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Bulimia nervosa is a potentially life-threatening disorder that is characterized by eating an abnormally large amount of food in a relatively short time span. It is then followed by purging that could include vomiting, the excessive use of laxatives, or extreme exercise. There can be several short-term as well as long-term complications when adolescents experience this condition. According to the Golisano Children’s Hospital between 1 and 4 percent of adolescents and young females in the U.S. are experiencing Bulimia nervosa.

When treating bulimia nervosa in adolescence there are several factors to take into consideration to make sure treatment is as effective as possible. These factors often include age, medical history, overall health, the extent of symptoms, and individual and family preferences. The immediate or extended family often plays a crucial role in the effectiveness of treatment no matter what the age of the individual. This is especially true, however, when working with adolescents.

Parental Education

When an adolescent is experiencing an eating disorder parents need to gain as much knowledge as possible to provide positive and effective support.  According to the National Eating Disorders Association, there are several basic facts parents need to understand about bulimia nervosa to be part of the treatment process.

The following are a few of the misconceptions parents may have regarding bulimia nervosa and other eating disorders:

  • My Child is Too Young to Have Bulimia Nervosa – Some individuals have developed an eating disorder as young as five. Even those who don’t develop a disorder until their teens or older may often have experienced other similar behaviors or extreme thoughts at a much younger age.
  • Eating Disorders are Only Focused on Food – While there may be an extreme focus on food, there are often many other factors involved. There are often links between an eating disorder and perfectionism and different types of obsessive behaviors. There can also be connections to anxiety and depression.
  • Anorexia Nervosa is the Only Serious Eating Disorder – Several different types of eating disorders, including bulimia nervosa, can potentially become life-threatening. Young people that force themselves to vomit could suffer from a ruptured esophagus while those that abuse laxatives may experience electrolyte imbalances that cause heart attacks.
  • The Underlying Cause Must Be Discovered – While there are sometimes traumatic events or specific reasons involved in an eating disorder, this often isn’t the case. Bulimia nervosa may be caused by certain personality traits or a variety of biological and psychological factors.
  • Bulimia Nervosa Is Easy to Recognize – People may think that it would be obvious to know if someone was excessively over-eating regularly and then purging to eliminate the calories. Individuals with Bulimia, however, are adept at hiding food and purging when no one is around. This may be true of even young children. It’s also important to note that individuals with Bulimia nervosa usually maintain a normal weight.

The Difference Between Family Therapy and Family-Based Treatment

Several different types of therapy are often used in the treatment of bulimia nervosa. Sometimes a combination of treatment is used. Some type of family therapy is often used when treating adolescents. The goals of family therapy can include developing a nurturing and supportive home environment, reducing tension in the family, or creating trust between family members. Reaching these goals may be part of the treatment plan. There are two general types of family therapies or treatments that may be used to reach these goals. While both involve the family there are several differences between the two types.

  • Family Therapy – Family therapy is often part of a bulimia treatment plan. It is a type of psychotherapy that includes immediate or extended family members. Therapy will often focus on types of communication and relationships within the family. A therapist may take either an educational or a behavioral approach to treatment, or a combination of both. Family therapy has often operated under the assumption that some sort of family problem is causing or contributing to the eating disorder. Family therapy methods have evolved in recent years, moving away from the belief that family dysfunction is at the root of an individual’s problem with an eating disorder. New research was put out by the Academy for Eating Disorder in 2010 that stated that family factors were not the primary reasons behind the development of most eating disorders. This position paper was published in 2010 and contributed to new methods in treatment that put a greater emphasis on including the family.
  • Family-Based Treatment (FBT) – FBT is also known as the Maudsley Method. It can be used in residential treatment programs as well as outpatient programs. It’s a type of treatment that works more quickly than other types of programs. The Eating Disorders Center for Treatment and Research states that one of the foundations of this particular treatment is recognizing that while the medical and health professionals are experts on eating disorders, the parent is the expert on the child. The treatment works in three distinct phases. Parents are in charge of a child’s eating during the first phase in an attempt to break negative cycles. The second phase returns independent eating to the child. The third phase focuses on broader issues and concerns related to the individual’s development. Sometimes a therapist will have a meal with the entire family to observe their interactions and behaviors. FBT treats families as a resource and a source of positive support.

Family Therapy in Conjunction with Other Therapies

Family Therapy will likely be one option among many that adolescents will have during their course of treatment. There are several types of therapies that medical professionals may use to treat Bulimia nervosa. Cognitive Behavioral Therapy (CBT) is a type of therapy that is often used when treating eating disorders. It involves restructuring a person’s thoughts and ultimately changing behavior patterns.

An adolescent may also be experiencing co-occurring disorders. These could include substance abuse or mood disorders. This will make it necessary to possibly include several forms of therapy along with family therapy. Different types of therapy may be conducted simultaneously, or each therapy may be used at various stages throughout the treatment process. Besides Family Therapy, Family-Based Treatment, and Cognitive Behavioral Therapy, there are several other types of therapies that may be used.

