Comparison of 2 Family Therapies for Adolescent Anorexia Nervosa

Abstract

IMPORTANCE Anorexia nervosa (AN) is a serious disorder with high rates of morbidity and mortality. Family-based treatment (FBT) is an evidence-based therapy for adolescent AN, but less than half of those who receive this approach recover. Hence, it is important to identify other approaches to prevent the development of the chronic form of AN for which there is no known evidence-based treatment.OBJECTIVE To compare FBT with systemic family therapy (SyFT) for the treatment of adolescent-onset AN. DESIGN, SETTING, AND PARTICIPANTSResearch in Anorexia Nervosa (RIAN) is a 2-group (FBT and SyFT) randomized trial conducted between September 2005 and April 2012. Interviewers were blinded to the treatment condition. A total of 564 adolescents receiving care at 6 outpatient clinics experienced in the treatment of AN were screened. Of these, 262 adolescents did not meet the inclusion criteria and 138 declined to participate; hence, 164 adolescents (aged 12-18 years) of both sexes meeting the criteria for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, AN (except for amenorrhea) were enrolled. Three participants were withdrawn from FBT and 7 were withdrawn from SyFT after serious adverse events occurred.INTERVENTIONS Two manualized family therapies with 16 one-hour sessions during 9 months. Family-based therapy focuses on the facilitation of weight gain, whereas SyFT addresses general family processes. MAIN OUTCOMES AND MEASURESThe primary outcomes were percentage of ideal body weight (IBW) and remission (Ն95% of IBW). The a priori hypothesis was that FBT would result in faster weight gain early in treatment and at the end of treatment (EOT).RESULTS There were no statistically significant differences between treatment groups for the primary outcome, for eating disorder symptoms or comorbid psychiatric disorders at the EOT or follow-up. Remission rates included FBT, 33.1% at the EOT and 40.7% at follow-up and SyFT, 25.3% and 39.0%, respectively. Family-based therapy led to significantly faster weight gain early in treatment, significantly fewer days in the hospital, and lower treatment costs per patient in remission at the EOT (FBT, $8963; SyFT, $18 005). An exploratory moderator analysis found that SyFT led to greater weight gain than did FBT for participants with more severe obsessive-compulsive symptoms. CONCLUSIONS AND RELEVANCEThe findings of this study suggest that FBT is the preferred treatment for adolescent AN because it is not significantly different from SyFT and leads to similar outcomes at a lower cost than SyFT. Adolescents with more severe obsessivecompulsive symptoms may receive more benefits with SyFT. TRIAL REGISTRATION clinicaltrials.gov. Identifier NCT 00610753

Efficacy of a Parent-Based, Indicated Prevention for Anorexia Nervosa: Randomized Controlled Trial (Preprint)

“…Along with low engagement rates in the intervention, the study was also characterized by high drop-out rates, i.e., over 50% in the control group and 65.6% in the intervention group. These rates exceed drop-out rates of both targeted intervention trials for ED in general [48,49] and of those reported for family-based treatment trials for AN which average between 15-25% [50][51][52].…”

Treatment of eating disorders in child and adolescent psychiatry

“…However, patients in the FBT arm spent fewer days in the hospital, produced lower treatment costs and gained weight faster at the beginning of treatment. Furthermore, patients with more severe obsessive- www.co-psychiatry.comcompulsive symptoms benefitted more from systemic treatment [31].…”

Evidence-based psychotherapy for treatment of anorexia nervosa in children and adolescents: systematic review

“…It was observed that studies that included only biological indicators, such as BMI and menstruation, had more favorable results, with a complete remission of 50% and 60% of the patients who started treatment. Studies that included psychopathological indicators, such as treatment outcome presented less favorable results, reaching 25%, as in the study by Agras et al 24 .…”

“…Several methodological limitations were identified in the studies assessed: lack of description regarding the inclusion and exclusion criteria 29,30 , loss of a significant number of participants (> 25%) during treatment and follow-up 9,24 , lack of clarity regarding the remission criteria or remission assessed exclusively on the basis of biological markers 12,25,[29][30][31] , difficulty in randomizing baseline participants 26,31 , presence of confounding variables, such as the need for hospitalization, the use of antidepressants for the treatment of comorbidities, which were not necessarily controlled in the analyses 18,22,26,27,30,31 and non-probabilistic samples 20,25,29,30 . In only one study no methodological limitations were found 28 .…”