Abstract
BackgroundThe aim of this research was to investigate the relationship between family functioning, adolescent-parent attachment and remission, as well as changes in these variables over time for adolescents with severe anorexia nervosa treated with family based treatment (FBT). Understanding how families respond to treatment is important because the family will be the ongoing context for psychosocial development in the longer term. The relationship between family functioning and outcome is also an important variable because it is potentially modifiable during treatment and this may improve outcome.MethodsFifty-seven female adolescents treated with FBT in a randomised controlled trial were assessed at baseline, FBT session 20 and 12-months post FBT session 20. Data on family functioning and adolescent-parent attachment was collected from patients and their parents at each time point. A series of regression analyses were used to determine the relationship between family functioning and comorbidity at baseline, and the relationship with remission status over time. Repeat measure mixed-effects models were used to assess changes in family functioning and attachment quality over time.ResultsGreater adolescent perceived family functioning impairment was positively related to psychiatric comorbidity at the start of treatment. Conversely, better family functioning predicted higher self-esteem and stronger attachment quality. Adolescent’s reporting better general family functioning, communication and problem solving were more likely to be remitted at session 20, but not at 12-month follow-up. There was no overall improvement in family functioning for any respondent either during treatment or at follow-up, and no significant relationship between change and remission at either session 20 or follow-up.ConclusionsThe adolescent’s perspective on family functioning at the start of treatment impacts on a positive outcome. Addressing family issues earlier in FBT may be important for some patients. Further research is needed in this area to determine how these findings could be integrated into the current FBT model.Trial registrationAustralian Clinical Trials Register number: ACTRN012607000009415 (www.anzctr.org.au).
Highlights
The aim of this research was to investigate the relationship between family functioning, adolescentparent attachment and remission, as well as changes in these variables over time for adolescents with severe anorexia nervosa treated with family based treatment (FBT)
While family factors are not recognised as causing anorexia nervosa (AN) [18], the illness does impact on the family and family functioning can operate as a maintaining factor effecting treatment response [19, 20]
While changes in family functioning during FBT were not related to remission status, adolescent perceived functioning at the commencement of treatment did predict remission
Summary
The aim of this research was to investigate the relationship between family functioning, adolescentparent attachment and remission, as well as changes in these variables over time for adolescents with severe anorexia nervosa treated with family based treatment (FBT). The relationship between family functioning and outcome is an important variable because it is potentially modifiable during treatment and this may improve outcome. Therapy approaches (FT) for adolescent anorexia nervosa (AN) are currently recommended as first line outpatient treatment [1,2,3,4]. Much of what we know about poor treatment response for adolescents identifies pre-existing factors such as length of illness, prior hospitalisation and being older, which are not modifiable when treatment begins [13, 16]. Family functioning is a variable that can be modified during treatment, potentially improving treatment response [17]. While family factors are not recognised as causing AN [18], the illness does impact on the family and family functioning can operate as a maintaining factor effecting treatment response [19, 20]
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