Evaluation of Family Treatment Models for Eating Disorders

James Lock

Disclosures

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

In This Article

Future Research

The current evidence supports the view that family interventions are useful for eating disorders in children and youth. In particular, FBT is likely the first-line treatment for adolescents with anorexia nervosa, while there is mixed support for its utility for adolescent bulimia nervosa.

A number of research protocols examining family treatments for adolescents with eating disorders are underway. A multisite RCT comparing FBT with systemic family therapy for adolescent anorexia nervosa has completed randomization (n = 160). This study should shed light on whether a particular form of family therapy is needed to help with anorexia nervosa. Another study has recently been completed that examined multifamily group therapy (MFG) for anorexia nervosa. Preliminary results suggest MFG is feasible and acceptable to families.[35] It remains unclear whether MFG is more helpful than single family FBT; however, some families appear to clearly benefit from the supportive presence of other families dealing with anorexia nervosa.[53,54] Hospitalization has not been shown to be more useful than outpatient treatment for adolescent anorexia nervosa, but hospitalization is still necessary at times. A study being conducted in Australia aims to determine whether families who receive FBT are able to decrease the need for or duration of hospitalization. Final results from this study are pending.

Despite the general enthusiasm for FBT, it is important to note that, although a significant majority of adolescents with anorexia nervosa (about 80%) significantly improve and about 50% fully remit when treated with FBT, there is need to improve these rates as we have no effective treatments for those who do not respond. We need to enhance FBT or develop new treatments to be more effective for those who do not respond to FBT as it is now formulated. For adolescent bulimia nervosa, a multisite study comparing FBT to CBT and supportive individual therapy is underway, but results from that study are still several years into the future. Clearly, much additional work needs to be done to determine the role of family interventions for this disorder.

Although there are a few examples of pilot dissemination of FBT for adolescent eating disorders, further research is needed to determine how best to make this treatment available to more patients. Therapist attitudes, patient and parental attitudes, program leadership, reimbursement plans, and treatment program structure are all potential obstacles to successful dissemination of FBT. Future studies are needed to determine how best to overcome these obstacles.

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