Treatment For Adolescent Anorexia Nervosa Research Articles

Feasibility, acceptability, and effectiveness of family-based treatment for adolescent anorexia nervosa: an observational study conducted in Brazil

There is strong evidence that family-based treatment is effective in cases of adolescent anorexia nervosa. Although family-based treatment has been studied in English-speaking countries, there is a need to examine the generalizability of this approach to non-English speaking cultures. This pilot-study aimed to examine the feasibility, acceptability, and effectiveness of family-based treatment in Brazil. Observational study of adolescents with anorexia nervosa (excluding menstrual criteria), as determined with the Diagnostic and Well-Being Assessment, referred for treatment at a specialized center in São Paulo, Brazil. The following data were collected at baseline, at the end of treatment, and after six months of follow-up: weight; height; body mass index; menstrual status; Eating Disorder Examination Questionnaire score; and Children Global Assessment of Functioning Scale score. Of 11 eligible patients/families, 9 (82%) enrolled in the study, and 7 (78%) completed the treatment. The mean patient age was 14.64 +/- 1.63 years (range, 12.33-17.00 years). The Wilcoxon signed rank test showed statistically significant improvement in weight and body mass index at the end of treatment, as well as after six months of follow-up, at which point none of the patients met the diagnostic criteria for any eating disorder. The results suggest that family-based treatment is acceptable and feasible for Brazilian families. Outcomes suggest that the approach is effective in this cultural context, leading to improvements similar to those reported in previous studies conducted in other cultures.

A randomised controlled multicentre trial of treatments for adolescent anorexia nervosa including assessment of cost-effectiveness and patient acceptability – the TOuCAN trial

A randomised controlled multicentre trial of treatments for adolescent anorexia nervosa including assessment of cost-effectiveness and patient acceptability – the TOuCAN trial

Early response to family‐based treatment for adolescent anorexia nervosa

The purpose of this study was to determine if early weight gain predicted remission at the end of treatment in a clinic sample of adolescents with anorexia nervosa (AN). Sixty five adolescents with AN (mean age = 14.9 years, SD = 2.1), from two sites (Chicago n = 45; Columbia n = 20) received a course of manualized family-based treatment (FBT). Response to treatment was assessed using percent ideal body weight (IBW) with remission defined as having achieved ≥ 95% IBW at end of treatment (Session 20). Receiver operating characteristic analyses showed that a gain of at least 2.88% in ideal body weight by Session 4 best predicted remission at end of treatment (AUC = 0.674; p = 0.024). Results suggest that adolescents with AN, receiving FBT, who do not show early weight gain are unlikely to remit at end of treatment.

Incorporating a multi-family therapy group in treatment for adolescent anorexia nervosa

fA multi-family therapy group (MFT) was developed to support young people with a diagnosis of anorexia nervosa (AN). This group was effective in supporting all family members in sharing their experience of the illness and the impact that it has on individuals and family experiences.

Family therapy in the treatment of adolescent anorexia nervosa: Current research evidence and its therapeutic implications

From the outset, the systemic and family movement has expressed an interest in eating disorders, more specifically anorexia nervosa, establishing causal links between family functioning and aetiology and advocating family therapy as the treatment of choice for this disorder. Because of high consistency between its explanatory and therapeutic dimensions, this model continues to dominate our conceptualizations and clinical practice, in spite of a lack of empirical support. This article summarizes present empirical evidence concerning both family functioning (explanatory dimension) and the effectiveness of family therapy (therapeutic dimension) in anorexia nervosa, and describes resulting changes in theoretical and clinical perspectives. A model of evidence-based family therapy is presented and several unresolved issues are raised. Overall, this overview of the literature supports the use of therapeutic models that are more flexible and normative, less guilt-inducing, more diversified (eclectic and integrative), and more rooted in the empirical literature.

