Treatment for Eating Disorders

Most individuals are seen for a course of outpatient treatment. In general, our program follows manualized treatment approaches backed by extensive clinical and research support. Because eating disorders usually have serious medical consequences, our program will also facilitate appropriate medical management through UCSF.

Adolescents are typically treated using manualized Family-Based Treatment, in which specific goals are set at the outset of treatment and reviewed throughout therapy. Treatment aims to address eating disorder issues in 15-20 sessions that are scheduled over 6-9 months. 

Treatment for eating disorders requires a multidisciplinary approach. Most treatments involve a combination of psychotherapy, psychoeducation, medical management, and nutritional counseling. Our program offers various types of therapy, which are selected according to the treatment that is most indicated for the particular disorder and the particular individual. There are several outpatient treatments that have been shown to be effective in the treatment of eating disorders.

Family Therapy

There are different types of family treatments. The type of treatment often provided by our team is called family-based treatment (FBT, or "Maudsley"), which is typically shorter than traditional family therapy (20 sessions), and instead of focusing on family dynamics, the initial focus is on putting parents temporarily in charge of helping to reduce the control that the eating disorder has over their child's life. The first stage of treatment focuses on weight restoration and reduction of eating disorder symptoms. Once the eating disorder is under control, parents return control of eating back to their child and help them with normal developmental tasks. The director of the UCSF Eating Disorders Program, Dr. Daniel Le Grange, is one of the developers of family-based treatment (FBT), pioneering this approach as an eminent clinical researcher in evidence-based treatment approaches for eating disorders. FBT is considered the first-line treatment approach for adolescents with eating disorders.

Our intensive family treatment program integrates many of the principles within family-based treatment in a one-week intensive immersion model that is ideal for families who do not have local eating disorders treatment, or who are feeling "stuck."

Cognitive-Behavioral Approaches

Cognitive Behavior Therapy (CBT) is the treatment of choice for adults with bulimia nervosa whose symptoms are moderate to severe. CBT is also recommended for adults with anorexia nervosa. CBT for bulimia nervosa is short-term (20 sessions) and for anorexia nervosa the length of treatment is longer. Individual and/or group therapy formats exist for CBT.

Research has continually demonstrated the effectiveness of CBT for bulimia nervosa. It is more effective than medication alone, supportive psychotherapy, behavior therapy, and is comparable to Interpersonal Psychotherapy (IPT; for a review see Wilson et al., 1997). Research also suggests that CBT is effective for anorexia nervosa and binge-eating disorder (Garner & Needleman, 1997). 

The therapy aims at correcting errors in thinking and perception that lead to negative self-perceptions and eating disorder symptoms. It is aimed at normalizing eating behavior and reducing restrictive eating by re-introducing 'taboo' foods into diets and meal planning. This therapy involves self-monitoring of food intake, bingeing and purging episodes, and thoughts /feelings that trigger these episodes. CBT also involves regular weighing.

Although CBT is slightly less researched in adolescents than adults, it has demonstrated effectiveness, and our clinic offers this treatment approach for patients when appropriate, especially when FBT is not indicated or feasible.

Other Treatments

For certain individuals, other treatments may be appropriate. Such treatments include adolescent-focused therapy for anorexia nervosa, supportive psychotherapy, and dialectical behavior therapy (DBT).