Evaluation of Family Treatment Models for Eating Disorders

James Lock

Disclosures

Curr Opin Psychiatry. 2011;24(4):274-279. 

In This Article

Abstract and Introduction

Abstract

Purpose of review Interest in the effectiveness of family interventions for eating disorders has increased over the past 5 years. This review considers the theoretical justification and current evidence base for the use of family treatments for eating disorders in children and adolescents.
Recent findings Family-based treatment is the best studied treatment. It has the strongest evidence base for effectiveness for anorexia nervosa in adolescents. Family-based treatment can be delivered in several formats and doses, and preliminary data suggest it can be disseminated by training and manuals. There is a more limited evidence base demonstrating the usefulness of family interventions for bulimia nervosa in adolescents.
Summary The implications of the findings of this review are that family interventions are the current first-line treatment for adolescent anorexia nervosa and promising for adolescent bulimia nervosa. Pilot studies suggest that family interventions can be disseminated in diverse clinical settings.

Introduction

This review focuses on the theoretical justification and the evidence base for family interventions for child and adolescent eating disorders. Relatively, recent comprehensive reviews document that no psychological or psychopharmacological treatment has demonstrated systemic effectiveness for anorexia nervosa in adults with this disorder.[1] For adults with bulimia nervosa, evidence suggests that a range of treatments are superior to placebo, including cognitive–behavioral therapy (CBT),[2] interpersonal psychotherapy (IPT),[3] and antidepressant medications.[4] Treatment reviews for binge eating disorder (BED), currently a research diagnosis in Diagnostic and Statistical Manual-IV-Revised (DSM-IV-R), suggest that CBT, IPT, and medications are effective in adults with this disorder.[5] Treatment recommendations for the larger and heterogeneous diagnostic group of eating disorders not otherwise specified remain unclear,[6] but recent studies suggest that a transdiagnostic version of CBT[7] may be the best approach for those who have more complex presentations and comorbidity.[8]

Turning to treatment research for eating disorders in children and adolescents, the portfolio of available studies is comparatively smaller. This is the case despite the fact that, with the exception of BED, eating disorders have their onset during the adolescent years.[9] There have been eight randomized clinical treatment trials (RCTs) for anorexia nervosa that included adolescents (patients between the ages of 12 and 18 years).[10–15,16••,17] All of these studies except one included an evaluation of some form of family intervention.[17] Several of the studies compared different formats or doses of family interventions,[12,13,15] whereas only three studies compared a family intervention with another form of therapy.[10,14,16••] Two studies also examined the utility of specialized hospitalization compared with outpatient interventions.[11,17] These studies found no benefits from hospitalization compared with outpatient treatment, but outpatient treatment was more cost-effective.[18] In the outpatient treatment studies of anorexia nervosa, a particular form of family intervention [family based treatment (FBT)] wherein parents actively intervene to help their children with anorexia nervosa is more effective than comparison conditions. For adolescent bulimia nervosa, there are only two RCTs that focused on this age group.[19,20] Both these studies included a family intervention as a comparison group, but results were inconsistent between the two studies. There are no published RCTs for BED in youth, although some promising work using IPT for this age group is being piloted.[21–23] To date, there are no published RCTs examining medications for adolescent eating disorders in children and youth.

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