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By Maia Szalavitz Tuesday, October 5, 2010
Treatment for anorexia has traditionally focused on individual rehabilitation of the patient, often in a residential treatment center away from the family. Indeed, for decades, leading treatment centers have recommended "parent-ectomy" — removing the influence of a dysfunctional family, who were often blamed for exacerbating the patient's eating disorder — as part of treatment. But a new study suggests that tactic is misguided.
The first randomized controlled trial to compare outcomes of family-based treatment to individual therapy for teenagers with anorexia has found that involving the family in treatment is more than twice as effective as individual care.
The study, which was published in the October 4 issue of the Archives of General Psychiatry, was led by researchers at Stanford and the University of Chicago. It followed 121 adolescents aged 12 to 18 with anorexia. Half of the participants were given individual therapy, the other half were treated with the "Maudsley Method," also known as family-based treatment (FBT), an approach to family therapy for anorexia pioneered at the Maudsley Hospital in London.
In the FBT group, parents were taught to monitor their children's eating and exercise behaviors, and to support and reinforce healthy eating. Individual therapy for anorexia focused more on the psychological problems believed to underlie patients' eating disorders; patients were taught to be mindful of their feelings instead of trying to escape them by starving themselves, and were asked to control their own eating behavior, rather than ceding responsibility to parents.
Patients in both groups were in treatment for one year. At follow-up, one year after treatment, 49.3% of the family therapy group were in full remission, defined as reaching at least 95% of normal body weight and scoring in the normal range on a psychiatric measure of disordered eating. By comparison, 23% of individual-therapy patients were in remission.
Relapse rates for family-based treatment were also lower than those typically seen after residential treatment, according to the study authors, at about 10% versus 40%.
Anorexia is more common in females and affects about 1% of women and girls. It is marked by starvation-level dieting and over-exercise, and is fatal in about 10% of severe cases.
More about: Anorexia, Anorexia nervosa, Bulimia, Bulimia Nervosa, Eating Disorder Treatments, Eating Disorder Treatments for Teens, Eating Disorder Treatments for Children & Teens, Rosewood Ranch, Rosewood Centers for Eating Disorders.
Randomized Clinical Trial Comparing Family-Based Treatment With Adolescent-Focused Individual Therapy for Adolescents With Anorexia Nervosa
James Lock, MD, PhD; Daniel Le Grange, PhD; W. Stewart Agras, MD; Ann Moye, PhD; Susan W. Bryson, MA, MS; Booil Jo, PhD
Arch Gen Psychiatry. 2010;67(10):1025-1032. doi:10.1001/archgenpsychiatry.2010.128
Context Evidence-based treatment trials for adolescentswith anorexia nervosa are few.
Objective To evaluate the relative efficacy of family-basedtreatment (FBT) and adolescent-focused individual therapy (AFT)for adolescents with anorexia nervosa in full remission.
Design Randomized controlled trial.
Setting Stanford University and The University of Chicago(April 2005 until March 2009).
Participants One hundred twenty-one participants, aged12 through 18 years, with DSM-IV diagnosis of anorexia nervosaexcluding the amenorrhea requirement.
Intervention Twenty-four outpatient hours of treatmentover 12 months of FBT or AFT. Participants were assessed atbaseline, end of treatment (EOT), and 6 months' and 12 months'follow-up post-treatment.
Main Outcome Measures Full remission from anorexianervosadefined as normal weight ( 95% of expected for sex, age, andheight) and mean global Eating Disorder Examination score within1 SD of published means. Secondary outcome measures includedpartial remission rates (>85% of expected weight for heightplus those who were in full remission) and changes in body massindex percentile and eating-related psychopathology.
Results There were no differences in full remission betweentreatments at EOT. However, at both the 6- and 12-month follow-up,FBT was significantly superior to AFT on this measure. Family-basedtreatment was significantly superior for partial remission atEOT but not at follow-up. In addition, body mass index percentileat EOT was significantly superior for FBT, but this effect wasnot found at follow-up. Participants in FBT also had greaterchanges in Eating Disorder Examination score at EOT than thosein AFT, but there were no differences at follow-up.
Conclusion Although both treatments led to considerableimprovement and were similarly effective in producing full remissionat EOT, FBT was more effective in facilitating full remissionat both follow-up points.
Trial Registration clinicaltrials.gov Identifier: NCT00149786
Author Affiliations: Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California (Drs Lock, Agras, and Jo and Ms Bryson); Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, Illinois (Dr Le Grange); and private practice, Bloomfield Hills, Michigan (Dr Moye).