Family Therapy for Anorexia Nervosa with Emerging Adults: Rethinking Transitions, Autonomy and Support in Eating Disorder Care

At our April Eating Disorders Community of Practice hosted by the King’s Maudsley Partnership, we shared the early clinical and research learning from the use of Family Therapy for Anorexia Nervosa with Emerging Adults (FT‑AN-EA) within adult eating disorder services. The presentation sparked a wide‑ranging discussion, bringing together clinicians and researchers across child, adolescent and adult services, and highlighting an area of growing consensus: emerging adulthood (18–25) requires a different clinical logic. 

Why focus on emerging adults? 

Emerging adulthood is a period marked by rapid transitions: legal adulthood, leaving school, entering higher education or employment, moving away from home, and developing intimate relationships. For emerging adults (EAs) with anorexia nervosa, these changes can significantly destabilise recovery. 

Ccurrent service structures often respond to these transitions with a hard boundary: turning 18 triggers a move from child and adolescent mental health services (CAMHS) to adult services. This shift is usually driven by age rather than clinical readiness, resulting in disrupted care and premature endings to effective treatments. 

The question posed was a simple but powerful one: rather than forcing young people and families to adapt to service thresholds, why not adapt evidence based treatments to the developmental needs of EAs? 

Why family therapy, beyond 18? 

Family Therapy for Anorexia Nervosa (FT-AN) has a strong evidence base in CAMHS. However, it is rarely offered once a young person reaches adulthood, often on the assumption that family involvement is no longer appropriate. 

We aim to challenge this assumption. In practice, many EAs remain closely connected to their families financially, practically and emotionally. Families often continue to play a key role in food provision, housing and day‑to‑day support. Excluding them at 18 risks removing a critical recovery resource. 

FT‑AN-EA was therefore developed not as “CAMHS therapy done later”, but as a developmentally adapted model that retains family involvement while firmly placing the EA at the centre of decisions.  

How FT‑AN is adapted for emerging adults 

Our research highlighted several adaptations to the traditional family therapy model: 

• Emerging adult–led engagement –  The EA is the central focus in therapy and actively chooses whether and how family members are involved. This reinforces agency and consent from the outset. Treatment adapts to their living situation and relational context.  

• Developmentally appropriate monitoring – Physical health and weight monitoring are typically led by the EA, with decisions about what is shared with family members negotiated collaboratively. This is respectful of the EA’s independence, confidentiality and motivation. 

• Flexible support –  Support with eating is tailored to real‑world contexts, including EAs living away from home, studying at university, or relying on remote support from parents or partners. 

• Returning responsibility to the emerging adult early on. – The right amount of support is offered flexibly by family, and once weight restoration is established, responsibility is returned to the EA quickly. This enables focus on motivation for recovery. 

• Earlier and more in-depth work around Issues of Individual Development   This aspect of therapy begins earlier than in CAMHS and includes more individual sessions, creating space to explore identity, relationships, sexuality, gender and future aspirations, topics that many EAs benefit from discussing alone with a therapist. 

• Intentional endings and relapse prevention Families are typically re‑invited towards the end of therapy to reflect on progress, celebrate achievements and support relapse prevention, acknowledging ongoing uncertainty rather than promising certainty. 

What did the early data show?

The retrospective case series presented showed encouraging findings: 

• Low dropout rates 

• Weight restoration outcomes similar to CAMHS family therapy  

• Outcomes compared favourably to FREED individual therapy data 

• Very low inpatient admission rates 

• High rates of discharge to GP care 

However, one of the most striking findings, and a key focus of the room discussion, related to EAs transitioning from CAMHS to adult services. For this group, treatment length in adult services often resembled a “restart”, suggesting that transitions themselves represent a significant therapeutic rupture. 

This strongly resonated with clinicians’ professional experience in the room. 

Key themes from the discussion 

Several areas of strong convergence emerged: 

• Age‑based transitions are clinically costly 
  Participants agreed that transitions driven by age rather than need undermine engagement, prolong treatment and increase anxiety for families and clinicians alike. 

• Relationship matters more than model 
  Across FT‑AN-EA and individual therapies, the therapeutic alliance, trust, continuity and collaboration, were repeatedly identified as a key active ingredient for change. 

• Family involvement needs reframing, not removal 
  Rather than “parental control” or sudden exclusion at 18, family involvement with EAs works best when it is chosen, flexible and negotiated with the EA. 

• Identity work is central to recovery 
  Weight restoration alone is not enough. Supporting EAs to build a meaningful identity beyond the eating disorder is essential for sustainable recovery. 

• Outcomes need to be broader than BMI 
  There was shared unease about narrow outcome measures that do not currently capture autonomy, functioning, identity development and relapse resilience. 

What does this mean for services? 

The discussion concluded with a clear message: 
The challenge is not a lack of effective clinical approaches, but a mismatch between developmental need and service architecture. 

Implications include: 

• Designing emerging‑adult pathways that are developmentally appropriate and span traditional CAMHS–adult divides. 

• Prioritising continuity of treatment over age thresholds. 

• Supporting clinicians in adult services with training and supervision to engage flexibly with families and emerging adults. 

• Implementing outcome frameworks to reflect what recovery looks like at this life stage, beyond weight restoration. 

Looking ahead 

FT‑AN-EA offers a compelling example of how services can respond intelligently to complex emerging adulthood needs by adapting family focused treatments. As Danilen’s presentation and the subsequent discussion made clear, adapting service delivery to context appropriate developmental needs is not just preferable, it is essential in improving outcomes for emerging adults with eating disorders. 

If you want to learn more about our work in this area please contact us on KMPCYP@slam.nhs.uk. Learn more about the Pears Maudsley Centre for Children and Young People. 

Learn more about Danilen Narsigadoo and his work. 

References: 

Dodge, E., Baudinet, J., Austin, A., Eisler, I., Le Grange, D., & Dimitropoulos, G. (2024). Family therapy for emerging adults with anorexia nervosa: Expert opinion on evidence, practice considerations, and future directions. European Eating Disorders Review, n/a(n/a). https://doi.org/10.1002/erv.3129 

Nursigadoo, D., Dodge, E., Allen, K., Schmidt, U., & Baudinet, J. (2026). Family Therapy for Anorexia Nervosa with Emerging Adults: A Retrospective Case Series in Routine Clinical Care. European Eating Disorders Review. https://doi.org/10.1002/erv.70107