Family Therapy For Anorexia Nervosa Research Articles

The Role of the Dietitian within Family Therapy for Anorexia Nervosa (FT-AN): A Reflexive Thematic Analysis of Child and Adolescent Eating Disorder Clinician Perspectives.

Despite dietitians being important members of the multidisciplinary team delivering family therapy for anorexia nervosa (FT-AN), their specific responsibilities and roles are unclear and their involvement in the treatment can be a contentious issue. Clinicians (n = 20) experienced in the delivery of FT-AN who were working at a specialist child and adolescent eating disorder service responded to an online survey about their experience of including a dietitian in FT-AN and how they understand the role. Both categorical and open-ended questions were used. Reflexive thematic analysis was used to analyse the qualitative free-text responses of clinician perspectives on the role of the dietitian in FT-AN. All clinicians agreed that dietetics had a role within FT-AN and most frequently sought dietetic involvement in the early phases of FT-AN. Reflexive thematic analysis of responses identified three main themes. These were (1) collaboration is key, (2) confidence as a core consideration and (3) case-by-case approach. These themes evidenced the role of the dietitian within FT-AN and highlighted both the benefits and concerns of this involvement. This study demonstrated that dietitians can take a core role as collaborators within therapy-led teams that facilitate joint working and sharing of expertise. However, dietetic input should be considered on a case-by-case basis, given its potential for creating an over-focus on nutrition and potentially diminishing parental confidence in feeding. When indicated for selected cases, nutritional counselling should be offered in joint sessions with the therapist rather than separately. The findings of the study were limited by the small sample size of participants recruited from a single centre and heterogeneity in the professional background of respondents. Although the integration of dietetics within the multidisciplinary team and the ability of dietitians to individualise patient care can enhance FT-AN treatment, potential benefits and disbenefits should be considered for each case.

How young people perceive change to occur in family therapy for anorexia nervosa: a qualitative study.

Family therapy for anorexia nervosa (FT-AN) is the first line recommended treatment for child and adolescent anorexia nervosa. Despite evidence of its efficacy, little is understood about the treatment mechanisms. This study aimed to understand how young people who have received FT-AN perceive change to occur across treatment. Fifteen adolescents (age 12-18 years) completed individual semi-structured interviews online. Recordings were transcribed verbatim and analysed using reflexive thematic analysis. Four inter-connected themes describing the process of change during treatment were generated; (1) relationships as the vehicle for change, (2) an awakening, (3) through, not around-no way out, (4) the life beyond. Current data match relatively closely with theoretical models of FT-AN and emphasise the importance of building trust with all family members, including the young person. Additionally, supporting the family to create a trusting context in which there is a sense that the only way out of the illness is by going through it (rather than avoiding it) is critical. Empirical investigation of each of the described mechanisms is needed.

Exploring the experience of young people receiving treatment for an eating disorder: family therapy for anorexia nervosa and multi-family therapy in an inpatient setting

BackgroundResearch indicates that family therapy for anorexia nervosa (FT-AN) and multi-family therapy (MFT) are effective treatments for adolescents experiencing anorexia nervosa (AN). However, less is known about young people’s experiences of these two treatments, as there is limited qualitative research, and to date no qualitative research within an inpatient setting. It is argued that the lack of such insight limits the development of services for young people experiencing AN.MethodFive young people were recruited to the study from a specialist inpatient unit who were receiving treatment on the AN pathway which included both FT-AN and MFT. Semi structured interviews were undertaken and analysed using Interpretative Phenomenological Analysis.ResultsFour superordinate themes and ten subthemes were developed from the data. The four superordinate themes were: ‘Process of Understanding’, ‘Reviving Connection’, ‘Emerging from the Eating Disorder and ‘Development of I’.ConclusionsThere appeared to be two overarching concepts: the role of the individual and the role of others, that helpfully framed the results. The superordinate themes: ‘Emerging from the Eating Disorder’ and ‘Development of I’ focused on the development of the individual. Conversely, the superordinate themes: ‘The Process of Understanding’ and ‘Reviving Connection’ were centred on the relationships existing within the family system. The results could help inform future service developments regarding inpatient provision and service design.Plain English SummaryThe most widely used and recognised treatment for anorexia nervosa in young people is family therapy for anorexia nervosa (FT-AN). An alternative treatment is multi-family therapy (MFT). Both treatments are deemed to be effective and usually happen in the community. However, some hospitals provide these treatments while the young people are in-patients. There is no research exploring young people’s experiences of these two treatments while in an in-patient unit.Young people who had received both FT-AN and MFT in an inpatient setting were asked to share their experiences of these two treatments. Their stories were analysed by a researcher. The analysis identified four themes: ‘Process of Understanding’, ‘Reviving Connection’, ‘Emerging from the Eating Disorder and ‘Development of I’.The results highlighted that the young people appeared to place more value on the role of others and perhaps others changing enabled them to change. The research highlighted the benefit in others’ understanding and therefore how improving societal understanding more broadly would be helpful. The young people reflected that both they and their parents benefited from FT-AN and MFT in an in-patient setting and it is proposed that this could help inform future service developments regarding inpatient provision.

