia nervosa in adolescents
Gowers, S., Clark, A., Roberts, C., Griffiths, A., Edwards, V., Bryan, C., Smethurst, N., Byford, S., & Barrett, B. (2007) · British Journal of Psychiatry · doi:10.1192/bjp.bp.107.036764 · Cited by 245 · cited 3× · see citing works
“With the exception of the most recent RCT for adolescent AN (Gowers et al., 2007), all other published RCTs utilized FBT or a variant of it.”
BackgroundAnorexia Nervosa, Parental ‘Expressed Emotion’ and Dropping Out of Treatment
Szmukler, G., Eisler, I., Russell, G., & Dare, C. (1985) · British Journal of Psychiatry · doi:10.1192/bjp.147.3.265 · Cited by 239 · see citing works
Crow, S. J., Agras, W. S., Halmi, K. A., Mitchell, J. E., & KRAEMER, H. C. (2002) · International Journal of Eating Disorders · doi:10.1002/eat.10088 · Cited by 233 · see citing works
Comparison of long-term outcomes in adolescents with anorexia nervosa treated with family therapy.
Lock, J. D., Couturier, J., & Agras, W. (2006) · Journal of the American Academy of Child and Adolescent Psychiatry · doi:10.1097/01.chi.0000215152.61400.ca · Cited by 217 · cited 2× · see citing works
“…which have both been tested in studies that included subthreshold and atypical (i.e., EDNOS) cases (Le Grange et al., 2007; Lock et al., 2005; Lock et al., 2006; Loeb et al., 2007); for the prevention of AN in symptomatic children and adolescents at high risk for developing the full disorder…”
BackgroundSelf-citationBinge eating in females: A population-based investigation
Bruce, B., & Agras, W. S. (1992) · International Journal of Eating Disorders · doi:10.1002/1098-108x(199212)12:4 · Cited by 194 · see citing works
Classification of eating disorders: toward DSM-V.
Wilfley, D. E., Bishop, M. E., Wilson, G., & Agras, W. (2007) · International Journal of Eating Disorders · doi:10.1002/eat.20436 · Cited by 188 · see citing works
Anorexia nervosa in a long‐term perspective: results of the Heidelberg‐Mannheim Study.
Deter, H., & Herzog, W. (1994) · Psychosomatic Medicine · doi:10.1097/00006842-199401000-00003 · Cited by 187 · cited 1× · see citing works
“…cases. but would also elevate their perceived clinical significance, which could have positive implications for early identification and intervention, and in turn, for improved course of illness and prognosis (Deter & Herzog, 1994; Le Grange & Loeb, 2007; Ratnasuriya, Eisler, & Szmukler, 1991).”
BackgroundTurner, H., & Bryant-Waugh, R. (2004) · European Eating Disorders Review · doi:10.1002/erv.552 · Cited by 171 · cited 1× · see citing works
“Notably, EDNOS is markedly more prevalent in clinical samples than either AN, BN, or the two combined (Ricca et al., 2001; Turner & Bryant-Waugh, 2004), and there has been much debate in the field as to how to best parse this broad but clinically compelling category (Crow, 2007; Fairburn & Cooper,…”
BackgroundFamily criticism and self‐starvation: a study of expressed emotion
Grange, D. L., Eisler, I., Dare, C., & Hodes, M. (1992) · Journal of Family Therapy · doi:10.1046/j..1992.00451.x · Cited by 153 · cited 4× · see citing works
“However, separated FBT appears to be more effective for families with high levels of expressed emotion, particularly criticism (Eisler et al., 2000; Le Grange et al., 1992).”
BackgroundInfluentialEating disorder diagnoses: empirical approaches to classification.
Wonderlich, S., Joiner, T. E., Keel, P., Williamson, D. A., & Crosby, R. D. (2007) · American Psychologist · doi:10.1037/0003-066x.62.3.167 · Cited by 151 · cited 1× · see citing works
“…AN, BN and EDNOS has changed with each iteration of DSM, with no DSM diagnostic scheme for eating disorders to date reflecting an empirically derived classification system such as taxometric or latent class analysis (Wonderlich, Crosby, Mitchell, & Engel, 2007; Wonderlich et al., 2007).”
