family dynamics

1. Eating, once carefree, becomes overly cautious
2. Skipping meals, especially lunch at school
3. Thinness without vibrancy
4. Overconcern about nutritional content of foods
5. Cutting our food groups deemed not to be “healthy”
6. Rejection of the foods of one’s cultural heritage
7. New reluctance to eat with family, friends, and in public
8. Increasing preoccupation around body image, thinness, and a flat tummy.
9. Connecting self-worth to body shape/size; unable to see one’s own beauty.
10. Constantly comparing, fears about being teased, distorted negative body image.
11. Delayed puberty or regression in puberty, such as amenorrhea
12. Rapid plunge or increase in weight, regardless of starting body size or BMI.
13. Adult-like mindset to “dieting”, disconnected from the need for a child or teen to grow and mature.
14. Obsessive ritualistic behaviors around food, sneaking food, micro biting, etc.
15. Falling off one’s own growth curves; failure to reach Expected Weight/Height
16. Excessive exercise with the intent to alter one’s natural body shape.
17. “Picky”, selective eating that does not resolve.
18.  Bulimic symptoms – purging or using laxatives.
19.  Increase in anxiety, depression, even suicidal ideation 
20.  Medical symptoms such as dizziness, fainting, low heart rate, low body  temperature,  weakness,  gastric, and bowel discomforts

Eating Disorders remain one of the most lethal of the psychiatric illnesses. The medium onset of anorexia has dropped from 14 years of age to 12 years of age. Children as young as 6 years old are concerned about being “fat”. Boys and children from all ethnic/cultural backgrounds experience negative body image concerns. Bullying around body size and shape is now becoming the most common form of bullying in middle school.

Regardless of body size, Anorexia Nervosa and Bulimia Nervosa have serious medical and mental health consequences. Restrictive Eating Disorders will have medical complications that are the direct result of starvation and weight loss. Children and Adolescents who are diagnosed with Atypical Anorexia, are children who begin in larger bodies or higher weight bodies. These children can suffer the same if not more, from a severe and rapid plunge with weight loss. The heart and all organs are compromised with starvation, regardless of body size. The brain is one of the primary organs impacted by starvation, which impacts mood, anxiety, and mental health in general.

1. Children and Adolescents follow a predictable pattern of growth that determines the growth and health of all organs, brain matter, and their entire skeletal system.
2. Dieting and weight loss in children can have potential irreversible impact on both physical and emotional growth
3. 40-60-% of peak bone mass is accrued during adolescents
4. Compromised Bone Health can lead to a lifetime of increased fracture risk.
5. Starving is damaging to the heart and causes bradycardia.
6. Brain is under development until age 25. Emotional maturity can be stunted, as can growth
7. During Puberty, nutritional and hormonal factors play a major development in Bone Development
8. The oestrogens, Estrogen and Testosterone, are thought to play a key role in increasing and maintaining bone mass in adolescent males and females
9. Anorexia and Bulimia can come with an increased risk of suicidal ideation
10.  Without proper intervention, an acute eating disorder turns into a chronic eating disorder

SOURCE:
Girls: https://www.cdc.gov/growthcharts/data/set2clinical/cj41c072.pdf

SOURCE:
Boys: https://www.cdc.gov/growthcharts/data/set2clinical/cj41c071.pdf

An Eating Disorder in Teens is characterized by a lot of ‘excuses’. “I am not hungry”. “I already ate”. I “This is not healthy” “I need to take a shower right after dinner.  “No one eats lunch! it is not cool!” And food groups begin to drop off their list of acceptable foods…

 Early Intervention is the Key – If you see an eating disorder specialist, especially one trained in FBT, they will help you intervene early in this process. The goal is to prevent acute symptoms from becoming chronic.

Family-Based Treatment (FBT)

Family-Based Treatment (FBT) has emerged, internationally, as one of the most effective methods for treating eating disorders in young people. This approach involves the family directly in the recovery process, empowering parents to guide their child back to health. Turning the ship around, back in the direction it  came from, when eating was more carefree.