Comparing randomized controlled trials of outpatient family-based or inpatient multimodal treatment followed by outpatient care in youth with anorexia nervosa: Differences in populations, metrics, and outcomes.

Various approaches exist to treat youth with anorexia nervosa (AN). Family-based treatment (FBT) has never been compared to long inpatient, multimodal treatment (IMT) in a randomized controlled trial (RCT). The aim of this study was to compare data on body weight trajectories, change in eating disorder psychopathology, hospital days and treatment costs in RCTs delivering FBT or IMT. Review of RCTs published between 2010 and 2020 in youth with AN, delivering FBT or IMT. Four RCTs delivering FBT (United States, n=2; Australia, n=2), one RCT delivering Family Therapy for AN (United Kingdom) and two RCTs delivering IMT (France, n=1; Germany, n=1) were identified from previous meta-analyses. The comparison of studies was limited by (1) significant differences in patient baseline characteristics including pretreated versus non-pretreated patients, (2) use of different psychometric and weight measures and (3) different initial velocity of weight recovery. Minimal baseline and outcome reporting standards for body weight metrics andnature/dose of interventions allowing international comparison are needed and suggestions to developing these standards are presented. An RCT should investigate, whether FBT is a viable alternative to IMT, leading to comparable weight and psychopathology improvement with less inpatient time and costs.

Long-term follow-up of a randomized controlled trial comparing systemic family therapy (FT-S) added to treatment as usual (TAU) with TAU alone in adolescents with anorexia nervosa.

Randomized controlled trials showed the efficacy of family therapy for anorexia nervosa during adolescence, but studies examining its long-term beneficial effect are still needed. This article presents the results of a 54-month post-randomization follow-up of a previously reported randomized controlled trial that compared two post-hospitalization outpatient treatment programs: Treatment As Usual alone versus Systemic Family Therapy added to Treatment As Usual. A consecutive series of 60 female adolescents with anorexia nervosa (DSM-IV) were randomized (30 per group). During the first 18 months, in the Treatment As Usual group, subjects received a multidisciplinary treatment. In the other group, Systemic Family Therapy sessions targeting intra-familial dynamics were added to Treatment As Usual. At 54 months, the primary outcome was defined using the Morgan and Russell global Outcome Categories (Good or Intermediate versus Poor). Secondary outcomes were the Global Outcome Assessment Schedule score, body mass index, amenorrhea, number of hospitalizations, eating disorder symptoms, psychopathological features, and family functioning. Analyses were carried out using an Intention-To-Treat with the Last Observation Carried Forward procedure. Data of 59/60 subjects were available. At 54 months, significant effects in favor of adding Systemic Family Therapy to Treatment As Usual were shown for the Global Outcome Categories (60% of Good/Intermediate versus 31% in the control group, p = .026), mean body mass index (p = .048), resumption of menses (70.0% vs. 40% p = .020), and mental state score (p = .010). Family cohesion scores were lower in the Systemic Family Therapy group (p = .040). Adding Systemic Family Therapy focusing on intra-familial dynamics to a multidimensional outpatient treatment program appeared to lead to a better long-term outcome in young women who suffered from severe anorexia nervosa during adolescence.