MethodLong-term stability of eating disorder diagnoses.
Fichter, M., & Quadflieg, N. (2007) · International Journal of Eating Disorders · doi:10.1002/eat.20443 · Cited by 146 · cited 2× · see citing works
“…of illness for patients to cross over from AN restricting type (AN-R) to AN binge/purge type (AN-BP), and from AN-BP to BN (Eddy et al., 2008; Fichter & Quadflieg, 2007; Fichter, Quadflieg, & Hedlund, 2006; Milos et al., 2005; Tozzi et al., 2005; Wentz, Gillberg, Gillberg, & Rastam, 2001),…”
BackgroundWentz, E., Gillberg, C., Gillberg, I. C., & Råstam, M. (2001) · Journal of Child Psychology and Psychiatry · doi:10.1111/1469-7610.00757 · Cited by 144 · see citing works
Support for the continuity hypothesis of bulimic pathology.
Stice, E., Killen, J., Hayward, C., & Taylor, C. (1998) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.66.5.784 · Cited by 144 · see citing works
Personality subtyping and bulimia nervosa: psychopathological and genetic correlates
Wonderlich, S. A., Crosby, R. D., Joiner, T. E., Peterson, C. B., Bardone‐Cone, A. M., Klein, M. H., Crow, S. J., Mitchell, J. E., Grange, D. L., Steiger, H., et al. (2005) · Psychological Medicine · doi:10.1017/s0033291704004234 · Cited by 140 · cited 2× · see citing works
“While for a percentage of these cases, the symptoms may be transient, the subsyndromal state can be associated with marked clinical severity and risk, similar to full-threshold presentations (Binford & Le Grange, 2005; Crow, Agras, Halmi, Mitchell, & Kraemer, 2002; Le Grange et al., 2006; Le Grange, Loeb, Orman, & Jel…”
BackgroundRole of therapeutic alliance in family therapy for adolescent anorexia nervosa
Pereira, T., Lock, J., & Oggins, J. (2006) · International Journal of Eating Disorders · doi:10.1002/eat.20303 · Cited by 137 · see citing works
Self-citationEarly identification and treatment of eating disorders: prodrome to syndrome
Grange, D. L., & Loeb, K. L. (2007) · Early Intervention in Psychiatry · doi:10.1111/j.1751-7893.2007.00007.x · Cited by 132 · see citing works
Self-citationClassification of child and adolescent eating disturbances
Bravender, T., Bryant-Waugh, R., Herzog, D., Katzman, D., Rd, K., Lask, B., LeGrange, D., Lock, J., Loeb, K., Madden, S., et al. (2007) · International Journal of Eating Disorders · doi:10.1002/eat.20458 · Cited by 129 · see citing works
Self-citationPeebles, R., Wilson, J. L., & Lock, J. D. (2006) · Journal of Adolescent Health · doi:10.1016/j.jadohealth.2006.05.013 · Cited by 128 · see citing works
Self-citationRicca, V., Mannucci, E., Mezzani, B., di Bernardo, M., Zucchi, T., Paionni, A., Placidi, G., Rotella, C., & Faravelli, C. (2001) · Eating and Weight Disorders · doi:10.1007/bf03339765 · Cited by 125 · cited 4× · see citing works
“Notably, EDNOS is markedly more prevalent in clinical samples than either AN, BN, or the two combined (Ricca et al., 2001; Turner & Bryant-Waugh, 2004), and there has been much debate in the field as to how to best parse this broad but clinically compelling category (Crow, 2007; Fairburn & Cooper, 2007; Fairburn et al.”
