Treatments for teenagers with anorexia that involve the entire family may be more effective than therapies that focus just on the teen, according to a new study.
One year after treatments for the eating disorder were completed, the percentage of patients considered fully recovered was twice as high for the family-based treatment as for the individual treatment, researchers found.
The study was the largest yet comparing the treatment types, researchers said. Their findings were published today (Oct. 4) in the journal Archives of General Psychiatry.
"For a really long time, parents have been seen as being an obstacle to treatment," said study researcher James Lock, a professor of psychiatry and behavioral sciences at Stanford University. "Family-based treatment and the effectiveness that it has shown in this study suggests that families really are a resource to these kids, and they really should be included in the care of their children ."
However, the researchers did not discount treatments that focus on the individual, saying this may be the best approach for some. About a quarter of the patients in the study did very well using this type of therapy. Future research may help therapists select treatments best suited for particular patients, the study said.
The results countered previous theories, including that having parents in treatment sessions is detrimental, with families often being blamed for contributing to the disorder.
About 0.5 to 0.7 percent of teen girls suffer from anorexia, and one in 10 patients dies from it. While several forms of therapy exist, very few studies have examined how effective they are.
Individual therapy focuses on helping an adolescent learn to manage his or her eating and weight gain , and to separate emotions from bodily needs. Family-based therapy puts parents initially in charge of changing their child's behavior and making sure he or she eats properly and doesn't overexercise. Eventually, this responsibility is transferred to the child.
Individual therapy has been around longer and is more widely practiced than family-based therapy, Lock said.
Lock and colleagues recruited 121 anorexia patients, ages 12 to 18, and randomly assigned them to either individual or family-based therapy for one year. Patients were evaluated before treatment, and six months and one year after treatment. They were considered recovered if their weight was at least 95 percent of their expected body weight and they had normal scores on psychiatric tests designed to assess attitudes toward eating.
At the end of treatment, 42 percent of patients in the family-based therapy had recovered, compared with 23 percent of patients in the individual therapy.
While this difference appears large, from a scientific point of view, it could not be ruled out that chance played a role in the findings at this stage, the researchers said.
However, the follow-up results were more solid. Six months later, 40 percent of patients who received family-based therapy had recovered, and one year later 49 percent had recovered, compared with 18 percent and 23 percent of patients, respectively, who'd received individual therapy.
Patients in the family-based therapy were also less likely to relapse, with only 10 percent falling back into their anorexia, compared with 40 percent of patients in the individual therapy. This suggests the family-based therapy is a more sustainable treatment, Lock said.
Parents in charge
Family-based treatment may be more effective than individual treatment because it takes decisions about eating out of the hands of patients, researchers said.
"The person with anorexia often does not want or believe they should make changes," Lock said. "They like what they're doing, so it's hard for them to make changes, it's hard for them to see the need for it. Parents can see the need for it and therefore that can really help."
Also, the family-based therapy focuses more on changing adolescent behaviors, while the individual therapy used in this study was more focused on the emotional and psychological aspects of the condition, he said.