Brief early adolescent multi-family therapy (BEAM) trial for anorexia nervosa: a feasibility randomized controlled trial protocol

IntroductionMulti-family therapy (MFT) is a recommended treatment for adolescent anorexia nervosa internationally. Despite recent significant advances in single-family therapy, the evidence base for MFT remains relatively small. Several individual and family factors have been associated with poorer outcomes in single-family therapy, many of which may be addressed or ameliorated by MFT if delivered early in treatment. This trial aims to determine the feasibility and acceptability of adding a five-day multi-family therapy group to the early stages of family therapy for anorexia nervosa. Secondary objectives are to explore effect size changes in key individual and family factors across treatment.MethodsThis feasibility trial will use a randomised controlled design. Sixty adolescents (age 10–17 inclusive) with anorexia nervosa or atypical anorexia nervosa and their parents will be recruited from a community-based specialist eating disorder service in London, UK. Participants will be randomly allocated to receive six months of eating disorder focussed family therapy with a five-day MFT group (experimental group) or without (control group). Block randomisation will be conducted by the King’s Clinical Trials Unit and researchers will be blind to participants’ intervention allocation. Feasibility, acceptability and secondary outcomes measures will be collected at baseline, post-MFT, end of treatment, six-month and 12-month follow-up. Feasibility and acceptability will be assessed according to trial sign-up rates, retention, measure completion rates and satisfaction. Secondary outcomes include physical health improvements, changes in psychiatric symptoms, emotion regulation and reflective function capacity, expressed emotion, parental difficulties and therapeutic alliance. Descriptive data and exploration analysis of trends and effect sizes will be reported upon at trial completion.DiscussionThe five-day MFT program developed for this study is novel, brief and more accessible than previous MFT models. The inclusion of a data collection point during treatment and follow-up will allow for an investigation of trends during and after treatment. This will allow exploration and comparison of future potential mediators and moderators of MFT and FT-AN outcomes and how these may differ between treatments.Trial registrationISRCTN registry; ISRCTN93437752, on 27 January 2021.

Variability in remission in family therapy for anorexia nervosa.

The evolution toward more stringent conceptualizations of remission in family therapy for adolescent anorexia nervosa (AN) has, with time, introduced variability in outcomes across randomized controlled trials (RCTs). An examination of remission across the history of research on family therapy for AN shows that earlier studies adopted lenient definitions and generally yielded higher rates of remission than studies of the past decade that have used stricter definitions of remission. In this study, we investigate the reactivity of remission rates to the application of different definitions of remission used within the family therapy for AN literature, within a single RCT data set. We conducted a secondary analysis of data from a single-site RCT which compared the relative efficacy of two formats of family therapy in a sample of 106 Australian adolescents with AN. Using end-of-treatment data, we compared remission rates using 11 definitions of remission that have been used in studies of family therapy for AN spanning more than three decades. We found wide variability in remission rates (21.7-87.7%; Cochran's Q χ2 (10, N = 106) = 303.55, p = .000], depending on which definition of remission was applied. As expected, more lenient criteria produced higher remission rates than more stringent definitions. Applying different criteria of remission to a single data set illustrates the impact of changing how remission is defined. Failure to consider the greater stringency of remission criteria in recent studies could result in false inferences concerning the efficacy of family therapy for AN over time.

Intensive treatment program (ITP): A case series service evaluation of the effectiveness of day patient treatment for adolescents with a restrictive eating disorder.

Family Therapy for Anorexia Nervosa (FT-AN) is the first line treatment for adolescents with anorexia nervosa in the UK. However, research suggests between 10 and 40% of young people have a poor outcome. For those for whom FT-AN alone is not effective there is a clear need to develop additional treatments. This paper describes the effectiveness of an additional treatment for adolescents who had not responded to FT-AN, the Intensive Day Treatment Program (ITP) embedded within a comprehensive outpatient service at the Maudsley Hospital. Data from a retrospective chart review of patient files were analyzed for 105 young people aged 11-18 with restrictive eating disorders referred to the program in the first four and a half years of its operation. Young people attended ITP for only on average 28.41 days. Over this time they made significant improvements in a range of domains, including weight gain, eating disorder symptomatology, motivation to recover, quality of life and comorbid symptomatology. Young people continued to make improvements post ITP in outpatient treatment provided by the same service and 73.2% had a good or an intermediate outcome at the point of discharge from the service. This uncontrolled case series indicates that ITP can contribute to positive outcomes for young people who require intensification of treatment. ITP outcomes are discussed in comparison to the published literature concerning day programs for adolescents with a diagnosis of an eating disorder.

