Abstract
The present study presents an investigation of family functioning in the families of adolescents with severe restrictive eating disorders (REDs) assessed before and 6 months after a multidisciplinary family treatment program that combined psychodynamic psychotherapy, parental role intervention, and triadic or family-centered interventions. Nutritional counseling and neuropsychiatric monitoring of the overall treatment and care process were also provided. Family functioning was assessed using the clinical version of the Lausanne Trilogue Play (LTPc), a semi-structured procedure for observing family dynamics, previously validated for this patient population. The LTPc is divided into four phases. In phase 1, the mother interacts with the patient while the father assumes the role of observer. In phase 2, the father plans an activity with the patient while the mother observes. In phase 3, all the family members interact. Finally, in phase 4, the parents talk while the adolescent observes. A significant change emerged in family functioning after the treatment, but only for the interactive phase 2, when the father is required to interact with the daughter while the mother silently observes. The results of this study suggest that a relatively brief multidisciplinary treatment program may significantly improve family functioning in the families of patients diagnosed with severe REDs. Although appropriate clinical trials are needed to further test the efficacy of this treatment, the results also reinforce the concept that treatment programs targeting the individual patient and both the parents should be a first-line approach in adolescents with severe REDs.
Highlights
Restrictive eating disorders (REDs) are a heterogeneous group of potentially severe psychopathological conditions that have shown an increased incidence among young people in recent years, especially in the high-risk group of 15- to 19-yearold girls [1,2,3]
The aim of the present study was to look for significant pre-post differences in family functioning in the families of adolescent patients with severe REDs who underwent a 6-month (± two) multidisciplinary treatment program
Patients were considered eligible for the study if they were 11–18 years old and if they had a diagnosis of RED
Summary
Restrictive eating disorders (REDs) are a heterogeneous group of potentially severe psychopathological conditions that have shown an increased incidence among young people in recent years, especially in the high-risk group of 15- to 19-yearold girls [1,2,3]. REDs are thought to have a multifactorial etiology involving individual vulnerability factors influenced by biological, psychological, environmental, and family-related factors [4,5,6,7,8] Among the latter, previous research has highlighted that family relations are frequently dysfunctional in the families of individuals affected by REDs [9,10,11]. The focus of family functioning research in this specific area has shifted away from the role of family-related factors in maintaining REDs to enhancement of protective family factors that may improve interventions [22] In these families, parents often tend to adapt their own lives to the RED symptoms of their daughters; for example, they may accept meal rituals in order to avoid conflicts [23]. Engagement of the whole family in the adolescent’s treatment and care process is recognized as a key prognostic factor [4, 7, 17, 24,25,26,27,28,29]
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