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The Role of Family Therapy for Adolescents With Anorexia Nervosa

(PSYCHIATRIC TIMES) - Anorexia nervosa (AN) is a serious psychiatric condition with a prevalence estimated at 0.48% to 0.7% among adolescent females aged 15 to 19 years.1 Comorbid psychological conditions are also common in patients with AN. Some 60% of patients with eating disorders have a lifetime anxiety or affective disorder. The mortality rates associated with this severely disabling condition are higher than for any other psychiatric disorder,2 with about half of the deaths occurring from suicide and the remainder as a result of the physical complications of AN. In addition, AN is an expensive illness to treat, with costs comparable to those for schizophrenia.3

Family therapy, one of the few treatments for AN that has been systematically examined, may show the most promise, especially for adolescent patients.4 The inclusion of parents in their children's treatment for eating disorder is not universally accepted, particularly when parents are encouraged to make strong behavioral interventions. However, recent studies suggest that families should be included in treatment and that they are often a powerful resource for helping their children recover.
"Worst attendants" or partners in recovery?

The role of families in the management of AN has been controversial from the earliest medical descriptions of the disorder. Gull5 called families the "worst attendants" and Charcot referred to parents as a pernicious influence on their offspring with AN.6 The clinical recommendation arising from these observations was to remove the parents from involvement in their child's care in a maneuver sometimes called parentectomy. Other experts have justified excluding or minimally involving families when treatment targets the individual developmental needs of adolescents, including autonomy, assertiveness, and self-control.7

In contrast, Minuchin and colleagues8 found that family involvement in treatment appeared to benefit young patients with AN, albeit with a focus primarily on ameliorating family pathology related to rigidity, enmeshment, conflict avoidance, and overprotectiveness. It was left to Dare and Eisler and their colleagues at the Maudsley Hospital in London to develop a family treatment protocol that used families as a therapeutic resource to enhance recovery for adolescent AN.9
The birth of FBT

Family-based treatment (FBT), sometimes called the Maudsley method or Maudsley approach, is a treatment that was inspired by Minuchin's findings that families could be an asset in treating youngsters with AN. Dare and Eisler also recognized that inpatient weight restoration in the hands of competent staff often set the stage for recovery. They believed that parents, with appropriate guidance and encouragement, could provide the support at home, thus avoiding hospitalization.

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