Creating Community – The Introduction of Multi‐Family Therapy for Eating Disorders in Australia

It is well established that connection and support are associated with supporting recovery from eating disorders whereas isolation and feeling misunderstood can be barriers to change. While the consumer and recovery movements have long advocated for treatments that go beyond symptom reduction alone to include factors such as connection with others, there are few treatments that are designed to target these directly for young people with eating disorders and their families. In 2014 the Sydney Children's Hospital Network Eating Disorder Service at The Children's Hospital at Westmead introduced multi‐family therapy (MFT), the first program of its kind in Australia, with a primary aim being to increase solidarity and support for families in addition to helping promote eating disorder recovery more broadly. Rooted in the principles of family therapy for anorexia nervosa, MFT generally brings together six to eight families for a four‐consecutive day workshop followed by six single follow‐up workshops over the course of six months. This paper reviews the current literature available on MFT, describes its introduction at a specialist tertiary eating disorder service in Australia, explores preliminary feedback from families, and discusses the importance of creating solidarity for families affected by eating disorders.

Predictive factors for outcome in adolescents with anorexia nervosa: To what extent does parental Expressed Emotion play a role?

In studies on family therapy in Anorexia Nervosa, family relationships, as assessed by Expressed Emotion, have been associated with outcome. Our aim was to explore the contribution of Expressed Emotion as a predictor of 18-month outcome, above and beyond the usual predictive factors. Sixty adolescent girls suffering from Anorexia Nervosa and their parents were assessed at baseline and 18 months later. Levels of Expressed Emotion were evaluated in both parents with the Five-Minute Speech Sample. After controlling for treatment group and initial clinical status, high maternal Emotional Over-Involvement at baseline was significantly associated with better clinical state. More precisely, high maternal Emotional Over-Involvement was associated with higher nutritional status, lower eating disorder severity and fewer re-hospitalizations 18 months later. No associations were found with paternal levels of Expressed Emotion. Therefore, our study confirmed the importance of taking into account both maternal and paternal Expressed Emotion. Our results also underlined that high maternal Emotional Over-Involvement plays a positive role in the outcome of Anorexia Nervosa and needs to be explored further.

Young people’s experience of family therapy for anorexia nervosa: a qualitative meta-synthesis

ABSTRACTFamily therapy is a key treatment approach for anorexia nervosa (AN), and family-based treatment (FBT) is now well supported for the treatment of adolescents. Qualitative research exploring treatment for AN from the patient’s perspective has an important role in understanding engagement and stimulating potential augmentations. The aim of this review was to describe patients’ experiences of family interventions for AN. Five databases were searched: PSYCINFO, MEDLINE, SCOPUS, CINAHL, and Web of Science, and a systematic review and meta-synthesis of 15 studies were conducted. Fourteen descriptive themes emerged, which were grouped into four conceptual themes: relinquishing control ambivalently (initial treatment resistance, authoritative care, and recovery not done alone), improved family relationships (increase openness and honesty, decreased conflict, improved intra-family understanding, rectifying structural issues, and externalisation of AN), neglect of underlying issues (cause of AN, issues othe...

Multiple family therapy for anorexia nervosa at the Eating Disorder Service, the Children's Hospital at Westmead

The Eating Disorder Service at The Children's Hospital at Westmead (CHW) is a tertiary service that offers a range of family focused treatment options for young people with an eating disorder. Multiple Family Therapy (MFT) is the newest treatment option provided by the service. MFT is now a key intervention offered by a number of services overseas, most notably at the Maudsley Hospital, London, where the model was developed. Despite it's use for more than a decade overseas, we are the first service in Australia to systemically integrate MFT as an additional treatment option within the standard suite of interventions offered. MFT theoretically builds upon the core constructs of family based treatment for anorexia nervosa, whilst adding the unique experience of solidarity for young people and their families. The content of MFT is experiential, involving activities and specific debriefing techniques to help families develop ways to work together against anorexia, increase attunement to their child's needs and feel more agency around the process of recovery. The MFT program at CHW provides the opportunity for up to eight families to work together for a 4-day workshop. Follow-up care is provided by outpatient family therapy or integration into the Intensive Family and Adolescent Eating Disorders Day Program. MFT targets families not progressing in outpatient care or who present with some other complexity with the view that engagement in treatment may be enhanced through the group experience of MFT and the opportunity to receive treatment input from multiple sources. The presentation will describe MFT constructs, the programs implementation at CHW, show material from the therapeutic activities completed and present preliminary data and family experiences from the first five groups.

