Family-based Therapy May Effectively Treat Adolescent Anorexia Nervosa

Stewart Agras, M.D. Professor of Psychiatry Emeritus Stanford University School of MedicineMedicalResearch.com Interview with:
Stewart Agras, M.D.
Professor of Psychiatry Emeritus
Stanford University School of Medicine

MedicalResearch: What was the study about?

Dr. Agras: Family-based treatment (FBT) has been shown to be more effective than individual psychotherapy for the treatment of adolescent anorexia nervosa. This treatment focuses on helping the family to re-feed their child. The question posed in this study was whether Family-based treatment would have any advantages over Systemic family therapy (SyFT) focusing on family interactions that may affect the maintenance of the disorder. The participants were 164 adolescents with anorexia nervosa and their families – one of the largest studies of its type.

MedicalResearch: What is the background of study?

Dr. Agras: Anorexia nervosa has one of the highest death rates, from suicide or starvation, of any psychiatric disorder particularly in longstanding cases and is associated with major psychosocial disability. There are no evidence-based treatments for these cases hence it is important to treat anorexia early in its course in adolescence to reduce the number of persistent cases.

MedicalResearch: What were the main findings?

Dr. Agras: Both family therapies were equally effective in weight restoration and reducing eating disorder symptoms at the end of treatment and at follow-up.

However, Family-based treatment led to faster initial weight gain and significantly fewer days in hospital. This reduced the cost of treatment by half (about $9000 vs $18,000). It is likely that the early weight gain resulting from the focus on re-feeding with Family-based treatment reduced the risk of hospitalization. However, SyFT was found in a moderator analysis to be more effective than Family-based treatment for patients with obsessive-compulsive symptoms.

MedicalResearch: Were you surprised by any aspect of the results?

Dr. Agras: Yes. We expected Family-based treatment to be more effective than SyFT at end of treatment because of its specific focus on helping the family to re-feed their child.

MedicalResearch: What should clinicians and patients take away from this report?

Dr. Agras:

  • First, this study confirmed the effectiveness of Family-based treatment in treating adolescents with anorexia nervosa and demonstrated major cost-savings from its use compared to SyFT.
  • Second, for patients with more severe obsessive-compulsive symptoms SyFT may be the better choice. Parents should know that there is effective outpatient treatment for most adolescents with anorexia nervosa, that Family-based treatment is the preferred treatment, but that SyFT may be more useful for some adolescents.
  • Finally, this study confirmed that patients with a shorter duration of anorexia nervosa improved more than those with a longer duration, underlining the need for early identification of this disorder in adolescence together with early treatment.

 

Citation:

Comparison of 2 Family Therapies for Adolescent Anorexia Nervosa: A Randomized Parallel Trial.

Agras W, Lock J, Brandt H, et al. Comparison of 2 Family Therapies for Adolescent Anorexia Nervosa: A Randomized Parallel Trial. JAMA Psychiatry. Published online September 24, 2014. doi:10.1001/jamapsychiatry.2014.10

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