  • Interpersonal Therapy – This therapy focuses on how an individual relates to other people. The person will work to understand and improve personal relationships. This type of therapy may often work well with family therapy. Interpersonal therapy often works through three phases. The first phase identifies problems in past relationships. The second phase focuses on learning new strategies for building better relationships and how to implement them. The third phase involves reviewing the progress that is made.
  • Acceptance and Commitment Therapy – This type of therapy focuses on changing actions instead of feelings or thoughts. An adolescent will identify basic values and then work toward achieving goals that are related to those values. The individual is taught strategies that will help them disempower feelings and thoughts related to the eating disorder. Even though certain thoughts and feelings may be present, individuals are still capable of reaching their goals.
  • Group Therapy – Group therapy is often used for younger individuals experiencing an eating disorder. This enables individuals to receive support from peers and to realize they’re not alone. Being able to connect to other people, and in particular, their peers provides a network of encouragement and understanding. Group therapy might include aspects of other types of therapy methods or it could be more informal. Group therapy for adolescents would normally be led by an adult.

The Role of Siblings

Whether there is one sibling or several, these individuals are sometimes ignored when the family is dealing with the pressing issue of a child with aeating disorder like bulimia nervosa.  While it is difficult, the needs of each child must be taken into consideration even when one particular child is experiencing a serious eating disorder. Siblings can also have an incredible impact on the individual experiencing an eating disorder. If at all possible, siblings should play a role in the treatment process and take part in at least part of the therapy. A health professional can help parents determine how much information siblings should be given regarding the individual’s condition and what role they should take in the treatment process.

The National Institutes of Health states that there may even be positive effects when an individual grows up with a sibling who has an eating disorder. The person may pay more attention to their lifestyle and well-being after witnessing a sibling that has experienced an eating disorder. It’s important to pay close attention to other children in the family to make sure they receive the support they need while still being able to play an active role in the treatment process of their sibling. That specific role will depend on several factors including the age of the sibling, the maturity level, and the type of relationship shared between the sibling and the individual receiving treatment.

Reintegration Into the Family

For treatment to be successful there needs to be an ongoing collaboration with the parents during the treatment process. A young person will gradually be able to rebuild relationships and increasingly reintegrate back into family functions and activities. Parents need to remember that this is a process and that it’s crucial to remain patient and nonjudgmental. Reintegration will look different for each family. It may start with time spent together as a family while the adolescent is still in a residential treatment program. The family may spend a few hours at a time together enjoying a meal or engaging in a favorite activity.

Before a child leaves residential treatment the home environment may need to be altered to make the transition home as smooth and effective as possible. An adolescent who felt pressure to get all A’s might need to join a musical or athletic activity to create balance. Sometimes even rearranging the furniture in the home can symbolize a new start. Along with professional guidance, parents can help guide the child back into a routine. This might include reintegration into a school schedule and extracurricular activities. While focusing on bulimia nervosa treatment for the child, it’s also necessary for parents to think of their own needs as well. Parents will need to set boundaries and carve out time for themselves to maintain their well-being.


When looking for bulimia nervosa treatment options it’s important to find a facility that provides specialized care for adolescents along with genuine concern for each individual. Lauren Ozbolt, a board-certified adolescent psychiatrist, states when working with adolescents at Clementine, “If this was my daughter, what would I do?” Clementine not only provides individualized treatment for each adolescent but also provides strong family interaction. They offer a team of health and medical professionals with extensive experience working with adolescent girls. Their treatment programs include individual psychotherapy sessions, daily group therapy, exposure therapy, and life skills development.

They provide comprehensive academic and family support. They offer close communication with families and direct access to health professionals on the treatment team. There are a variety of parent education programs available as well as weekly family therapy options that are provided on-site or remotely. If you’re looking for a high level of psychiatric and medical care in a residential setting, contact Clementine for more information.

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Houston, TX | South Miami, FL | Malibu Lake, CA | Naperville, IL | Portland, OR | Briarcliff Manor, NY | Twin Lakes, VA


Melissa Spann, PhD, LMHC, CEDS-S

Melissa Orshan Spann, PhD, LMHC, RTY 200, is Chief Clinical Officer at Monte Nido & Affiliates, overseeing the clinical operations and programming for over 50 programs across the U.S. Dr. Spann is a Certified Eating Disorder Specialist and clinical supervisor as well as an accomplished presenter and passionate clinician who has spent her career working in the eating disorder field in higher levels of care. She is a member of the Academy for Eating Disorders and the International Association of Eating Disorder Professionals where she serves on the national certification committee, supervision faculty, and is on the board of her local chapter. She received her doctoral degree from Drexel University, master’s degree from the University of Miami, and bachelor’s degree from the University of Florida.