Anorexic Teens May Gain From Whole-Family Treatment
MONDAY, Oct. 4 -- Family-based treatment for anorexic teenagers may be more effective in the long-term than individual counseling, a new study finds.
"Family therapy has been part of the landscape for the treatment of anorexia nervosa for maybe 40 years, but this specific form has been evolving as a likely effective treatment for the last 10," said Dr. James Lock, lead author of a study in the October issue of Archives of General Psychiatry. "But this is the first study to actually compare this treatment to an active treatment."
Anorexia nervosa, an eating disorder most common among teenage girls, can stunt growth, delay puberty and reduce peak bone mass. Almost 6 percent of anorexics die from heart failure or suicide each decade, the authors write.
"Family treatment is offered in specialty centers but not typically available in most communities," said Lock, a professor of psychiatry and behavioral sciences at Stanford University School of Medicine. "This would be an argument to bolster [its] availability, and training people to be able to use it."
The family therapy model featured in this trial involved the family in treatment as opposed to simply blaming parents for causing the disorder.
"The tradition through much of modern mental health was the parents were somehow the fault or to be blamed, and for treatment you had to get the patient out from underneath the family that caused it," said Dr. Richard E. Kreipe, medical director of the Child and Adolescent Eating Disorders Program at Golisano Children's Hospital, University of Rochester Medical Center.
But practitioners are moving away from this model.
"The idea here is that the disorder is disabling and confusing to both the patient and to the family, and that the family actually needs to learn how to help directly solve the problem of the child eating and over-exercising, and find solutions at home where the child is living," explained Lock, who is also psychiatric director of the Comprehensive Eating Disorders Program at Stanford's Lucile Packard Children's Hospital.
"It's behaviorally focused. It's process focused. It absolutely really makes the point that families, as far as we know, aren't the cause," Lock said.
The family therapy explored in this study focused on parents actively helping kids learn to eat and gain weight, then turning more autonomy over to the patients as their functioning improves.
Here, 121 adolescents, mostly girls, were randomly assigned to receive either family-based therapy or individual therapy. They ranged in age from 12 to 18 years.
Both groups received 24 hours of professional treatment over the course of a year. Follow-ups were scheduled six and 12 months after treatment ended.
At the end of treatment, both groups had the same full remission rates with full remission defined partly as achieving normal or close-to-normal weight and displaying an average number of symptoms.
But differences started to emerge at the six- and 12-month marks.
At six months, 40 percent of those in family-based treatment were in full remission versus 18 percent of those in individual therapy. At one year, the numbers were 49 percent and 23 percent, respectively.
"Anorexia nervosa is very difficult to treat, but the important issue is the data are becoming increasingly clear that the long-term outcomes, especially if you can get patients into treatment early, are extremely positive," said Kreipe, who is also medical director of the Western New York Comprehensive Care Center for Eating Disorders and past president of the Society of Adolescent Health & Medicine.
"We would be better off if we defined anorexia as a developmental illness rather than a mental illness," Kreipe added. "This has to do with being an adolescent, [and] issues of autonomy and control and physical control as one goes through puberty. Yes, it has a mental element but also a biological piece and a psychological piece."
The U.S. National Institute of Mental Health has more on eating disorders.
Posted: October 2010
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