Family therapy: the most effective treatment for adolescent anorexia nervosa

2016-02-22 09:50 source: DXY Author: Zhang ChenchengAnorexia nervosa is a serious mental disorder with a lifetime prevalence of about 2% in


2016-02-22 09:50 source: DXY Author: Zhang Chencheng

Anorexia nervosa is a serious mental disorder with a lifetime prevalence of about 2% in men and 0.16-0.3% in men. In the past 40 years, the research on the effectiveness and practice of family therapy for adolescent anorexia nervosa has been carried out.

London Mosley hospital doctor Blessitt for the past 12 months (or more) the related literature about the use of family treatment of adolescent anorexia are reviewed, the latest research results and summary of views in Current Opinion Psychiatry magazine in 2015 11.

Family therapy for anorexia nervosa (family therapy-anorexia, FT-AN) is also known as family therapy (family-based treatment, FBT) or Mozley family therapy (Maudsley family therapy, MFT) (nervosa).


For a number of empirical studies, the latest evidence shows that about 50-85% of adolescents receiving FT-AN treatment within 12 months after a good outcome. FT-AN

The early stage of treatment mainly support parents to guide children in the management of eating, eating and weight stability will focus into effect and the factors of normal adolescent growth condition continues, and strive to achieve the family daily life style


Main points

1 systemic family therapy for adolescent anorexia nervosa can achieve a good level of recovery, although it is still not clear the specific mechanism of effective treatment.

2 FT-AN, family meal intervention, treatment and family function is worthy of in-depth study of the importance of some of the elements.

3 recent studies have shown that multiple family therapy is highly acceptable, and the body weight, symptoms, and family health are significantly improved.

4 multidisciplinary collaboration with FT-AN may be challenging, but it can effectively reduce the need for hospitalization, shorten length of stay, improve symptoms, and achieve a high percentage of treatment completion.

5 the need for further research on design excellence and research resources.

The effect of eating disorder management in the treatment of adolescent anorexia nervosa


The study of eating disorders in some families is particularly focused on the management of eating disorders, but it is not clear how the factors determine the effectiveness of family therapy. Goart

Other studies have shown that family therapy as a routine treatment (treatment as usual),

TAU, which focuses on the internal dynamics of the family to improve the condition. It also raises questions about the potential impact of family therapy on eating behavior.

Another treatment for adolescents with anorexia nervosa with two kinds of manual method were studied to discuss this problem, including focus on the family manual for treatment of eating disorders (FT-AN) and systemic family therapy (systemic family therapy, SyFT manual).


The results showed that the response to treatment was similar between the two treatments, the remission rate and expected weight at the end of treatment (expected body weight),

There was no statistically significant difference in EBW. But it is interesting that, in terms of the overall sample FT-AN

In the early stage of treatment, the weight gain was faster, and the hospitalization time was shorter, so that the overall cost of treatment was significantly less than the SyFT group.

In addition, exploratory adjustment factor analysis showed that the SyFT group had higher body weight gain than the FT-AN group. Although the two treatment manuals are significantly different, the actual treatment may be less than expected. With the development of the two kinds of treatment and the experience of the therapist, we can expect the family to focus on the management of food problems.

The effect of family meals in the treatment of anorexia nervosa


It has been a long history to treat adolescent anorexia nervosa. It is FT-AN

Second important interventions in the course of diagnosis and treatment have an important impact on early weight gain. As a supportive intervention, family meals can help parents to promote their children to eat, the formation of parenting advantage, but also for the therapist

Understanding of family relationships, beliefs, behaviors and structures. A number of recent studies have illustrated the family meal process.


Analysis of the 30 family meal records showed that 90% of the patients in the parents insist on eating after the struggle (15/30 family), or agreed to no resistance to eating (12/30)

In the case of a family to be able to eat. And Godfrey

That young people full after eating is not always suitable to eat more food, the key is to eat a ", this is to make parents feel points to win in the battle against the disease, while gradually reducing youth participation



Who will offer a family meal is conceptualized as authorized in the parents of the intervention, and become into a chance of the family, it can promote the sense of parental efficacy and take care of the whole family, while the formation of consensus against disease. Author thinks home

Family meals can also be used to explore the following issues: family barriers; measures that parents can take when they are not eating or eating disorders; when the patient is eating, the family and adolescents do well and need improvement.