Focus on anorexia nervosa: modern psychological treatment and guidelines for the adolescent patient.

Anorexia nervosa is a serious condition associated with high mortality. Incidence is highest for female adolescents, and prevalence data highlight a pressing unmet need for treatment. While there is evidence that adolescent-onset anorexia has relatively high rates of eventual recovery, the illness is often protracted, and even after recovery from the eating disorder there is an ongoing vulnerability to psychosocial problems in later life. Family therapy for anorexia in adolescence has evolved from a generic systemic treatment into an eating disorder-specific format (family therapy for anorexia nervosa), and this approach has been evidenced as an effective treatment. Individual treatments, including cognitive behavioral therapy, also have some evidence of effectiveness. Most adolescents can be effectively and safely managed as outpatients. Day-patient treatment holds promise as an alternative to inpatient treatment or as an intensive program following a brief medical admission. Evidence is emerging of advantages in detecting and treating adolescent anorexia nervosa in specialist community-based child and adolescent eating-disorder services accessible directly from primary care. Limitations and future directions for modern treatment are considered.

Services for eating disorders: how comprehensive is comprehensive?

The theme of my commentary will be “how comprehensive is comprehensive?”. I will add a number of points that are not mentioned by K. Halmi that I think are important to developing a comprehensive service, and highlight a number of areas that are mentioned. These include: a) the emergence of new concepts in the nomenclature of eating disorders; b) the need to separate children and younger adolescents from adults and older adolescents in treatment facilities; c) the role of prior trauma and its link to psychiatric comorbidity; d) the importance of the Maudsley family based treatment approach for the treatment of children and adolescents, and e) the role of complementary treatments. Approximately one-half of patients treated in eating disorder clinics do not meet full criteria for either anorexia nervosa, bulimia nervosa or binge eating disorder, and are best diagnosed with eating disorder not otherwise specified according to DSM-IV. There has been some work aimed at more specifically delineating this large subgroup. One myth that exists is that patients with eating disorder not otherwise specified are less severely ill than patients with full syndromes, but this is not necessarily true. Consider someone who vomits several times a day but does not binge eat, in contrast to someone who binges and purges twice a week. The term “purging disorder” has been coined to describe such individuals who purge but don’t binge, and they have been found to be just as impaired and to have similar medical morbidity, psychiatric comorbidity and course of illness as patients with bulimia nervosa 1,2. Brewerton et al reported that the lifetime prevalence of any purging to lose weight was 12.6% in a large representative sample of women in the United States 3. This group had significantly higher lifetime histories of major depression, substance abuse, post-traumatic stress disorder (PTSD) and victimization experiences, as well as higher body mass index and number of comorbid psychiatric disorders. One of the issues that Halmi does not address is how to manage the treatment of eating disorder patients of different ages. Most experts in the field recommend age-appropriate services and consider it optimal to separate children and younger adolescents from adults and older adolescents during treatment in inpatient, residential, partial hospital and day treatment facilities 4. It is important to protect children and adolescents from being exposed to older patients, who may inadvertently “teach” children new maladaptive behaviors, and who often have very serious “adult” issues to process, such as working through traumatic life experiences. It is now well established that eating disorder patients with bulimic symptomatology have significantly higher rates of criminal victimization experiences and resulting PTSD or partial PTSD, which in turn mediates higher rates of comorbidity 5-7. Such patients can be quite challenging and are overrepresented in inpatient settings. This necessitates that comprehensive eating disorder services are well prepared to assess and treat severely traumatized individuals and all trauma-related disorders 5. Halmi notes that “the most robust evidence-based trials for anorexia nervosa are those of family therapy with adolescents”, and this very important finding deserves further elaboration. The first major study that reported the efficacy of family therapy for anorexia nervosa indicated its usefulness in weight recovered patients upon discharge from the Maudsley hospital 8. After one year of treatment, family therapy was found to be more effective than individual therapy in patients whose illness was not chronic and had begun prior to age 19 years. In addition, a more provisional finding was the greater value of individual supportive therapy in older, more chronic patients. These results were confirmed at 5-year follow-up 9. Since then other studies have successfully applied the Maudsley model of family based treatment in underweight children and adolescents with anorexia nervosa 10. Some comprehensive programs have incorporated specific complementary and spiritually oriented treatments into their armamentarium, such as massage therapy, yoga, meditation and 12-step groups. In one study of patients with anorexia nervosa, massage therapy significantly reduced measures of body dissatisfaction as well as plasma cortisol levels 11. In bulimia nervosa, those who received massage reported less depression and anxiety and had significantly improved scores on several subscales of the Eating Disorders Inventory 12. Other complementary treatments, such as yoga, can be an effective method for increasing self-awareness, personal reflection and body satisfaction, as well as reducing anxiety 13,14. Principles of mindfulness meditation are an integral part of dialectical behavior therapy, an empirically validated treatment for bulimia nervosa, binge eating disorder and borderline personality disorder 15-17. Some models have incorporated 12-step programs, such as Overeaters Anonymous, which has been shown to be helpful in eating disorder patients 18. Mounting evidence suggests that spirituality is an important but underestimated factor in the long-term process of full recovery from an eating disorder 19-23, and comprehensive treatment programs would do well to honor these findings.

