Though relatively rare-affecting less than 2 percent of the adolescent population-anorexia nervosa is a life-threatening illness with a high mortality rate. Patients with the condition believe they are fat, and use food restriction and exercise to maintain dangerously low body weights. The disease kills about one in every 10 patients but the results of a new study could change the way they are treated and improve survival rates.

Traditionally, patients are hospitalized, separated from their parents, and counseled individually. Researchers at Stanford University collaborated with researchers at the University of Chicago to test a family-based therapy approach against the individual psychotherapy model. In family-based therapy the parents are included in treatment and enlisted to interrupt their child's unhealthy behavior.

In an article published on Stanford University's website, James Lock, MD, PhD, one of the study's authors and a professor of psychiatry and behavior sciences said the research was desperately needed.

The study looked at 121 male and female anorexia patients aged 12 to 18 and is the first head-to-head comparison of these two common treatment approaches. Published in October 2010 in the Archives of General Psychiatry, the study found that 49.3 percent of family-based therapy patients were in full remission compared with 23.2 percent of individual psychotherapy patients-about twice as effective.

"Although both treatments were helpful to a proportion of patients, this study strongly suggests that as first-line treatment, family-based interventions are superior," said Lock, who is also psychiatric director of the Comprehensive Eating Disorders Program at Packard Children's Hospital.

"For the first time we can confidently present parents with a treatment we consider the gold standard for this patient population," added Daniel Le Grange, PhD, the other lead author of the study and a professor of psychiatry and behavioral neuroscience at the University of Chicago.

Lock noted that individual psychotherapy works better in some cases, and that he and his colleagues at Packard Children's routinely offer both types of therapy.

Lock hopes the study's results will encourage those who treat adolescent anorexia nervosa to use family-based therapy. "The model of putting kids in the hospital and excluding their parents or of professionals expecting young adolescents to manage their own eating without their parents' help really should be reconsidered."

Going Forward

Adolescents who develop the condition typically have a family history of weight problems and other mental health issues such as depression or substance abuse. Problem solving difficulties, being too rigid, overly-critical, intrusive or overprotective are also characteristics of these families. Over the past 20 years, the occurrence of anorexia nervosa has increased.

The results of the study represent a change in philosophy according to Edward Abramson, Ph.D. and clinical psychologist who specializes in eating disorders. "In the past, individual therapy focused on resolving the patient's underlying anxiety and emotional problems with minimal involvement from the family. Blame was often assigned to the parents and it was the therapist's job to straighten out the family dynamic," said the expert who is also the author of the forthcoming book, It's Not Just Baby Fat (Jan. 2011).

In family therapy, parents are not seen as malevolent but instead play an active role in helping their children get well. "Mom and dad learn how to speak to a vulnerable child," says Abrams explaining that the therapist provides appropriate responses to a child when she says she's not hungry, for example or complains that food is gross. "Parents learn to help the child externalize the disorder and see the negative thoughts as the anorexia talking."

Abrams believes family therapy is a gentler approach. Family-based treatment uses the parents' own skills to treat the symptoms of anorexia, rather than focusing on family problems that supposedly caused the disorder. "Lock's research makes no distinction about the source of the problem and recognizes that the family can be instrumental in helping their child get to a healthy weight," Abram says.


Stanford University School of Medicine

Interview with Edward Abramson, Ph.D.
Professor Emeritus of Psychology at the California State University

Clinical psychologist specializing in eating disorders and author of several books including the forthcoming, It's Not Just Baby Fat (Jan. 2011)

Children's Hospital of Philadelphia