Enhanced cognitive behaviour therapy (CBT-E) is the first-line treatment for bulimia nervosa (BN) in adulthood. There is limited evidence for therapies for children and adolescents with BN; however family-based treatment (FBT) is being increasingly used. This case study contrasts the delivery of FBT with an augmented version (CBT-E) in two adolescents presenting with BN. In both cases, the adolescents achieved remission from BN symptoms, (cessation of bingeing and compensatory behaviour) at the end of treatment. The families reported that FBT provided a platform for them to work together and view BN as a family issue, rather than leaving the onus on the young person to recover independently. The addition of CBT-E strategies assisted with managing cognitions associated with bodyweight and shape concerns and appeared to be useful in a more complex presentation with comorbidities. Future research should examine the effectiveness of augmenting CBT-E strategies to FBT using larger samples and more rigorous research designs.Practitioner points • Involving families in the treatment of adolescent BN is both effective and acceptable to young people and their families. • Two promising treatment approaches, FBT-BN and CBT-E, can effectively be combined to provide a therapy which has the strengths of both modalities alone. • Adolescents with comorbidities or complex presentations may benefit most from combining the two modalities to develop additional skills and strategies.

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