FBT is a protocol in 3 phases:

Phase 1 – Weight Restoration: The family takes control of the teen’s restrictive eating habits, by supervising  and supporting fuller nutrition and intake to stop the downward  weight loss spiral and begin to “weight restore”.  Parents temporarily stop calorie –burning exercise and intervene with eating disorder symptoms, such as throwing food away, pushing food around the plate, or purging.

Parents lend their child their “Wise Mind” when their child’s  thinking is so impaired and irrational.

Phase 2 – Begin to return control and choices to the adolescent:  

After a teen has made a lot of progress returning  to their own growth curve and is eating well, the  control of their eating is gradually returned back to the teen ,with ongoing family support. Flexibility and exposure work  is encouraged here. Reintroducing foods and eating in new places is encouraged. Full nutrition with all food groups represented here, is key .

Phase 3 – Establishing Healthy Independence: In phase 3,  the focus shifts to establishing normal adolescent development and healthy, independent eating habits. Full mental and physical weight restoration occurs here. For a child or a teen, these numbers are a moving target. We are looking here for “State not Weight”, meaning full mental health recovery may need more than the  minimum acceptable medical weight.

FBT, around the globe, is considered the Gold Standard for pediatric and adolescent eating disorders. A good eating disorder specialist will help you decide whether outpatient care is best for your child right now, or if you need a higher level of care, if this is assessed to be the best step for your child now. Either way,  Eating Disorder Treatment,  when done right, and done early, can lead to lasting  and positive outcomes for your child. 

Families don’t cause eating disorders, they are the best source of support. Don’t let an early acute course of an eating disorder become a chronic course.  Your involvement can change this course.

Resilience Golden Rule for Early Intervention: Intervene!

Eating Disorders progress fast. Early Detection and Early Intervention is key. Do not delay – Seek Professional Evaluation today 

Seeking Professional Evaluation:

If you suspect your child might be struggling with an eating disorder, it’s crucial to seek professional help immediately. Early intervention can make a significant difference in recovery and ensure a positive prognosis.

For more information or support, contact us at Resilience DBT & Eating Recovery (973) 783-2292 and visit our website at www.ResilienceTherapy.com. Our offices are at  33 Plymouth Street, Suite 105, Montclair, NJ 07042, Tel: (973) 783-2292.  We offer resources, support, and guidance for families seeking intervention and support around their teens relationship to food and body image

Treatment offered in surrounding towns: Montclair, West Orange, Cedar Grove, Verona, Caldwell, North Caldwell, Wayne, Glen Ridge. Telehealth offered in multiple states.

Eating Disorder Awareness Week, 2024 Information is in Partnership with 2024 https://www.nationaleatingdisorders.org/ .This post is part of our commitment to raising awareness about eating disorders and urge early diagnosis and intervention, share this message, and let’s work together to keep our children safe and healthy.

Understanding FBT

Family-Based Treatment (FBT), or the Maudsley Approach is an evidence-based approach that is considered First-Line-of-Treatment. Around the globe, It is considered to be the Gold Standard for the Early Intervention of Pediatric and Adolescent Eating Disorders. FBT empowers parents to take an active role in their child’s refeeding providing them with the tools and support they need to help their child overcome their eating disorder and keep their child in the least restrictive environment – your home!

For an early intervention of an eating disorder, FBT is designed to be a complete and final treatment. FBT is a protocol of approximately 20 sessions that take place over 6-12 months, beginning weekly. The practice of Family Based Treatment is an advanced eating disorder certification, and the FBT provider an already seasoned individual and family Eating Disorder therapist. The FBT protocol promotes   efficient progress, and is tailored and customized for every child and each family system.  The treatment from start to finish occurs in 3 phases:

Phase 1 – Refeeding/Weight Restoration. Parents take charge and  plate all meals and snacks and temporarily halt calorie burning exercise and eating disorder behaviors
Phase 2 – Gradually Transition Control of eating back to the Child/Teen
Phase 3 – Treatment Termination and focus on Age-Appropriate Adolescent Issues Establishment upon full weight and mental health recovery.

