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Family-Based Treatment May Be Better For Teens With Anorexia

October 4, 2010

Individual therapy and family-based treatments both appear effective in treating anorexia nervosa in teens, although adolescents in family-based programs may be more likely to achieve full remission six or 12 months after treatment, according to a report in the October issue of Archives of General Psychiatry, one of the JAMA/Archives journals.

The rate of new cases of anorexia nervosa is about 74 of every 100,000 individuals, and the prevalence of this disorder among adolescent girls is 0.5 percent to 0.7 percent, according to background information in the article. “Physical health impacts in adolescents include growth retardation, pubertal delay or interruption and peak bone mass reduction,” with 5.6 percent of individuals per decade dying from heart failure or suicide, the authors write. “Although various forms of individual and family therapy are used in the treatment of adolescents with anorexia nervosa, most have not been systematically examined. Hence, there is little guidance for providing evidence-based interventions for either adolescents or adults with anorexia nervosa.”

James Lock, M.D., Ph.D., of Stanford University School of Medicine, Stanford., Calif., and colleagues randomly assigned 121 teens age 12 to 18 (61 at the University of Chicago and 60 at Stanford) who had anorexia nervosa to one of two treatment groups. One group (60 teens) was enrolled in an adolescent-focused individual therapy program, which focused on enhancing autonomy, assertiveness, identifying and defining emotions, and tolerating these feelings instead of numbing them with starvation. Patients were asked to accept responsibility for food issues rather than ceding it to parents or other authorities. The other 61 teens were enrolled in a family-based treatment that promoted parental control of weight regain while restoring healthy family functioning. Each received 24 hours of outpatient treatment over 12 months, and were assessed before treatment, immediately after and then six and 12 months later.

At the end of treatment, there were no differences between groups in the rate of full remission (defined as a normal weight and an average score on an assessment of eating disorder symptoms). A total of 42 percent of family-based treatment participants and 23 percent of adolescent-focused individual therapy participants achieved full remission.

However, family-based treatment appeared superior to individual therapy for leading to full remission at the six- and 12-month follow-ups (40 percent vs. 18 percent after six months and 49 percent vs. 23 percent at 12 months). “This may have been due in part to differences in relapse from full remission, 10 percent for family-based treatment and 40 percent for adolescent-focused individual therapy, as well as more subjects reaching full-remission thresholds in family-based treatment,” the authors write. “Weight gain appeared faster for family-based treatment as assessed by age- and sex-adjusted body mass index percentile, though this effect was no longer found at follow-up. Participants in family-based treatment were also hospitalized significantly less often.”

The findings suggest family-based treatment is superior, although teen-centered therapy remains an important alternative for families who would prefer an individual approach. “Additional studies are needed comparing family-based treatment with other credible treatments, including cognitive behavioral treatment and other forms of family therapy, to delineate the best approach to treating adolescent anorexia nervosa,” the authors conclude.

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