The Role of Family Therapy for Adolescents With Anorexia Nervosa

By James Lock, MD, PhD | September 1, 2006

New directions for studying FBT include assessing the utility of the approach for adolescents with bulimia nervosa, evaluating FBT's effects on young adults living at home or with relatives, as well as assessing the integration of the approach in more intensive treatment settings such as day programs, intensive outpatient programs, and inpatient programs. Other therapy formats, particularly family group formats, are also being developed.²⁹

A particular challenge common to many evidence-based treatments is efficient and effective dissemination of the approach to clinicians in practice. Training professionals and future professionals in FBT remains a limiting factor in making this approach available to patients outside of specialty centers.

The long-standing controversy concerning whether parents should be involved in the treatment of their adolescent children with AN appears to be resolving. The studies of family treatment conducted thus far clearly support actively including parents in the treatment of their adolescent children with AN. Parents and other family members are an important resource, especially for these younger patients in crisis. Most important, by using family treatment it appears to be possible to forestall the evolution of more chronic, often intractable, and devastating forms of AN.

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References

1. Hoek H, van Hoeken DV. Review of the prevalence and incidence of eating disorders. Int J Eat Disord. 2003;34:383-396.
2. Herzog DB, Greenwood DN, Dorer DJ, et al. Mortality in eating disorders: a descriptive study. Int J Eat Disord. 2000;28:20-26.
3. Streigel-Moore R, Leslie D, Petrill SA, et al. One-year use and cost of inpatient and outpatient services among female and male patients with an eating disorder: evidence from a national database of health insurance claims. Int J Eat Disord. 2000;27:381-389.
4. Le Grange D, Lock J. The dearth of psychological treatment studies for anorexia nervosa. Int J Eat Disord. 2005;37:79-91.
5. Gull W. Anorexia nervosa (apepsia hysterica, anorexia hysterica): 1868. Obses Res. 1997;5:498-502.
6. Silverman J. Charcot's comments on the therapeutic role of isolation in the treatment of anorexia nervosa. Int J Eat Disord. 1997;21:295-298.
7. Crisp AH. Anorexia Nervosa: Let Me Be. London: Academic Press; 1980.
8. Minuchin S, Rosman B, Baker I. Psychosomatic Families: Anorexia Nervosa in Context. Cambridge, Mass: Harvard University Press; 1978.
9. Russell GF, Szmukler GI, Dare C, Eisler I. An evaluation of family therapy in anorexia nervosa and bulimia nervosa. Arch Gen Psychiatry. 1987;44:1047-1056.
10. Lock J, Le Grange D. Can family-based treatment of anorexia nervosa be manualized? J Psychother Pract Res. 2001;10:253-261.
11. Lock J, Le Grange D, Agras WS, Dare C. Treatment Manual for Anorexia Nervosa: A Family-Based Approach. New York: Guilford Press; 2001.
12. Lock J, Le Grange D. Help Your Child Beat an Eating Disorder. New York: Guilford Press; 2005.
13. Le Grange D, Eisler I, Dare C, Russell G. Evaluation of family treatments in adolescent anorexia nervosa: a pilot study. Int J Eat Disord. 1992;12:347-357.
14. Robin AL, Siegal PT, Moye AW, et al. A controlled comparison of family versus individual therapy for adolescents with anorexia nervosa. J Am Acad Child Adolesc Psychiatry. 1999;38:1482-1489.
15. Eisler I, Dare C, Hodes M, et al. Family therapy for adolescent anorexia nervosa: the results of a controlled comparison of two family interventions. J Child Psychol Psychiatry. 2000;41:727-736.
16. Lock J, Agras WS, Bryson S, Kraemer HC. A comparison of short-and long-term family therapy for adolescent anorexia nervosa. J Am Acad Child Adolesc Psychiatry. 2005;44:632-639.
17. Halmi KA, Agras WS, Crow SJ, et al. Predictors of treatment acceptance and completion in anorexia nervosa: implications for future study designs. Arch Gen Psychiatry. 2005;62:776-781.
18. Dare C, Eisler I, Russell G, et al. Psychological therapies for adults with anorexia nervosa: randomized controlled trial of out-patient treatments. Br J Psychiatry. 2001;178:216-221.
19. Pike KM, Walsh BT, Vitousek K, et al. Cognitive-behavioral therapy in the posthospitalization treatment of anorexia nervosa. Am J Psychiatry. 2003;160: 2046-2049.
20. Eisler I, Dare C, Russell GF, et al. Family and individual therapy in anorexia nervosa: a five-year follow-up. Arch Gen Psychiatry. 1997;54:1025-1030.
21. Lock J, Couturier J, Agras WS. Comparison of long-term outcomes in adolescents with anorexia nervosa treated with family therapy. Am J Child Adolesc Psychiatry. 2006;45:666-672.
22. American Psychiatric Association Work Group on Eating Disorders. Practice guideline for the treatment of patients with eating disorders. Am J Psychiatry. 2006;163:1-54.
23. Krautter T, Lock J. Is manualized family-based treatment for adolescent anorexia nervosa acceptable to patients? Patient satisfaction at end of treatment. J Fam Ther. 2004;26:65-81.
24. Le Grange D, Gelman T. The patient's perspective of treatment in eating disorders: a preliminary study. S Afr J Psychol. 1998;28:182-186.
25. Pereria T, Lock J, Oggins J. The role of therapeutic alliance in family therapy for adolescent anorexia nervosa. Int J Eat Disord. In press.
26. Lock J, Couturier J, Bryson S, Agras WS. Predictors of dropout and remission in family therapy for adolescent anorexia nervosa in a randomized clinical trial. Int J Eat Disord. In press.
27. National Institute for Clinical Excellence. Core Interventions in the Treatment and Management of Anorexia Nervosa, Bulimia Nervosa, and Binge Eating Disorder. London: British Psychological Society; 2004.
28. Management of Eating Disorders. Rockville, Md: Agency for Healthcare Research and Quality; 2006. AHRQ publication 06-E010.
29. Dare C, Eisler I. A multi-family group day treatment programme for adolescent eating disorders. Eur Eat Disord Rev. 2000;8:4-18.

Evidence-based References

Le Grange D, Lock J. The dearth of psychological treatment studies for anorexia nervosa. Int J Eat Disord. 2005;37:79-91.
Lock J, Agras WS, Bryson S, Kraemer HC. A comparison of short- and long-term family therapy for adolescent anorexia nervosa. J Am Acad Child Adolesc Psychiatry. 2005;44:632-639.

Dr Lock is associate professor of child psychiatry and pediatrics in the department of psychiatry and behavioral sciences at Stanford University School of Medicine, where he has taught since 1993. He is board-certified in adult as well as child and adolescent psychiatry. He directs the eating disorder program in child psychiatry and is active in treatment research for children and adolescents with eating disorders.

Dr Lock indicates that he has received research funding from the National Institutes of Health and royalty payments from Guilford Press for sales of the books Treatment Manual for Anorexia Nervosa and Help Your Teenager Beat an Eating Disorder.

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The Role of Family Therapy for Adolescents With Anorexia Nervosa

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