FBT can be an excruciating process, in the beginning The child or teen with a starved anorexic brain will fight against being fed. They have internal voices telling them “ Don’t eat this, it will make you fat” . “You are not worthy” , etc. As an empathic parent, you may want to listen to these statements and accommodate. Your child is in pain and you want to be sensitive. However, these words may come out of your child’s mouth, but they are not really your child but the words of an illness that is trying to take over your child.

During intake, we often ask a child or teen to give their eating disorder voice an image or a character, like an animal, or a type of weather or a Disney Character. When asked, for a metaphor, one little girl told therapist and her family, “There is no witch who is as mean as my eating disorder voices” . Her mother who spoke very little English, understood this, and burst into tears.

In early refeeding, every bite can be excruciating. The child needing to weight restore needs 3 meals and 3 snacks per day, and the parents take on a similar role as an inpatient or PHP staff, and have to be firm about meal and snack completion. Temporarily, refeeding is an all consuming process and can be an exhausting process for parents. But FBT research shows, renourishment is most successful when conducted by the people who love the child the most… his or her parents.

How does DBT Skill Training help the FBT Treatment?

FBT is designed to be a complete treatment for anorexia, but when there are co-occurring or unsafe mental health symptoms, such as suicidal ideation or self-harm urges, Dialectical Behavior Therapy (DBT) is another evidence-based therapy that offers safety and support to the treatment. DBT combines cognitive-behavioral techniques with mindfulness practices. DBT is a comprehensive  system of coping skills and DBT focuses on four key skill areas: mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness. These skills help individuals better understand and manage their thoughts, feelings, and actions, promoting healthier choices and improved relationships.

The Compatibility of FBT & DBT: A Powerful Combination

FBT and DBT complement each other well, providing a comprehensive approach to eating disorders and mental health treatment. Here’s how these two therapies work together:

FBT focuses on renourishment to restore brain function and logical thinking, while empowering the parents to take charge. FBT is a cutting edge approach. Waiting for the starving person to want recovery or be insightful is an approach over the years that has led to a deepening of the eating disorder.

DBT offers coping skills training at the same time that FBT supports the eating disorder recovery process. By combining both approaches, treatment can address both the process of renourishment and provide coping skills for both teen and for parents to surf through the 3 stages of FBT, safely. DBT skills can enhance the effectiveness of FBT by helping parents and children better manage emotions, communicate more effectively, and cope with distressing refeeding moments

Both FBT and DBT have much in common. They are both transparent methods that allow family members to work effectively together. By helping to prioritize collaboration and validation, a supportive therapeutic environment is created that fosters trust and open communication, and moves the treatment forward to completion.

FBT and DBT can be tailored to meet the unique needs of each family, allowing for flexibility and customization of the treatment.

At Resilience DBT & Eating Recovery, our skilled therapists specialize in both FBT and DBT, providing a comprehensive and evidence-based treatment approach for your family. We understand the unique challenges faced by parents and children navigating eating disorder recovery, and we’re committed to supporting you every step of the way.

By combining the strengths of FBT and DBT, your family can benefit from a comprehensive treatment plan that addresses both the emotional and behavioral aspects of eating disorders. This powerful union can help your child achieve lasting recovery while fostering healthier family dynamics and communication.

The compatibility of FBT and DBT offers an innovative and comprehensive approach to eating disorder treatment. By combining these evidence-based therapies, Resilience DBT & Eating Recovery, we can support your family in overcoming the challenges of eating disorder recovery and promoting lasting healing. Reach out to Resilience today to learn more about our comprehensive approach and how we can help your child and family on the path to recovery.