What is the role of family-based therapy in the treatment of anorexia nervosa?

Updated: Jun 10, 2019
  • Author: Bettina E Bernstein, DO; Chief Editor: Caroly Pataki, MD  more...
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Psychological issues encompass the coping strategies engendered by eating disorders. According to Kreipe and Birndorf, the treating clinician may threaten the homeostatic balance that has been achieved within the family system secondary to dealing with the patient with anorexia; negative emotions, such as anger and denial, may be directed at the clinician. [89]

Individuals with anorexia nervosa may respond best to family-based treatment, also known as the Maudsley method, an established therapeutic modality for achieving and maintaining remission from anorexia nervosa. [107, 24]

This treatment modality should take into account the level of negative expressed emotion in the patient’s family and be performed conjointly only if that level is not excessive. [45, 3, 116] Simultaneous sessions can be more productive because, if patients feel intense negative emotions from their families, they are more likely to be noncompliant with treatment.

A large, randomized, controlled study of 121 adolescents and young adult subjects found that although family-based therapy was equally as effective as adolescent-focused therapy, [117] family-based therapy resulted in more successful maintenance of improvement after 12 months, as measured by superior outcomes at 6 months and 12 months posttreatment.

For some adolescents with more severe anorexia nervosa, extending family-based treatment beyond 20 weeks' duration may be needed. One study of 69 medically unstable adolescents found that continuing family-based treatment beyond 20 weeks' duration improved outcomes. [118]

Although an earlier meta-analysis/review did not find a difference in outcome between family-based therapy and educational interventions, that review incorrectly grouped several studies together that were different in approach. [119] Specifically, some of those studies did not have a standardized approach and had an insufficient number of subjects.

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