Family-Based Treatment (FBT) for ARFID

Family-Based Treatment (FBT) is a therapeutic approach that has shown promising results in treating ARFID in children and adolescents.  In some cases, FBT-ARFID is an appropriate intervention for young adults who are living at home with parental support.  

FBT-ARFID is considered “a parental empowerment model” that’s structured to increase parent motivation and effectiveness at disrupting food restriction of any form. FBT-ARFID is a collaborative approach that views the parents (or a single parent/caregiver) as  a essential resource and driver of the treatment process.  The goal of FBT for ARFID is to help the individual establish regular eating patterns, expand food repertory/reduce avoidance behaviors and in some cases, increase food volume.  

In FBT-ARFID, parents are guided in using specific strategies to address treatment targets including central ARFID challenges: food avoidance, under-eating, and a restricted range of acceptable foods.  

FBT-ARFID typically involves three phases:

1. Engagement, Education and Action: Phase 1 starts with educating the family about ARFID and the FBT approach. From there we move in to establishing goals and building parental confidence and skill acquisition to support the process of disrupting disordered eating behaviors.  Phase 1 introduces the concept of “always,” “sometimes” and “never” foods which guides the systematic approach to food expansion. 

2. Phase 2 begins once a) [under continued parent management] the individual is consuming the quantity and range of foods necessary to support health and growth while doing so without significant challenge in the home environment. And b) the individual has reaching normative weight to height expectations and is fully stable from a medical/health perspective. In phase 2, parents are still in charge of feeding but are gradually ceding age-appropriate control back to the child/teen.  

3. We enter into Phase 3 once eating has been normalized and the individual is self-nourishing effectively both independently at home and in a variety of other settings.  The family is now guided in shifting focus from eating/health concerns on to more typical developmental issues.  This phase is the time to consider and address any remaining emotional or behavioral concerns that are unrelated to the eating problem.  Of course, it’s essential in Phase 3 to build a plan for relapse prevention.

FBT-ARFID results are encouraging with up to 75% of individuals achieving full remission or significant improvement in symptoms. 

1 Locke, J. (2022). Family-Based Treatment for Avoidant/Restrictive Food Intake Disorder (-32nd ed.). Routledge.