Treatment cooperation


Medical treatment has been the focus of research in the field of family therapy and general psychotherapy, but the authors found that only 4

Study on the treatment coordination. Although the data are limited, the study of the effect of treatment on adolescent anorexia nervosa seems to be consistent with the results of other studies on eating disorders

Can not be exchanged, and the two scores were associated with different levels of treatment results.

The parents with the score and patients continued to receive treatment and the initial behavior changes (i.e. early weight gain), and teenagers score more inclined to predict physiological variables and long-term results of changes, such as weight gain after treatment.

Forsberg et al. Have explored the role of treatment in the treatment of anorexia nervosa in adolescents, and they argue that the complexity of the study includes the difficulty in controlling the interaction between symptom changes and the formation of treatment. The study was conducted to determine the degree of fit between the fourth treatments, but by that time almost 1/4 of the patients had been relieved (> 95%).

The estimates of treatment effects were highly conservative, and the study did not find a significant relationship between parental support and complete remission at the end of treatment. Forsberg also cited the further research content, including family members with degrees in patients, parents and therapists with the objective on the "consensus", and focus on the specific symptoms and changes in relationship with dynamic changes with early.

Family function and treatment outcome


The focus of the study on family function assessment of adolescent anorexia nervosa has been from the role of the formation of the disease to the potential role of the regulation of treatment outcome. Ciao

Changes in family functioning were reported in randomized controlled trials (randomized controlled trial, RCT), using the McMaster

The family functioning Rating Scale (Family Assessment Device, FAD) was compared at baseline and at the end of treatment from the perspective of different family members FT-AN

Adolescent focused therapy.

The family function at baseline and after treatment with relatively less damage overall no change, but the two sub scales (communication and behavior control) showing a two-way role in treatment, FT-AN treatment can improve the treatment of the disease but the individual part increased. Therefore, the author believes that it is necessary to explore the effect of treatment on family function and the effect of family function on the treatment and recovery process.

Multiple family therapy


A number of studies have reported that MFT has good results in the treatment of anorexia nervosa. Gabel et al. In a retrospective cohort study of 25 patients receiving MFT and TAU

Compared with the cases of only TAU, the results showed that the weight gain of MFT group was larger. Marzola et al. 54 adolescents were followed up with MFT intervention at the age of 30

Months of treatment, the results showed that the remission rate (> 95%EBW) 59.3%, partial remission rate (> 85%EBW) of 27.7%.

The other two case series study showed that MFT-AN had a higher family acceptance, more than 90% completion of treatment, significant improvement in body weight and other symptoms, improved patient outcomes and improved family relationships. There is a small qualitative study suggests that parents with emotion, self-efficacy and sense of hope, patient increase and early treatment increase the motivation of introspection.

Progress of FT-AN in the treatment of anorexia nervosa in adolescents

The growing interest in FT-AN in the treatment of adolescent anorexia nervosa by multidisciplinary team of experts. Hughes et al. Found that the advantages of developing FT-AN were significant decrease in hospitalization demand, shorter length of stay, improved weight and higher proportion of treatment.


It also includes professional role conversion, First impressions are strongest and team members of the plight of many challenges such as care model. Team training and supervision, team meetings and open dialogue on issues can increase the number of experts

FT-AN treatment of self-confidence. Hughes

Such as multidisciplinary approach to increase the team to reduce barriers to communication. Formal meetings and supervision are necessary to promote support, development, and compliance models, while training ensures the reliability of treatment.

Although the family treatment for adolescents with anorexia nervosa has been recognized as an effective treatment, but the author pointed out that the future studies are needed to explore the specific level of family therapy to the improvement in the outlook, benefit in the treatment of the best reaction potential and patient populations clearly. In the future, it is also necessary to carry out the research on the design of good research under the appropriate testing efficiency, and compare the family therapy with other treatments.

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