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Dodge et al. (1995) first reported on the use of family therapy for BN in a small case series, demonstrating that family psychoeducation and parental coaching in disrupting binge/purge behaviors led to significant reductions in bulimic symptoms for adolescents. More recently, Le Grange and Lock 2007 described and manualized a family-based treatment for adolescents with BN (FBT-BN), derived from the approach that has demonstrated efficacy for adolescents with AN. Similar to FBT-AN, FBT-BN is agnostic about the causes of the disorder and assumes that adolescent development is negatively affected by characteristics of the eating disorder. These characteristics include secrecy, shame, and dysfunctional eating patterns, and in addition to impeding adolescent development, they are thought to have confused and disempowered parents and other family members. FBT-BN works in three stages (Table 26–6). However, there are several important differences between FBT-BN and FBT-AN. Notably, in FBT-BN, treatment is not focused on weight restoration, but rather on the regulation of eating patterns and the elimination of purging. An additional difference is that in BN, the treatment approach is more collaborative between parents and the affected adolescent. For adolescents with BN, the secretive nature of the disorder, along with the shame and guilt associated with these symptoms, may lead to it being more easily overlooked by parents. Finally, adolescents with BN may be more likely to have psychiatric comorbidity than those with AN, which needs to be addressed in treatment.

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Table Reference Number
TABLE 26–6. Three phases of family-based treatment of bulimia nervosa

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