Family Therapy for Child and Adolescent Eating Disorders: A Critical Review

Abstract

Eating disorder-focused family therapy has emerged as the strongest evidence based treatment for adolescent anorexia nervosa supported by evidence from nine RCTs, and there is increasing evidence of its efficacy in treating adolescent bulimia nervosa (three RCTs). There is also emerging evidence for the efficacy of multi-family therapy formats of this treatment, with a recent RCT demonstrating the benefits of this approach in the treatment of adolescent anorexia nervosa. In this article we critically review the evidence for eating disorder-focused family therapy through the lens of a moderate common factors paradigm. From this perspective, this treatment is likely to be effective since it provides a supportive and non-blaming context that one, creates a safe, predictable environment that helps to contain anxiety generated by the eating disorder, two, promotes specific change early on in treatment in eating disorder related behaviors, and three provides a vehicle for the mobilization of common factors such as hope and expectancy reinforced by the eating disorder expertise of the multidisciplinary team. In order to improve outcomes for young people, there is a need to develop an improved understanding of the moderators and mediators involved in this treatment approach. Such an understanding could lead to the refining of the therapy, and inform adaptations for those families who do not currently benefit from treatment.

Family profiles in eating disorders: family functioning and psychopathology

“…Studies addressing specific forms of EDs and their associations with psychopathological profiles and family functioning are scarce. The present study may add to previous literature and supports clinical work in the treatment of adolescents diagnosed with EDs, as suggested by Jewell et al68 In fact, clinicians could organize different interventions depending on the particular ED the adolescent is manifesting and the specific familial functioning (represented for instance by their members’ capacity to adaptively communicate, support each other, and be flexible).…”

Observation and analysis “in vivo” of family meals of patients with eating disorder / Observación y análisis “en vivo” de comidas familiares de pacientes con trastorno alimentario

“…El escenario de la comida familiar se puede volver una "lucha de fuerzas" que desgasta y no aporta soluciones, al promover el mantenimiento de tante, esta técnica ha arrojado resultados variables. Por un lado, si los padres tienen éxito en lograr "un bocado más", obtienen una importante sensación de logro; pero, por otro lado, la intervención tambiénpuede ser inútil cuando en la familia pondera la evitación de conflicto (Godfrey et al, 2015;Jewell, Blessitt, Stewart, Simic y Eisler, 2016).…”

“…Sin embargo, sus intentos de incidir en el comportamiento de la paciente (con base a expresiones agresivas, hostiles, descalificantes o En este sentido, los resultados del presente estudio confirman la importancia del entrenamiento en la expresión de las emociones y de habilidades para el desarrollo de la confrontación asertiva y útil, que permita romper la evitación como conducta mantenedora de la enfermedad (Couturier et al, 2013;Hughes et al, 2014;Jewell et al, 2016;Lock et al, 2001;Lock et al, 2006;Lock et al, 2016;Lock y Le Grange, 2013). No obstante, la utilidad de la CTF ha sido un tema cargado de controversias.…”

Simpler therapy may successfully treat adolescents with anorexia nervosa

“…Family-based treatment (FBT) is an effective evidence-based therapy for adolescent anorexia nervosa (AN) and is the recommended approach to treatment at the present time 1. The effectiveness of other treatments such as individual psychotherapy (ego-oriented therapy) and generic family therapy (systemic family therapy) is based on less evidence and such treatments are not as effective as FBT 1.…”

“…The effectiveness of other treatments such as individual psychotherapy (ego-oriented therapy) and generic family therapy (systemic family therapy) is based on less evidence and such treatments are not as effective as FBT 1. Whether treatment involving the whole family, or a simpler treatment involving parents only, differ in effectiveness is not known.…”