A study that compares family therapy, individual supportive therapy, and CBT for adolescents with bulimia nervosa is just getting under way at the University of Chicago and Stanford University. When completed, it will be the largest study of adolescent bulimia nervosa undertaken. It will provide information on whether individual supportive therapy, CBT, or family therapy is the most effective approach for the disorder and will help identify patients who might benefit differentially from one treatment.
While clinicians await the results of these trials, the current evidence suggests that for adolescents with eating disorders, the best available treatment is family therapy aimed at helping parents manage their child’s eating disorder symptoms.32 While the evidence for the superiority of this form of family therapy over other treatments is still limited, the data suggest that it is effective in many cases. Family therapy also appears to be useful clinically in nonresearch populations, and manualized versions of the approach are available.30,33,34 At the same time, there is undoubtedly an important role for other therapies, including individual therapy for adolescents with anorexia nervosa and bulimia nervosa, especially in situations where family therapy is not an option.29
Medications for eating disorders in children and adolescents should be reserved for those with comorbid conditions (eg, anxiety, depression) or for those who are not responsive to psychosocial treatments. The use of medication for the treatment of adolescents with anorexia nervosa—even for comorbid conditions—might best be deferred until weight is normalized to help ensure that anxiety, obsessive-compulsive behaviors and thoughts, and depressed affect are not primarily nutritionally or behaviorally based.
Among the many challenges clinicians face is developing specific expertise in treating child and adolescent eating disorders. Most eating disorder specialists focus on treating adults, and few have sufficient training or appreciation of developmental differences in younger patients who have an eating disorder. Furthermore, many nonspecialist clinicians have little training in the treatment of eating disorders, particularly in family therapy. Although there are regional centers of excellence in the treatment of child and adolescent eating disorders, these are few in number and are located mostly in urban centers. Reliance on hospital and residential treatment is, in part, a result of these limitations of trained professionals. Efforts to address these disparities by integrating eating disorder treatment training in clinical training programs, use of distance learning, and distance therapy are needed.
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