BackgroundInfluentialA critical examination of the amenorrhea and weight criteria for diagnosing anorexia nervosa
Watson, T., & Andersen, A. E. (2003) · Acta Psychiatrica Scandinavica · doi:10.1034/j.1600-0447.2003.00201.x · Cited by 120 · cited 1× · see citing works
“…Agras, Halmi, Mitchell, & Kraemer, 2002; Le Grange et al., 2006; Le Grange, Loeb, Orman, & Jellar, 2004; McIntosh et al., 2004; Ricca et al., 2001; Watson & Andersen, 2003; Wonderlich et al., 2005), and a portion of EDNOS cases will ultimately go on to meet full criteria for an eating disorder…”
BackgroundClassification of Eating Disturbance in Children and Adolescents: Proposed Changes for the DSM-V
Bravender, T., Bryant-Waugh, R., Herzog, D. B., Katzman, D., Kriepe, R., Lask, B., Grange, D. L., Lock, J. E., Loeb, K. L., Marcus, M. D., et al. (2010) · European eating disorders review · doi:10.1002/erv.994 · Cited by 117 · see citing works
Self-citationThe dearth of psychological treatment studies for anorexia nervosa.
Grange, D. L., & Lock, J. (2005) · International Journal of Eating Disorders · doi:10.1002/eat.20085 · Cited by 111 · see citing works
Self-citationDSM‐IV threshold versus subthreshold bulimia nervosa
Grange, D. L., Binford, R. B., Peterson, C. B., Crow, S. J., Crosby, R. D., Klein, M. H., Bardone‐Cone, A. M., Joiner, T. E., Mitchell, J. E., & Wonderlich, S. A. (2006) · International Journal of Eating Disorders · doi:10.1002/eat.20304 · Cited by 99 · cited 1× · see citing works
“…clinical severity and risk, similar to full-threshold presentations (Binford & Le Grange, 2005; Crow, Agras, Halmi, Mitchell, & Kraemer, 2002; Le Grange et al., 2006; Le Grange, Loeb, Orman, & Jellar, 2004; McIntosh et al., 2004; Ricca et al., 2001; Watson & Andersen, 2003; Wonderlich et al.,…”
Loeb, K. L., Walsh, B., Lock, J., Grange, D. L., Jones, J., Marcus, S., Weaver, J., & Dobrow, I. (2007) · Journal of the American Academy of Child and Adolescent Psychiatry · doi:10.1097/chi.0b013e318058a98e · Cited by 96 · cited 2× · see citing works
“…been tested in studies that included subthreshold and atypical (i.e., EDNOS) cases (Le Grange et al., 2007; Lock et al., 2005; Lock et al., 2006; Loeb et al., 2007); for the prevention of AN in symptomatic children and adolescents at high risk for developing the full disorder (Loeb, Le Grange,…”
BackgroundSelf-citationKrautter, T. H., & Lock, J. (2004) · Journal of Family Therapy · doi:10.1111/j.1467-6427.2004.00267.x · Cited by 86 · cited 3× · see citing works
“Contrary to the AN study (Krautter & Lock, 2004), being assigned to an individual psychotherapy as opposed to FBT did not appear to confer any additional benefits in terms of therapeutic alliance or treatment acceptability.”
BackgroundResultSelf-citationCognitive-behavioral group psychotherapy of bulimia nervosa: Importance of logistical variables
Mitchell, J. E., Pyle, R. L., Eckert, E. D., Zollman, M., Crosby, R. D., Zimmerman, R., Pomeroy, C., & Seim, H. C. (1993) · International Journal of Eating Disorders · doi:10.1002/1098-108x(199311)14:3 · Cited by 82 · see citing works
Thinking afresh about the classification of eating disorders
Fairburn, C. G., & Cooper, Z. (2007) · International Journal of Eating Disorders · doi:10.1002/eat.20460 · Cited by 81 · cited 1× · see citing works
“…the two combined (Ricca et al., 2001; Turner & Bryant-Waugh, 2004), and there has been much debate in the field as to how to best parse this broad but clinically compelling category (Crow, 2007; Fairburn & Cooper, 2007; Fairburn et al., 2007; Waller, 2008; Wilfley, Bishop, Wilson, & Agras, 2007).”
BackgroundAnxiety in anorexia nervosa and its management using family-based treatment.
Hildebrandt, T., Bacow, T., Markella, M., & Loeb, K. (2012) · European eating disorders review · doi:10.1002/erv.1071 · Cited by 81 · see citing works
Self-citationAdolescents with bulimia nervosa and eating disorder not otherwise specified-purging only.