Letters to the Editor

20 February 2008 Dear Editor, SUCCESSFUL OUTCOME OF FAMILY THERAPY FOR ANOREXIA NERVOSA? We were surprised to read about ‘an impressive recovery’ from anorexia nervosa in a case report of a patient who was treated with the Maudsley family therapy approach.1 The accompanying letter describes a less favourable outcome of the same treatment in another anorexic patient. The development of medical science was recently described by Richard Smith, who served as Editor of the British Medical Journal for 13 years.2 Smith notes that ‘The history of medicine is largely a history of ineffective treatments. “The role of the doctor,” joked Voltaire, “is to amuse the patient while nature takes its course” . . . The simplest way to see if a treatment works is to give it to a patient and see what happens. The resulting publication is called a case report and was for many years the mainstay of medical journals. You don't need to be much of a scientist to see the limitations of such evidence. What would have happened if the patient hadn't been given the treatment? How do I know as a reader whether or not the reported patient is like my patient and whether or not what happened to the patient would happen to my patient?’ Smith also discusses many other problems with the case report.2 The randomised controlled trial (RCT) is now the accepted form, or rather, the ‘gold standard’ for the development of medical treatments. Smith even refers to the RCT as ‘one of the greatest scientific inventions of the 20th century’.2 We ourselves published the successful outcome of the treatment of an individual Australian patient as a case report in this journal.3 However, this was after the treatment had been demonstrated, in an RCT, to be effective.4 We want to make the treatment available to Australian and other patients, and in an initial effort to do so, we chose to describe the successful outcome in our first Australian patient in a case report. However, as we have recently pointed out in a report of the outcome in a larger group of Australian patients, our treatment should be compared with the treatments used in Australia in an RCT.5 If, on the other hand, a treatment has been demonstrated to be minimally effective in RCTs, it should no longer be used. We recently reviewed the RCTs which have evaluated the effect of family-based treatments for anorexia nervosa and found no compelling evidence that family therapy is effective.6 If an ineffective treatment is still used, as is often the case in the management of anorexia nervosa, and a patient improves while receiving that treatment, one should not only be surprised; one should also conclude that the improvement was probably not because of the treatment. However, as Peter Medawar pointed out, ‘If a person is poorly, receives treatment to make him better, and then gets better, then no power of reasoning known to medical science can convince him that it may not have been the treatment that restored his health’.7