A randomised controlled treatment trial of two forms of family therapy in adolescent anorexia nervosa: a five‐year follow‐up

There is growing evidence that family therapy is an effective treatment for adolescent anorexia nervosa. This study aimed to ascertain the long-term impact of two forms of outpatient family intervention previously evaluated in a randomised controlled trial (RCT). A five-year follow-up was conducted on a cohort of 40 patients who had received either 'conjoint family therapy' (CFT) or 'separated family therapy' (SFT). All patients were traced and 38 agreed to be reassessed (29 interviewed in person, 3 completed telephone interviews, 6 completed questionnaires and/or agreed for parents/GP to be interviewed). Overall there was little to distinguish the two treatments at 5 years, with more than 75% of subjects having no eating disorder symptoms. There were no deaths in the cohort and only 8% of those who had achieved a healthy weight by the end of treatment reported any kind of relapse. Three patients developed bulimic symptoms but only one to a degree warranting a diagnosis of bulimia nervosa. The one difference between the treatments was in patients from families with raised levels of maternal criticism. This group of patients had done less well at the end of treatment if they had been offered conjoint family meetings. At follow-up this difference was still evident, as shown in the relative lack of weight gain since the end of outpatient treatment. This study confirms the efficacy of family therapy for adolescent anorexia nervosa, showing that those who respond well to outpatient family intervention generally stay well. The study provides further support for avoiding the use of conjoint family meetings at least early on in treatment when raised levels of parental criticism are evident.

How enthusiastic should we be about family‐based treatment for adolescent anorexia nervosa?

How enthusiastic should we be about family‐based treatment for adolescent anorexia nervosa?

Predictors of dropout and remission in family therapy for adolescent anorexia nervosa in a randomized clinical trial

The purpose of this study is to explore the predictors of dropout and remission in the treatment of adolescent anorexia nervosa (AN) using family therapy. Data derived from a randomized clinical trial comparing short and long term family therapy for adolescents with AN were used. A rotated component analysis was employed to reduce the number of variables and to address problems of collinearity and multiple testing. Dropout was defined as participating in less than 80% of the assigned therapy. Participants were classified as remitted if they obtained an ideal body weight greater than 95% and a global eating disorder Examination score within two standard deviations of community norms at the end of 12 months. Co-morbid psychiatric disorder and being randomized to longer treatment predicted greater dropout. The presence of co-morbid psychiatric disorder, being older, and problematic family behaviors led to lower rates of remission. A reduction of child behavioral symptoms, a decline in problematic family behaviors, and early weight gain were all within treatment changes that increased the chance of remission. Co-morbid psychiatric disorder, family behaviors, and early response to treatment are important factors when predicting dropout and remission in family therapy for adolescent AN.

The use of target weights in the inpatient treatment of adolescent anorexia nervosa

This study investigates how weight targets are set, monitored and used in the treatment of adolescents with anorexia nervosa (AN) within inpatient services in the UK and Europe. Data were collected by means of a questionnaire and analysis of specimen weight charts returned by 21 sampled services. Target weights were set in the majority of services and were a key element of the therapeutic process. However there was considerable variation in how target weights were calculated, expected rates of weight gain and the link between length of stay and attainment of targets. At present little outcome evidence exists on which services can base decisions around these variables; so a consensus is hard to achieve. Nevertheless some inconsistencies seem to exist between aspects of current practice which might usefully be addressed. Copyright © 2006 John Wiley & Sons, Ltd and Eating Disorders Association.

Effective interventions for adolescents with anorexia nervosa

Background: Anorexia Nervosa (AN) is a serious psychiatric illness with both psychological and medical sequelae that usually onsets during adolescence. The illness presents formidable challenges to clinicians. Despite these facts, there are few treatments studies for the adolescent age group.Aims: This report provides a critical review of the most common treatments and the empirical support for them for adolescent AN.Method: Clinical and research literature was reviewed to identify empirically supported treatments with an emphasis on identifying pertinent randomized controlled trials. However, relevant clinically oriented reports and consensus clinical guidelines were also included when other systematic research was unavailable in order to provide a more comprehensive view of current treatment strategies for adolescents with AN.Results: There are only five randomized clinical trials specifically addressing treatment for adolescent AN. Only 207 subjects were enrolled in these studies with an average cell size of about 20 subjects. Data from these trials suggest that family therapy wherein parents re-feed their adolescent offspring is effective for AN in this age group. However, other treatment approaches (e.g. individual therapy, group therapy, hospitalization, medication) have not been sufficiently or systematically studied.Conclusions: Family therapy based on parental re-feeding is an effective approach for adolescent AN. However, the superiority of family therapy over other types of interventions has not been sufficiently demonstrated. There is an urgent need to conduct treatment research in this area to guide clinical care for this vulnerable population.Declaration of interest: Dr Lock is supported by NIH Grant R01MH070621-01.