Binford, R. B., & Grange, D. L. (2005) · International Journal of Eating Disorders · doi:10.1002/eat.20167 · Cited by 75 · see citing works
Predictors and moderators of outcome in family-based treatment for adolescent bulimia nervosa.
Grange, D. L., Crosby, R., & Lock, J. (2008) · Journal of the American Academy of Child and Adolescent Psychiatry · doi:10.1097/chi.0b013e3181640816 · Cited by 64 · see citing works
Self-citationIs family therapy useful for treating children with anorexia nervosa? Results of a case series.
Lock, J. D., Grange, D. L., Forsberg, S. E., & Hewell, K. (2006) · Journal of the American Academy of Child and Adolescent Psychiatry · doi:10.1097/01.chi.0000233208.43427.4c · Cited by 62 · cited 1× · see citing works
“…which have both been tested in studies that included subthreshold and atypical (i.e., EDNOS) cases (Le Grange et al., 2007; Lock et al., 2005; Lock et al., 2006; Loeb et al., 2007); for the prevention of AN in symptomatic children and adolescents at high risk for developing the full disorder…”
BackgroundSelf-citationPatients' Perspective of Treatment in Eating Disorders: A Preliminary Study
Grange, D. L., & Gelman, T. (1998) · doi:10.1177/008124639802800309 · Cited by 59 · cited 2×
“An early qualitative description of FBT in a modest sample of adolescents with AN (Le Grange & Gelman, 1998) demonstrated that this form of therapy was ultimately acceptable for adolescents and their families.”
BackgroundA 'trans-transdiagnostic' model of the eating disorders: a new way to open the egg?
Waller, G. (2008) · European eating disorders review · doi:10.1002/erv.869 · Cited by 58 · cited 1× · see citing works
“…the two combined (Ricca et al., 2001; Turner & Bryant-Waugh, 2004), and there has been much debate in the field as to how to best parse this broad but clinically compelling category (Crow, 2007; Fairburn & Cooper, 2007; Fairburn et al., 2007; Waller, 2008; Wilfley, Bishop, Wilson, & Agras, 2007).”
BackgroundBulimia nervosa in adolescents: a disorder in evolution?
Grange, D. L., Loeb, K., Orman, S. V., & Jellar, C. C. (2004) · Archives of Pediatrics & Adolescent Medicine · doi:10.1001/archpedi.158.5.478 · Cited by 57 · see citing works
Self-citationTreating Bulimia in Adolescents: A Family-Based Approach
du Plessis, T. (2008) · Journal of Child and Adolescent Mental Health · doi:10.2989/jcamh.2008.20.1.10.495 · Cited by 55 · cited 2× · see citing works
“There are currently FBT manuals for the treatment of AN (Lock, Le Grange, Agra, & Dare, 2001) and BN (Le Grange & Lock, 2007), which have both been tested in studies that included subthreshold and atypical (i.e., EDNOS) cases (Le Grange et al., 2007; Lock et al., 2005; Lock et al., 2006; Loeb et…”
BackgroundZaitsoff, S. L., Doyle, A. C., Hoste, R., & Grange, D. L. (2008) · International Journal of Eating Disorders · doi:10.1002/eat.20515 · Cited by 53 · cited 2× · see citing works
“The only study that examined the therapeutic alliance and treatment acceptability across FBT and individual supportive psychotherapy (SPT), revealed no differences between these two treatments (Zaitsoff et al., 2008).”
BackgroundStrict versus lenient weight criterion in anorexia nervosa
McIntosh, V., Jordan, J., Carter, F. A., Mckenzie, J. M., Luty, S., Bulik, C., & Joyce, P. (2004) · European Eating Disorders Review · doi:10.1002/erv.557 · Cited by 43 · cited 2× · see citing works
“…(Binford & Le Grange, 2005; Crow, Agras, Halmi, Mitchell, & Kraemer, 2002; Le Grange et al., 2006; Le Grange, Loeb, Orman, & Jellar, 2004; McIntosh et al., 2004; Ricca et al., 2001; Watson & Andersen, 2003; Wonderlich et al., 2005), and a portion of EDNOS cases will ultimately go on to…”
BackgroundTesting the validity of eating disorder diagnoses.
