Comparison of Long-Term Outcomes in Adolescents With Anorexia Nervosa Treated With Family Therapy

Department of Psychiatry and Behavioral Sciences, Stanford University, CA 94305, USA.
Journal of the American Academy of Child & Adolescent Psychiatry (Impact Factor: 7.26). 07/2006; 45(6):666-72. DOI: 10.1097/
Source: PubMed


To describe the relative effectiveness of a short versus long course of family-based therapy (FBT) for adolescent anorexia nervosa at long-term follow-up.
This study used clinical and structured interviews to assess psychological and psychosocial outcomes of adolescents (ages 12-18 years at baseline) who were previously treated in a randomized clinical trial using family therapy between 1999 and 2002.
Eighty-three percent (71/86) of subjects participated in follow-up assessments of current psychological and psychosocial functioning. In addition, 49% (35) were interviewed using the Eating Disorder Examination. Mean length of follow-up was 3.96 years (range 2.3-6.0 years). There were no statistically significant differences between the two groups on any measure at long-term follow-up. As a whole, the group was doing well with 89% above 90% ideal body weight, 74% with Eating Disorder Examination scores within the normal range, and 91% of postmenarcheal females not on birth control had menstrual return.
A short course of family therapy is as effective as a longer course at follow-up.

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    • "found to outperform adolescent-focused individual psychotherapy, resulting in higher rates of remission at a 6-month and 12-month follow up (Lock et al., 2010). Other controlled trials have found it to result in higher rates of weight gain than using individual therapy (Robin et al., 1999; Russell et al., 1987) and studies have found that most of those who improve with FBT maintain their improvements at a 4-year and 5-year follow up (Eisler et al., 1997; Lock et al., 2006). There are several fundamental tenets of FBT (Lock and Le Grange, 2013): 1. "
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    ABSTRACT: There is increasing research evidence that family-based treatment (FBT) is the most effective form of treatment currently available for adolescents with anorexia nervosa, while preliminary evidence suggests that it may also be effective for adolescents with bulimia nervosa. Originally designed as a weekly outpatient treatment, FBT's efficacy has led to its adaptation for use in other treatment settings, such as partial hospitalization or intensive outpatient programmes. Although FBT cannot be replicated in these treatment settings, FBT principles can be borrowed and implemented. This article reviews challenges that arise when incorporating FBT into more intensive treatment settings while attempting to remain true to the intent of the original treatment approach.Practitioner pointsFBT cannot be replicated in higher levels of care, but FBT principles can be effectively incorporated into a day treatment programme for eating disorders.Challenges in incorporating FBT into higher levels of care include adequate parental involvement and empowerment.
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    • "Furthermore, up to 40% are remitted of eating disordered cognitions and behaviours by the end of treatment, which compares favourably with other forms of adolescent-oriented treatment. These typically demonstrate approximately 22% remission of cognitive eating disorder symp- tomatology and 66% weight restoration (Lock et al., 2006). In Australia, FBT has been shown to reduce the rate of hospital readmissions by up to 50% (Wallis et al., 2007). "

    Full-text · Article · Nov 2012 · Australian and New Zealand Journal of Psychiatry
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    • "Adolescents who did not meet the full DSM criteria for BN were admitted to both the Schmidt et al (2007) and Le Grange et al (2007) studies as well. The rationale for including these cases is that adolescents present earlier in the course of their disorder, those with clinically important symptoms require treatment, and this range of symptom presentation is a more accurate sample relevant to the clinical realities of child and adolescent eating disorders (WCEDCA, 2007; Peebles, Wilson, & Lock, 2006). In the studies of FBT-AN, there is no indication that that those who did not meet all diagnostic criteria fared better or worse than those that did not (Lock et al., 2005; Le Grange et al., 2004). "
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    ABSTRACT: This paper describes the transdiagnostic theory and application of family-based treatment (FBT) for children and adolescents with eating disorders. We review the fundamentals of FBT, a transdiagnostic theoretical model of FBT and the literature supporting its clinical application, adaptations across developmental stages and the diagnostic spectrum of eating disorders, and the strengths and challenges of this approach, including its suitability for youth. Finally, we report a case study of an adolescent female with eating disorder not otherwise specified (EDNOS) for whom FBT was effective. We conclude that FBT is a promising outpatient treatment for anorexia nervosa, bulimia nervosa, and their EDNOS variants. The transdiagnostic model of FBT posits that while the etiology of an eating disorder is unknown, the pathology affects the family and home environment in ways that inadvertently allow for symptom maintenance and progression. FBT directly targets and resolves family level variables, including secrecy, blame, internalization of illness, and extreme active or passive parental responses to the eating disorder. Future research will test these mechanisms, which are currently theoretical.
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