Evaluation of Family Treatment Models for Eating Disorders

James Lock


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

In This Article

Family-based Treatment for Bulimia Nervosa

There are only two RCTs that have evaluated family interventions for bulimia nervosa in adolescents. The first of these studies was published in 2007 by Schmidt et al.[19] The authors compared a nonmanualized form of FBT with a guided self-help version of CBT (CBT-GSH). The mean age of participants was 17.6 years. The main finding of the study was that FBT and CBT-GSH appeared to be equally effective for adolescent bulimia nervosa. The pattern of response was also similar between the two treatments, with abstinence rates from binge eating and purging increasing during treatment and continuing to increase during the 6-month follow-up period. The authors also noted that CBT-GSH was more cost-effective, as less therapist time was utilized. Several aspects of this study should be noted to understand the results in context. First, as noted above, FBT was not a manualized version. Second, the average age of participants was almost 18 years. In fact, many potential participants refused to be randomized because they found FBT an unacceptable alternative. The age of consent is 16 years of age in the UK where the study was undertaken. Thus, this sample may be better considered a young adult sample than a typical adolescent one.

The other study of FBT for adolescent bulimia nervosa was also published in 2007.[20] It included 80 adolescents of age 12–18 years with a mean age of 16.1 years. The treatment was manualized, and supervision and adherence to the approach were monitored.[52] The study compared FBT with a psychodynamic type of individual therapy called supportive psychotherapy (SPT), which was also manualized. The study found that abstinence rates were significantly greater both at the end of treatment and at follow-up for those who were treated with FBT. The overall abstinence rate at the end of treatment was 39% and at 6-month follow-up it was 30% in FBT, and for SPT abstinence rates were 18% at the end of treatment and 10% at 6-month follow-up. These rates of abstinence for FBT are similar to those achieved by Schmidt et al. using a family intervention for bulimia nervosa; however, the pattern is different. In contrast to the study by Schmidt et al., wherein abstinence rates increased after treatment, in the Le Grange et al. study relapse occurred after the end of treatment. It is uncertain what these differing patterns may mean at this point. Further, because the results from these two studies are discrepant, the role of FBT in treatment of adolescent bulimia nervosa is less certain than it is for adolescent anorexia nervosa.