Wonderlich, S., Crosby, R., Mitchell, J., & Engel, S. (2007) · International Journal of Eating Disorders · doi:10.1002/eat.20437 · Cited by 34 · cited 1× · see citing works
“…AN, BN and EDNOS has changed with each iteration of DSM, with no DSM diagnostic scheme for eating disorders to date reflecting an empirically derived classification system such as taxometric or latent class analysis (Wonderlich, Crosby, Mitchell, & Engel, 2007; Wonderlich et al., 2007).”
MethodA Case Series of Family-Based Therapy for Weight Restoration in Young Adults with Anorexia Nervosa
Chen, E. Y., Grange, D. L., Doyle, A. C., Zaitsoff, S. L., Doyle, P. M., Roehrig, J. P., & Washington, B. N. (2010) · Journal of Contemporary Psychotherapy · doi:10.1007/s10879-010-9146-0 · Cited by 26 · see citing works
Doyle, A. C., McLean, C., Washington, B. N., Hoste, R., & Grange, D. L. (2009) · International Journal of Eating Disorders · doi:10.1002/eat.20584 · Cited by 19 · see citing works
Eating disorder not otherwise specified: next steps.
Crow, S. (2007) · International Journal of Eating Disorders · doi:10.1002/eat.20449 · Cited by 9 · see citing works
Eating Disorder Not Otherwise Specified
von Ranson, K. V. (2012) · Elsevier eBooks · doi:10.1016/b978-0-12-375000-6.00141-5 · Cited by 7 · cited 2× · see citing works
“…the two combined (Ricca et al., 2001; Turner & Bryant-Waugh, 2004), and there has been much debate in the field as to how to best parse this broad but clinically compelling category (Crow, 2007; Fairburn & Cooper, 2007; Fairburn et al., 2007; Waller, 2008; Wilfley, Bishop, Wilson, & Agras, 2007).”
Background
Flagged first, then by citations
10 of the 77 references couldn’t be matched to a known paper.
Cited by
Sorted by citations
Eating Disorders in Children and Adolescents: State of the Art Review
Campbell, K., & Peebles, R. (2014) · PEDIATRICS · doi:10.1542/peds.2014-0194 · Cited by 382 · see citing works
Grave, R., Calugi, S., Doll, H., & Fairburn, C. (2012) · Behaviour Research and Therapy · doi:10.1016/j.brat.2012.09.008 · Cited by 211 · see citing works
Solmi, M., Collantoni, E., Meneguzzo, P., Degortes, D., Tenconi, E., & Favaro, A. (2018) · International Journal of Eating Disorders · doi:10.1002/eat.22884 · Cited by 119 · see citing works
Caregiving and coping in carers of people with anorexia nervosa admitted for intensive hospital care
Raenker, S., Hibbs, R., Goddard, E., Naumann, U., Arcelus, J., Ayton, A. K., Bamford, B. H., Boughton, N., Connan, F., Goss, K., et al. (2012) · International Journal of Eating Disorders · doi:10.1002/eat.22068 · Cited by 86 · see citing works
Anxiety in anorexia nervosa and its management using family-based treatment.
Hildebrandt, T., Bacow, T., Markella, M., & Loeb, K. (2012) · European eating disorders review · doi:10.1002/erv.1071 · Cited by 81 · see citing works
Self-citationDimitropoulos, G., Freeman, V. E., Allemang, B., Couturier, J., McVey, G., Lock, J., & Grange, D. L. (2015) · Journal of Eating Disorders · doi:10.1186/s40337-015-0037-3 · Cited by 71 · see citing works
“Details of each intervention and phase of FBT have previously been described elsewhere [1,17].”
BackgroundMethodInfluentialSelf-citationGrave, R. D., Eckhardt, S., Calugi, S., & Grange, D. L. (2019) · Journal of Eating Disorders · doi:10.1186/s40337-019-0275-x · Cited by 58 · see citing works
“The atheoretical nature of the FBT [28] might suggest that it is well suited to the needs of younger adolescent patients.”