Medical complications in adolescents with anorexia nervosa: A review of the literature

The purpose of the current article is to summarize the evidence-based medical complications and treatments that are both common and unique to adolescents with anorexia nervosa (AN). Recent literature relating to the cardiovascular complications, refeeding syndrome, alterations in linear growth, impaired bone mineral accretion, and structural and functional brain changes was reviewed. The literature suggests that the medical complications in adolescents with AN are different from those reported in adults. The unique clinical presentation, the early onset, and the unknown impact of these complications underscore the need for early identification and treatment of AN in adolescents. AN is a serious disorder with significant and often life-threatening medical complications. The increasing growth of evidence highlights the importance of early identification and treatment by an interdisciplinary team of health care providers who have expertise in managing adolescents with AN and their medical sequelae.

Family-based treatment for adolescent anorexia nervosa: A promising approach?

Despite the fact that anorexia nervosa is a debilitating disorder with serious psychological and medical sequelae, few psychological treatments have been studied. Of these, interventions that involve the parents of the adolescent have proved to be most promising. This is especially true for those cases with a short duration of illness ( < 3 years). Even more compelling is the fact that the benefits of this family-based treatment have been shown to be enduring at 5-year follow-up. Examination of the available treatment studies, both controlled trials as well as case series, indicates that most adolescents with anorexia nervosa, even those who are severely ill, can be treated quite successfully as outpatients. The important caveat is that outcome appears to be most successful when the patient's parents are viewed as a resource rather than a hindrance. Optimism regarding these encouraging findings should be tempered until larger scale randomised trials have been conducted.

Treatment aims and philosophy in the treatment of adolescent anorexia nervosa in Europe

AbstractThis study describes the range of service provision and explores differences in treatment approaches and therapeutic aims, in the 12 countries participating in the European Union collaborative COST B6 Adolescent Project into the treatment of adolescent anorexia nervosa (AN). Following a number of group meetings, two questionnaires were administered, completed and returned by e‐mail. The first questionnaire examined features of the services provided, including details of the numbers of patients seen, inpatient admission criteria and aspects of patient management. The second questionnaire contained a list of 13 therapeutic aims, asking respondents to rank in order the six they considered most important in the first weeks of treatment. There was broad agreement between services concerning the need to offer a full spectrum of services in a range of settings. Nevertheless, there were significant differences in approaches, chiefly concerning the readiness to admit to hospital, the use of (individual or family) day units and the focus on weight restoration as opposed to therapeutic engagement. Copyright © 2002 John Wiley &amp; Sons, Ltd and Eating Disorders Association.

Family meals in the treatment of adolescent anorexia nervosa

AbstractThe literature on the use of family meals as a focus for treatment in anorexia nervosa is now quite old and interest in this area, both clinical and academic appears to have waned. In this paper we explain the use of family meals in our treatment of adolescent eating disorder patients. Whereas earlier descriptions tend to use the language of structural family therapy and emphasize intensification, we focus more on collaboration and on anxiety reduction. Copyright © 2002 John Wiley &amp; Sons, Ltd and Eating Disorders Association.

The Peter Pan Syndrome: Inpatient treatment of adolescent anorexia nervosa

Specific strategies designed for intervening in family, hospital, community, and school systems are discussed as crucial components in the treatment of adolescent anorexia nervosa. It is suggested that all these systems inadvertently collude in the “Peter Pan Syndrome”: maintaining the adolescent-identified patient in a latency age role in order to protect mother from depression and the family in its entirety from an “empty nest” developmental crisis. When strategic and structural alterations occurred within the above mentioned systems while the child was hospitalized and after discharge, the anorectic symptom was alleviated.