Child and Adolescent Psychiatric Clinics of North America
Family Interventions in Adolescent Anorexia Nervosa
Section snippets
History of the family's role in eating disorders
The view that the family has a central role in eating disorders can be traced at least as far back as the late 19th century. The views about the role of parents in anorexia nervosa (AN) varied from Lasegue's1 neutral stance in taking into account the “preoccupations of relatives,” to Gull,2 considering parents as “generally the worst attendants,” and Charcot3 thinking that their influence is “particularly pernicious.” These early descriptions did not see parents as playing a helpful role in
Uncontrolled open studies of family therapy for adolescent anorexia nervosa
Over the past 30 years evidence for the usefulness of using family interventions for eating disorders has been steadily accumulating.29 In their seminal work, Minuchin and his colleagues14 describe the use of structural family therapy to provide treatment of adolescent AN. In their case series, the Philadelphia team reported a remarkably high recovery rate of 86% with their treatment approach. This result was in stark contrast to most of the earlier accounts of treatment outcome with children
Randomized controlled trials of family therapy for adolescent anorexia nervosa
There have been a limited number of randomized controlled trials of family therapy for AN and all have been small. In the first of these, Russell and colleagues46 at the Maudsley Hospital compared family therapy with individual supportive therapy following in-patient treatment in 80 patients of all ages. Twenty-six of these were adolescents with AN, 21 had an age at onset on or before 18 years, and a duration of illness of less than 3 years. All patients were initially admitted to the hospital
Theoretic model of family intervention in adolescent anorexia nervosa
Although the role of the family environment in the etiology of eating disorders is unclear, there is less doubt that the presence of an eating disorder has a major impact on family life.61 With the passing of time, food, eating, and the concomitant concerns begin to saturate the family fabric. Consequently, daily family routines and coping and problem-solving behaviors are all affected.19 Steinglass and colleagues62 described a similar process in families with an alcoholic member and in
The stages of treatment of family intervention for adolescent anorexia nervosa
The practical application of family-based treatment for adolescent AN (FBT-AN) has been well described,19, 26, 27, 66 the most detailed version being available now in a manualized version for clinicians.28 In addition, a handbook to assist and guide parents through treatment has also been published.67 This manual depicts FBT-AN as problem-focused in nature where the primary strategy is to bring about behavioral change through unified parental action. The family is held in a positive light and
Multiple-family day treatment for adolescent anorexia nervosa
Multiple-family therapy (MFT), originally pioneered by Laqueur and colleagues69 in the treatment of schizophrenia as a way to use the combined resources of families to improve family communication, learn by analogy, and expand their social repertoires,70, 71 has been adapted for work with various psychiatric populations,72, 73, 74, 75, 76 including those with eating disorders.77, 78 The usual format of MFT is similar to most group therapies, that is, weekly or biweekly meetings, but more
Summary
Almost all treatment models assume a specific mechanism of change (eg, cognitive restructuring, changes in interpersonal relationships) that is seen as the target of the treatment goal. However, the fact that different treatments often lead to similar outcomes would suggest that our understanding of the mechanisms of change remain limited89 and it is likely that the actual mechanisms of change for different treatments will turn out to be different from what is assumed by theory. This is
Acknowledgment
The authors wish to thank James Roehrig, MA, for his contribution to this manuscript.
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Cited by (97)
Family-based treatment for eating disorders
2023, Encyclopedia of Mental Health, Third Edition: Volume 1-3Feeding and eating disorders
2020, Handbook of Clinical NeurologyCitation Excerpt :Partial day hospitalization programs theoretically allow for greater generalization of skills to home and everyday life. Especially for adolescents with AN, partial hospitalization provides the family more opportunity to be involved in the re-nourishing of the child, which has shown to be effective in the treatment of adolescents with AN (Le Grange and Eisler, 2009). Another level of care between inpatient and partial hospitalization is an intensive outpatient program (IOP).
Family-based Treatment of Eating Disorders: A Narrative Review
2019, Psychiatric Clinics of North AmericaCitation Excerpt :Historically, AN treatment excluded parental involvement in both diagnosis and intervention because parents were erroneously conceptualized as a causal factor in the pathogenesis of the ED.13,14 A philosophic and evidence-based shift away from an emphasis on family responsibility in the cause of ED has allowed parents to be actively involved in the course of treatment13,15 and to be viewed as a vital resource in aiding the young persons in the process of recovery.16 Further, a broader understanding of family dynamics that develop in the context of an ED includes not only the ways in which the disorder negatively affects the patient and family but also how the ED may be partially maintained within the family’s structural system.17
Inpatient and day patient treatment of adolescents with eating disorders
2018, Eating Disorders and Obesity in Children and AdolescentsBringing families to the table: Meaningful inclusion of families/significant others in adult eating disorder programmes
2022, Irish Journal of Psychological Medicine
This work was supported by an International Visiting Fellowship from the University of Sydney, Australia (Dr le Grange).