BackgroundTranslating Transdiagnostic Approaches to Children and Adolescents
Chu, B. (2012) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2011.06.003 · Cited by 56 · see citing works
Anxiety and oppositional defiant disorder: A transdiagnostic conceptualization
Fraire, M. G., & Ollendick, T. H. (2012) · Clinical Psychology Review · doi:10.1016/j.cpr.2012.11.004 · Cited by 49 · see citing works
Katzman, D., Peebles, R., Sawyer, S., Lock, J., & Grange, D. L. (2013) · Journal of Adolescent Health · doi:10.1016/j.jadohealth.2013.07.011 · Cited by 52 · see citing works
“Instead, pediatricians can be most effective if they remain neutral with the patient, and give feedback to parents and/or the therapist if there are any true concerns that need to be worked through in treatment [28].”
BackgroundInfluentialSelf-citationPsychotherapies for eating disorders: findings from a rapid review
Russell, H., Aouad, P., Lê, Â. H., Marks, P., Maloney, D., Barakat, S., Boakes, R., Brennan, L., Bryant, E., Byrne, S. M., et al. (2023) · Journal of Eating Disorders · doi:10.1186/s40337-023-00886-w · Cited by 48 · see citing works
Timko, C. A., Zucker, N. L., Herbert, J. D., Rodriguez, D., & Merwin, R. M. (2015) · Behaviour Research and Therapy · doi:10.1016/j.brat.2015.03.011 · Cited by 57 · see citing works
A Pilot Study of an Acceptance-Based Separated Family Treatment for Adolescent Anorexia Nervosa
Merwin, R. M., Zucker, N. L., & Timko, C. A. (2013) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2012.11.001 · Cited by 36 · see citing works
“However, ASFT seeks to enhance the effectiveness and generalizability of parent-facilitated exposure (Loeb et al., 2010) by embedding exposures within an ACT framework and broadening the targets of exposure beyond food/eating.”
BackgroundLampard, A. M., & Sharbanee, J. M. (2015) · Australian Psychologist · doi:10.1111/ap.12078 · Cited by 29 · see citing works
Exposure-Based Family Therapy (FBT-E): An Open Case Series of a New Treatment for Anorexia Nervosa
Hildebrandt, T., Bacow, T. L., Greif, R., & Flores, A. (2013) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2013.10.006 · Cited by 29 · see citing works
Self-citationCurzio, O., Maestro, S., Rossi, G., Calderoni, S., Giombini, L., Scardigli, S., Ragione, L., & Muratori, F. (2018) · European psychiatry · doi:10.1016/j.eurpsy.2017.12.024 · Cited by 23 · see citing works
Timko, C. A., Bhattacharya, A., Fitzpatrick, K. K., Howe, H. S., Rodriguez, D., Mears, C., Heckert, K., Ubel, P. A., Ehrenreich, J. T., & Peebles, R. (2021) · Contemporary Clinical Trials · doi:10.1016/j.cct.2021.106313 · Cited by 21 · see citing works
Cella, S., Cipriano, A., Iannaccone, M., & Cotrufo, P. (2017) · Research in psychotherapy · doi:10.4081/ripppo.2017.199 · Cited by 17 · see citing works
“Similarly, Minuchin et al. (1975) have described family characteristics of enmeshment, overprotective, rigidity, and lack of conflict resolution.”
BackgroundMoulding, N. (2015) · Violence against Women · doi:10.1177/1077801215596243 · Cited by 16 · see citing works
“It is now generally acknowledged that the family dynamics observed in cross-sectional research and clinical settings are often in response to the eating disorder rather than reflective of preexisting problems (Loeb et al., 2012).”
BackgroundBhattacharya, A., DeFilipp, L., & Timko, C. A. (2020) · Handbook of clinical neurology · doi:10.1016/b978-0-444-64123-6.00026-6 · Cited by 35 · see citing works
Reuman, L., & Thompson‐Hollands, J. (2020) · Clinical Psychology Science and Practice · doi:10.1111/cpsp.12375 · Cited by 17 · see citing works
Timko, C. A., Goulazian, T., Fitzpatrick, K. K., & Rodriguez, D. (2018) · Pilot and Feasibility Studies · doi:10.1186/s40814-018-0277-5 · Cited by 14 · see citing works
“Family-based treatment is the only empirically supported treatment for AN; one hypothesized mechanism of action is a reduction in parental accommodation of symptoms [13, 14].”
