In recent years, the treatment of adolescent eating disorders has witnessed a transformative shift, driven by innovative approaches aimed at improving outcomes for one of the most vulnerable patient populations. A groundbreaking study set in the Netherlands explores an adaptation of Family-Based Treatment (FBT), a standard therapeutic model for eating disorders, by relocating it from clinical settings into the home environment. This pioneering approach, known as Family-Based Treatment at Home (FBT-H), promises to address persistent challenges in treating adolescents suffering from eating disorders compounded by additional mental health conditions.
Eating disorders such as anorexia nervosa (AN) and other specified feeding or eating disorders (OSFED) notoriously impact adolescents during critical developmental stages. While FBT has long been recognized as the primary evidence-based intervention, its effectiveness has been limited by modest remission rates, especially in patients with concurrent anxiety, mood disorders, or other psychiatric comorbidities. Traditional FBT relies heavily on outpatient clinical visits, which may not sufficiently capture the nuanced family dynamics and stressors that contribute to the perpetuation of these conditions. This recognition has catalyzed interest in home-based interventions designed to place treatment within the natural settings where adolescents live and interact daily.
The innovative FBT-H model proposed in this study is designed to deliver therapeutic support directly in the home, thereby integrating treatment into the family’s ecosystem. By conducting approximately two sessions per week over a period of 6 to 12 months, clinicians can closely observe and intervene within the actual environments influencing adolescent behavior and symptom management. This method potentially enhances the fidelity and applicability of family-based techniques by facilitating real-time adjustments aligned with familial patterns of interaction and caregiving.
This mixed-methods trial incorporates rigorous quantitative and qualitative methodologies to evaluate the multifaceted outcomes of FBT-H. Ten adolescents, aged 12 to 18, diagnosed with AN or OSFED and co-existing mental health disorders, will undergo intensive monitoring over the course of a year. The primary clinical endpoint involves tracking weight change from the baseline to the one-year follow-up, providing an objective marker of physical recovery—a critical element in the treatment of eating disorders. Alongside weight metrics, the investigation delves deeply into secondary outcomes, including the severity of eating disorder symptoms, quality of life indices, parent-child relational dynamics, caregiver burden, and overall emotional well-being.
In addition to these quantitative measures, the study employs a qualitative lens by conducting interviews with adolescents, their parents, and practicing therapists involved in the treatment. This offers unprecedented insight into the lived experiences, perceptions, and attitudes towards the FBT-H framework, ensuring a comprehensive assessment that transcends purely clinical parameters. Understanding the subjective perspectives of all stakeholders is essential to refining FBT-H and enhancing its acceptability and feasibility on a broader scale.
The embedded somatic screening and clinical interviews conducted at baseline serve a crucial function in delineating the initial health status of participants. This holistic approach addresses mood and anxiety levels, thereby acknowledging the psychological complexity typical of adolescents with eating disorders and comorbid mental health challenges. Weekly monitoring of general well-being and therapeutic alliance further supports a dynamic and responsive treatment environment, facilitating early identification of potential setbacks or areas requiring intensified focus.
By situating treatment within the home, FBT-H harnesses ecological validity, tapping into everyday family routines and communication patterns that can either hinder or facilitate recovery. This environment-specific intervention also seeks to mitigate barriers often encountered in outpatient care, such as transportation difficulties, stigma related to clinic visits, and disruptions to school or social activities. The home setting may foster greater parental empowerment in managing the adolescent’s nutritional rehabilitation and emotional support, which are cornerstones of effective FBT.
Moreover, the extended delivery timeline of FBT-H—spanning up to a year—provides sustained therapeutic engagement, potentially enhancing treatment adherence and allowing for the gradual resolution of entrenched eating disorder behaviors. This contrasts with briefer, less frequent outpatient encounters typical of some FBT programs. The intensified contact in FBT-H ensures timely responsiveness and personalized adjustments tailored to changing clinical presentations and family circumstances.
Despite its promise, this study also rigorously examines the limitations and challenges inherent in home-based treatment modalities. Issues such as privacy concerns, potential familial resistance, and the logistical complexity of delivering consistent therapy across multiple home environments are critically evaluated. Such transparency is essential to refining best practices and establishing protocols that maintain therapeutic integrity while adapting to diverse household contexts.
Importantly, this research aligns with a broader global momentum toward community- and home-based mental health care, which underscores the value of embedding interventions within patients’ natural living conditions. By expanding the scope of assessment beyond traditional parameters—incorporating quality of life, family dynamics, and caregiver stressors—the study epitomizes a holistic approach to eating disorder treatment. It advocates for integrative strategies that target both physical recovery and psychosocial resilience.
The approval by the Dutch Medical Ethics Committee and the formal registration of the trial (Clinical Trial Number NCT06792227) underscore the scientific rigor and ethical oversight underpinning this research endeavor. Such compliance ensures that patient safety and rights remain paramount throughout the study while enhancing the validity and generalizability of findings within the field of adolescent psychiatry.
As this trial progresses, mental health professionals, researchers, and clinical practitioners eagerly anticipate data that may redefine treatment paradigms for adolescent eating disorders. Should FBT-H prove effective, it could revolutionize the accessibility, quality, and outcomes of care, particularly for youths grappling with the dual burden of eating disorders and co-occurring psychiatric conditions. The implications of this could be far-reaching, extending from clinical practice guidelines to policy development and infrastructural support for home-based care frameworks.
Ultimately, the FBT-H model reflects a compassionate and evidence-informed vision of mental health care—one that acknowledges the intricate interplay between individual pathology, family systems, and environmental context. By adopting a mixed-methods approach, the researchers ensure that both scientific metrics and human experiences shape the trajectory of innovation within this critical field. This promising study stands at the forefront of transforming adolescent psychiatric treatment, with the potential to significantly improve recovery trajectories and quality of life for young people worldwide.
—
Subject of Research: Family-Based Treatment applied at home for adolescents with eating disorders and co-occurring mental health conditions.
Article Title: Family-based treatment at home in adolescents with eating disorders and co-occurring mental health conditions: rationale and study design of a mixed methods trial.
Article References:
Schapink, A.A.H., van der Velde, J., Winkelhorst, K. et al. Family-based treatment at home in adolescents with eating disorders and co-occurring mental health conditions: rationale and study design of a mixed methods trial. BMC Psychiatry 25, 346 (2025). https://doi.org/10.1186/s12888-025-06672-z
Image Credits: AI Generated
DOI: https://doi.org/10.1186/s12888-025-06672-z
