Family-based treatment ‘better for teens with anorexia’

WASHINGTON - Family based treatments are likely to work better in treating anorexia nervosa in teens, suggests a new study.

However, adolescents in family-based programs are more likely to achieve full remission six or 12 months after treatment.

James Lock of Stanford University and colleagues randomly assigned 121 teens age 12 to 18 (61 at the University of Chicago and 60 at Stanford) who had anorexia nervosa to one of two treatment groups.

One group (60 teens) was enrolled in an adolescent-focused individual therapy program, which focused on enhancing autonomy, assertiveness, identifying and defining emotions, and tolerating these feelings instead of numbing them with starvation.

Patients were asked to accept responsibility for food issues rather than ceding it to parents or other authorities.

The other 61 teens were enrolled in a family-based treatment that promoted parental control of weight regain while restoring healthy family functioning. Each received 24 hours of outpatient treatment over 12 months, and were assessed before treatment, immediately after and then six and 12 months later.

At the end of treatment, there were no differences between groups in the rate of full remission (defined as a normal weight and an average score on an assessment of eating disorder symptoms).

A total of 42 percent of family-based treatment participants and 23 percent of adolescent-focused individual therapy participants achieved full remission.

However, family-based treatment appeared superior to individual therapy for leading to full remission at the six- and 12-month follow-ups.

“This may have been due in part to differences in relapse from full remission, 10 percent for family-based treatment and 40 percent for adolescent-focused individual therapy, as well as more subjects reaching full-remission thresholds in family-based treatment,” wrote the authors.

“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,” they wrote.

The findings suggest family-based treatment is superior, although teen-centered therapy remains an important alternative for families who would prefer an individual approach.

The findings were reported in the Archives of General Psychiatry, one of the JAMA/Archives journals. (ANI)