BackgroundStillar, A., Merali, N., Gusella, J. L., Scarborough, J., Nash, P., Orr, E. S., Henderson, K. A., Mayman, S. B., Files, N., & Lafrance, A. (2022) · European eating disorders review · doi:10.1002/erv.2935 · Cited by 13 · see citing works
Rohde, P. (2012) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2011.06.006 · Cited by 13 · see citing works
Exploring types of family environments in youth with eating disorders
Darrow, S., Accurso, E. C., Nauman, E. R., Goldschmidt, A. B., & Grange, D. L. (2017) · European eating disorders review · doi:10.1002/erv.2531 · Cited by 12 · see citing works
Wye, E. V., Matheson, B. E., Citron, K., Yang, H.-J., Datta, N., Bohon, C., & Lock, J. D. (2022) · Contemporary Clinical Trials · doi:10.2139/ssrn.4207563 · Cited by 11
Self-citationElias, R., Murphy, H. G., Turner, K. A., & White, S. (2019) · Journal of Cognitive Psychotherapy · doi:10.1891/0889-8391.33.4.343 · Cited by 9 · see citing works
Efficacy of Acceptance and Commitment Therapy on Breast Cancer Female Patients’ Hope
Montazer, A., Nemati, F., Dehghani, F., & Fallah, T. (2017) · International Journal of Cancer Management · doi:10.5812/ijcp.5526 · Cited by 9 · see citing works
Wallin, U., & Råstam, M. (2016) · European eating disorders review · doi:10.1002/erv.2447 · Cited by 9
González-Macías, L., Caballero-Romo, A., & García-Anaya, M. (2021) · Salud mental (Mexico) · doi:10.17711/sm.0185-3325.2021.006 · Cited by 8 · see citing works
Nilsen, J.-V., Hage, T. W., Rø, Ø., Halvorsen, I., & Oddli, H. (2019) · Eating Disorders · doi:10.1080/10640266.2019.1656469 · Cited by 8 · see citing works
Trastornos de la conducta alimentaria en adolescentes y jóvenes
Verínica, G. P. M., Carolina, L. C., & Marcela, M. B. (2012) · Revista Médica Clínica Las Condes · doi:10.1016/s0716-8640(12)70351-6 · Cited by 7 · see citing works
Chatoor, I., Webb, L. E., & Kerzner, B. (2019) · International Journal of Eating Disorders · doi:10.1002/eat.23129 · Cited by 6
Parents can experience impairment due to their children’s weight and problematic eating behaviors
Lydecker, J. A., Park, J., & Grilo, C. (2019) · Journal of Adolescent Health · doi:10.1016/j.jadohealth.2019.07.026 · Cited by 5 · see citing works
McCord, A., Rice, K., & Rock, A. (2025) · PeerJ · doi:10.7717/peerj.19247 · Cited by 4 · see citing works
“…disorder, family dysfunction, caregiver mental health or practical barriers have also been cited as negative influences on treatment delivery or outcome ( Arikian et al., 2007 ; Keel & Haedt, 2008 ; Lavender, 2020 ; Loeb et al., 2012 ; Shimshoni, Omer & Lebowitz, 2021 ; Tasaka et al., 2017 ).”
Lafrance, A., Strahan, E., & Stillar, A. (2021) · Eating Disorders · doi:10.1080/10640266.2021.1993706 · Cited by 4 · see citing works
“Others may resist active involvement in their child’s treatment for fear that they will be “to blame” if they struggle with implementation and their child decompensates (Goddard et al., 2011a; Lafrance et al., 2019; Loeb et al., 2012; Schmidt & Treasure, 2006; Stillar et al., 2016).”