Evidence-Based Psychosocial Treatments for Eating Problems and Eating Disorders

Eating disorders represent a significant source of psychological impairment among adolescents. However, most controlled treatment studies have focused on adult populations. This review provides a synthesis of existing data concerning the efficacy of various psychosocial interventions for eating disorders in adolescent samples. Modes of therapy examined in adolescent samples include family therapy, cognitive therapy, behavioral therapy, and cognitive behavioral therapy mostly in patients with anorexia nervosa. At this time, the evidence base is strongest for the Maudsley model of family therapy for anorexia nervosa. Evidence of efficacy for other treatments and other conditions is limited by several methodological factors including the small number of studies, failure to use appropriate control conditions or randomization procedures, and small sample sizes (i.e., fewer than 10 participants per treatment arm). Potential moderators and mediators of treatment effect are reviewed. Finally, results from adolescent studies are contrasted with those from adult studies of eating disorders treatment. Many studies of adult populations comprise late adolescent/young adult participants, suggesting that findings regarding the efficacy of cognitive behavioral therapy for bulimia nervosa in adults likely extend to older adolescent populations.

Patients' Perspective on Family Therapy for Anorexia Nervosa: A Qualitative Inquiry in a Chinese Context

This article presents a qualitative study of the subjective experiences of 24 Chinese adolescents and young women who have been suffering from anorexia nervosa and who have received family treatment from a university‐based family treatment centre in Hong Kong. In‐depth post‐treatment interviews were conducted and have been transcribed and thematised using content analysis. The narratives that have emerged have facilitated hearing the clients' and their family members' voices, especially in the areas of (a) perceived concepts of family therapy, (b) the perceived therapeutic relationship and its linkage to positive change, (c) perceived intervention strategies as employed in family treatment, and (d) the participants' own role in problem‐solving. The study has enabled the author to refine the family treatment model, which has been adapted from the Micucci's (1998) model, with additional components introduced by the author to enhance family treatment in a Chinese context.

Eating disorders in children and adolescents: an update

Children and adolescents with eating disorders frequently present to child mental health and paediatric services and have significant morbidity, psychosocial impairment and mortality. Efforts to treat these individuals have been hampered by a poor evidence base for effective interventions. This article reviews research published during 2004 with a primary focus on this challenging clinical area. Research published during 2004 has replicated past epidemiological findings and expanded our understanding of the relationship of family meal structure and disordered eating. Research has provided assistance in the well known clinical conundrums of excessive exercising in anorexia nervosa and predicting when return of menses will occur. There has also been clarification of adolescent bingeing. Potential advances include a new, noninvasive method of measuring body composition and investigations in adolescents on leptin, neuro and gastrointestinal peptides. Importantly, further evidence of the effectiveness of family therapy for anorexia nervosa and short-term benefits from intervention programs have been published. The research base that will influence clinical practice in child and adolescent eating disorders is increasing. More research is required in all areas of intervention.

Multiple family therapy for anorexia nervosa: concepts, experiences and results

AbstractMultiple family therapy (MFT) is an increasingly popular treatment approach for adolescents suffering from anorexia nervosa and their families. This paper describes the ingredients and different phases of this treatment, and outlines its indications and contra‐indications. Relationship patterns in families containing anorectic teenagers are examined, with a special emphasis on identifying areas for change in family relationships. Results with regard to the overall acceptability of the approach are presented.

The eating disorder inventory as an instrument to explore change in adolescents in family therapy for anorexia nervosa

Objective: to explore the changes in the Eating Disorder Inventory (EDI, Garner et al., 1983; Garner and Olsmtead, 1984) and its sub-scales in the course of two forms of family therapy for adolescent anorexia nervosa. Method: 40 patients (39 female, one male) and their families were randomly assigned to one of two forms of family therapy given over 12 months. (a) A conjoint family therapy(CFT) in which the adolescent was seen exclusively with parents and siblings. This is a well established form of treatment in child and adolescent mental health teams; (b) A control treatment, which is separated family therapy (SFT). In this, the parents were seen as a couple for parent guidance and the patient was seen for supportive counselling. The EDI was applied at baseline, 3 months, 6 months and at the end of treatment. Results: there were end of treatment between treatment group differences in the global EDI score and in the two sub-scales: Ineffectiveness and Interpersonal Distrust. Discussion: the EDI was shown to be useful in measuring change in therapy and in differentiating two forms of intervention. CFT seems to be associated with a diminution in a sense of Ineffectiveness and Interpersonal Distrust whereas SFT is associated with no change in these sub-scales. Copyright © 2000 John Wiley & Sons, Ltd and Eating Disorders Association.