A pragmatic randomised multi-centre trial of multifamily and single family therapy for adolescent anorexia nervosa

Abstract

BackgroundConsiderable progress has been made in recent years in developing effective treatments for child and adolescent anorexia nervosa, with a general consensus in the field that eating disorders focussed family therapy (often referred to as Maudsley Family Therapy or Family Based Treatment) currently offers the most promising outcomes. Nevertheless, a significant number do not respond well and additional treatment developments are needed to improve outcomes. Multifamily therapy is a promising treatment that has attracted considerable interest and we report the results of the first randomised controlled trial of multifamily therapy for adolescent anorexia nervosa.MethodsThe study was a pragmatic multicentre randomised controlled superiority trial comparing two outpatient eating disorder focussed family interventions - multifamily therapy (MFT-AN) and single family therapy (FT-AN). A total of 169 adolescents with a DSM-IV diagnosis of anorexia nervosa or eating disorder not otherwise specified (restricting type) were randomised to the two treatments using computer generated blocks of random sizes to ensure balanced numbers in the trial arms. Independent assessors, blind to the allocation, completed evaluations at baseline, 3 months, 12 months (end of treatment) and 18 months.ResultsBoth treatment groups showed clinically significant improvements with just under 60% achieving a good or intermediate outcome (on the Morgan-Russell scales) at the end of treatment in the FT-AN group and more than 75% in the MFT-AN group - a statistically significant benefit in favour of the multifamily intervention (OR = 2.55 95%; CI 1.17, 5.52; p = 0.019). At follow-up (18 months post baseline) there was relatively little change compared to end of treatment although the difference in primary outcome between the treatments was no longer statistically significant. Clinically significant gains in weight were accompanied by improvements in mood and eating disorder psychopathology. Approximately half the patients in FT-AN and nearly 60% of those in MFT-AN had started menstruating.ConclusionsThis study confirms previous research findings demonstrating the effectiveness of eating disorder focused family therapy and highlights the additional benefits of bringing together groups of families that maximises the use of family resources and mutual support leading to improved outcomes.Trial RegistrationCurrent Controlled Trials ISRCTN11275465; Registered 29 January 2007 (retrospectively registered)

Creating Community – The Introduction of Multi‐Family Therapy for Eating Disorders in Australia

“…Remission is generally defined as having a weight greater than 95% expected body weight and eating pathology scores within one standard deviation of community norms, although there is variation in how remission is defined across the literature. Accordingly, there has been increased interest in enhancing standard family therapy approaches so that some families may gain further benefit (Eisler et al, 2016a(Eisler et al, , 2016b. Accordingly, there has been increased interest in enhancing standard family therapy approaches so that some families may gain further benefit (Eisler et al, 2016a(Eisler et al, , 2016b.…”

Family-based treatment of eating disorders in adolescents: current insights

“…One RCT randomized 169 adolescents to either MFT (MFT-AN) or single-family therapy, although participants randomized to MFT-AN also received individual family meetings as needed 52. At the end of treatment, significantly more people in the MFT-AN group fell into good- or intermediate-outcome categories, although this difference was no longer statistically significant at 6-month follow-up.…”

The Clinical Significance of Posterior Insular Volume in Adolescent Anorexia Nervosa

“…The elevated mortality associated with AN is well-documented: AN remains one of the leading causes of premature mortality due to psychiatric causes with a Standardized Mortality Ratio of 5.9 (4.2–8.3, 95 th %CI) and a Standardized Mortality Ratio attributable to suicide of 31 (21–44, 95 th %CI) relative to other forms of mental illness or population controls (3). While there have been impressive advances in the treatment of AN, particularly for adolescents (4–6), treatments for both adults and adolescents have had limited effectiveness in improving disturbance in the experience of the body (often referred to as body image disturbance) (1, 7, 8). The degree of body image disturbance predicts poor treatment response (9) and has been reported to motivate hazardous weight loss behaviors (1, 2).…”