BackgroundCella, S., Iannaccone, M., Cipriano, A., & Cotrufo, P. (2020) · Weight Management · doi:10.5772/intechopen.91063 · Cited by 4 · see citing works
“In line with previous empirical research [36], the model tested showed that poor parental care does not have a direct effect on ED risk, but it has a significant indirect effect through low self-esteem.”
BackgroundResultA qualitative analysis of parental experiences in family-based treatment for anorexia nervosa
Wiese, J. (2014) · doi:10.17077/etd.ugpfy5oa · Cited by 2 · see citing works
“Since efficacy studies on FBT-AN had thus far been conducted only by the treatment developers themselves, Loeb et al. (2007) conducted a dissemination study of manualized FBT-AN to determine whether it could be successfully disseminated and administered by clinicians who are not the treatment developers.”
BackgroundWilkinson, H., Carbonnier, A., Wilkinson-Herbots, H., & Cooper, M. (2025) · Journal of Eating Disorders · doi:10.1186/s40337-025-01341-8 · Cited by 2 · see citing works
Perspectives on the Measurement of Outcome
Strober, M., & Lock, J. (2015) · doi:10.1002/9781118574089.ch64 · Cited by 2 · see citing works
Self-citationFamily Therapy for a Daughter with Anorexia Nervosa
Park, T. (2014) · Family and Family Therapy · doi:10.21479/kaft.2014.22.2.131 · Cited by 1 · see citing works
Jáuregui-Lobera, I., Garrido-Casals, O., Santiago, M., Bolaños-ríos, P., & Ruiz-Prieto, I. (2013) · Nutrición Hospitalaria · doi:10.3305/nh.2013.28.4.6581 · Cited by 1 · see citing works
Ghannadpour, J., Dieste, S., Buerkert, S., & Stewart, S. M. (2026) · Journal of Clinical Psychology · doi:10.1002/jclp.70158
Transforming Systems of Care for Girls: Addressing Eating Disorders in Girls Across Systems of Care.
Gupta, L., Shamshair, S., Okafor, O., & Weaver, L. (2025) · Child and Adolescent Psychiatric Clinics of North America · doi:10.1016/j.chc.2025.08.001
Dúo, I., Sepúlveda, A. R., León, M., Pastor, J., & López, M. P. (2015) · Revista de Psicopatología y Psicología Clínica · doi:10.5944/rppc.vol.20.num.2.2015.15168
“También se promueve la inclusión de la familia en el tratamiento FBT, tanto en la evaluación como en el tratamiento (Loeb et al., 2012; Eisler et al., 2007;Haigh y Treasure, 2003).”
BackgroundCook-Darzens, S. (2014) · Approches familiales des troubles du comportement alimentaire de l'enfant et de l'adolescent · doi:10.3917/eres.darze.2014.01.0377
- Authors
- Loeb, K. L., Lock, J., Greif, R., & Le Grange, D.
- Affiliations
- Fairleigh Dickinson University (US)
- Stanford University (US)
- Rutgers, The State University of New Jersey (US)
- Corresponding author
- Loeb, Katharine L.
- Venue
- Cognitive and Behavioral Practice
- Publisher
- Elsevier BV
- Published
- 2012-02
- Volume
- 19
- Issue
- 1
- Pages
- 17-30
- ISSN
- 1077-7229 (ISSN-L)
- PMC
- PMC3275816
- OpenAlex
- W1978891770
- Cited by
- 58
- References
- 77
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 1 · 2023: 2 · 2022: 3 · 2021: 3 · 2020: 3 · 2019: 4 · 2018: 6 · 2017: 3 · 2016: 2 · 2015: 7 · 2014: 5 · 2013: 6 · 2012: 6
- FWCI
- 5.28
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Cognitive and Behavioral Practice (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (5k23mh074506-05)
- National Institute of Mental Health (K23-MH074506, K08MH001457, R01MH079979, K24MH074467)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Health Sciences › Medicine › Psychiatry and Mental health › Child Nutrition and Feeding Issues
- Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
- Keywords
- family-based treatment, transdiagnostic model, eating disorders, youth, adolescents, anorexia nervosa, bulimia nervosa, eating disorder not otherwise specified, family environment, parental reactions, symptom maintenance, outpatient care
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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