Family-based early intervention for Anorexia nervosa

The family as a resource – not the cause

Anorexia always affects the entire family. In the treatment of children and adolescents, a family-based, trialogical approach has proven effective: the affected person, the parents, and the therapist work together to combat the eating disorder. The initial focus is not on exploring the causes of the illness, but on stabilizing the individual's physical health.

The first appointment – finding a way together

At the beginning, it’s about getting to know each other: the therapist takes time to understand the perspectives of both the affected person and the parents. This is followed by a diagnostic assessment, psychoeducation about the disorder, and clear treatment recommendations.

Initial goal: weight stabilization

The first goal is: no further weight loss. After that, the aim is to gradually increase weight – ideally by about 500 grams per week. The foundation for this is a structured meal plan with three main meals and three snacks per day. In some cases, a temporary exemption from sports or even school may be necessary to prevent further weight loss and support weight gain.

Division of responsibilities – Who does what?

In the first phase, parents are responsible for everything related to food: shopping for groceries, planning, preparing, and portioning the meals, and supporting their child during meals.

The affected person’s task is to eat all of the meals provided.

In weekly therapy sessions, the family and therapist reflect on the past week: What worked well? What was challenging? Together, they agree on concrete steps for the week ahead.

To support the process, several clear rules are introduced:

No discussions about food, weight, or appearance
No comments from parents on physical changes
No weighing at home – this is handled by a healthcare professional
Close medical monitoring

There is also close collaboration with a pediatrician or general practitioner. At the start, blood work and vital signs (blood pressure, pulse) are checked, an ECG is done, and height and weight are measured. During treatment, weekly weight checks are carried out. A bone density scan may also be recommended.

What if there’s no improvement with outpatient care?

If it becomes clear that outpatient treatment alone is not sufficient to achieve weight gain, therapy is intensified – for example, through home treatment or inpatient care.

Regaining responsibility and shifting toward psychotherapy

Once the situation has stabilized, responsibility for eating is gradually returned to the affected person, and physical activity is reintegrated into daily life. Therapy sessions increasingly take place without the parents – the focus now shifts to psychotherapy: Why did the eating disorder develop? What function might it serve? And what could life look like without an eating disorder?