Recovering Dignity: Rebuilding the Five Tenets of Family-Based Treatment for Adolescent Anorexia Nervosa

Family-based treatment (FBT) is widely regarded as the leading evidence-based treatment for adolescents with anorexia nervosa and has demonstrated benefits, particularly in supporting weight restoration. FBT is organised around five central tenets: an agnostic view of illness causation, a non-authoritarian therapeutic stance, parental empowerment, externalisation of the eating disorder and a pragmatic focus on symptom reduction. However, evidence of group-level efficacy does not establish that treatment is appropriate, accessible or psychologically safe for every young person and family. This lived-experience-informed critical analysis brings treatment research into conversation with qualitative evidence, recovery-oriented scholarship and emerging understandings of treatment-related harm. It examines how the five tenets distribute authority, credibility and responsibility and how their enactment may shape psychological safety and recovery. Agnosticism may become incuriosity about the functions and contexts of eating-disorder behaviours; non-authoritarianism may redistribute rather than reduce clinical authority; parental empowerment may displace the young person’s voice; externalisation may support separation from the eating disorder for some while invalidating the testimony of others; and pragmatism may privilege physical restoration without adequately addressing psychological and relational needs. These tensions may be particularly consequential for young people whose presentations include neurodivergence, trauma, chronic illness or other intersecting needs. Rather than rejecting FBT, we propose five corresponding shifts: from agnosticism to explorative curiosity, from non-authoritarianism to meaningful patient choice, from parental empowerment to shared empowerment, from externalisation to individualised differentiation, and from pragmatism to person-centred responsiveness. These shifts may preserve the urgency of nutritional care while strengthening collaboration, dignity and psychological safety.