Patients who undergo family-based anorexia treatments have a higher chance of attaining full remission 6 to 12 months after treatment, compared to individual therapy, say researchers in a new article published in Archives of General Psychiatry, October issue. A person with anorexia has an altered body-image which reaches a point where they may see themselves as being fat and bilious regardless of their actual size; this distorted body image causes severe anxiety, and losing weight is considered to be the solution. However, when they achieve weight-loss, patients continue feeling they are overweight and need to lose even more weight.
As background information, the authors write that there are about 74 new anorexia cases in every 100,000 people. The prevalence of anorexia nervosa among teenage girls is between 0.5% and 0.7%.
The authors write:
Physical health impacts in adolescents include growth retardation, pubertal delay or interruption and peak bone mass reduction.
Approximately 5.6% of patients with anorexia die every ten years, usually from suicide or heart failure.
The authors add:
Although various forms of individual and family therapy are used in the treatment of adolescents with anorexia nervosa, most have not been systematically examined. Hence, there is little guidance for providing evidence-based interventions for either adolescents or adults with anorexia nervosa.
James Lock, M.D., Ph.D., from Stanford University School of Medicine, Stanford., California, and team randomly selected 121 patients aged 12 to 18 years who had been diagnosed with anorexia nervosa into two groups:
- 60 of them were placed in an adolescent-focused individual therapy program which concentrated on assertiveness, enhancing autonomy, defining and identifying emotions, and tolerating rather than numbing feeling into starvation. Rather than passing responsibility for food issues to parents or other authorities, the patients were encouraged to accept that responsibility.
- 61 of them were placed in a family-based treatment that encouraged parental control of weight recovery, while at the same time regaining healthy family functioning. Each patient received 24 hours of outpatient treatment over 12 months. They were all assessed before and after treatment, and then again six and twelve months later.
Although rates of full remission at the end of treatment were virtually identical in the two groups, those in the family-based therapy had better results when followed-up at 6 and 12 months – 40% versus 18% full remission at 6 months and 49% versus 23% at 12 months.
The authors write:
This may have been due in part to differences in relapse from full remission, 10% for family-based treatment and 40% for adolescent-focused individual therapy, as well as more subjects reaching full-remission thresholds in family-based treatment. Weight gain appeared faster for family-based treatment as assessed by age- and sex-adjusted body mass index percentile, though this effect was no longer found at follow-up. Participants in family-based treatment were also hospitalized significantly less often.
Although individual based therapy is still an important and effective way of treating patients, family-based treatment appears to be superior.
The authors conclude:
Additional studies are needed comparing family-based treatment with other credible treatments, including cognitive behavioral treatment and other forms of family therapy, to delineate the best approach to treating adolescent anorexia nervosa.
Arch Gen Psychiatry. 2010;67(10):1025-1032. doi:10.1001/archgenpsychiatry.2010.128
Written by Christian Nordqvist