When a young person has anorexia, parents often blame themselves and feel quite helpless to aid in their recovery. Indeed, treatments often keep family members at arm's length, with residential therapy and individual counseling focused on helping the young person sort through the complex emotional and psychological issues at the root of their illness.
However, a new study suggests that parental participation and oversight may be just what many young people need to make a lasting recovery. The researchers found that teens who had family-focused therapy were twice as likely to be at a healthy weight a year after treatment as those who had individual therapy.
Family-based therapy differs from individual treatment in both form and focus. Whereas individual therapy centers on the psychological causes of anorexia, family-based therapy directly addresses the harmful behaviors of the disorder. Parents are enlisted to make sure their child eats enough and does not exercise too much. Therapy sessions also focus on enhancing how the family works together, building healthy relationships and dispelling any guilt parents feel about their child's condition. Ultimately, the responsibility for eating and weight control is transferred back to the child.
Previous studies have suggested that both family and individual therapy can help young people with anorexia. Now, in the new study, researchers have compared the treatments head-to-head. The study (a randomized controlled trial) included 121 young people with anorexia, ages 12 to 18, who were randomly assigned to have either family-based therapy or individual therapy for one year.
But 12 months after treatment had ended, the difference between the groups was much more pronounced, with 49.3 percent of young people in the family therapy group in remission, compared with 23.2 percent in the individual therapy group. Only 10 percent of those who'd had family therapy had a return of their anorexia symptoms during this time, compared with 40 percent of those who’d received individual treatment.
The researchers also found that teenagers who had family therapy gained weight faster during treatment, and were less likely to be admitted to the hospital. The study didn’t explore why family-based therapy might work better than individual treatment, but the researchers offer this theory: By focusing on the harmful behaviors of anorexia, family therapy may also help resolve the psychological issues at their root.
"Restrictive eating and overexercise contribute to the maintenance of anorexic thinking," says study author James Loch, MD, a professor of psychiatry and behavioral sciences at Stanford University. He notes that even healthy people can develop anxious, obsessive, and ritualistic thinking about food when they are starving. "If you disrupt the maintaining behaviors of anorexia and get the patients eating, you disrupt that sequence of thinking," he says.
Future studies will need to explore whether family-based therapy works better for some patients than others. It's also unclear how well this approach works for severely underweight teenagers, as this group wasn't included in the study.
What you need to know. If you're the parent of a teenager with anorexia, this study suggests that a long-lasting recovery may be more likely if your child has family-based therapy rather than individual treatment. However, the researchers note that individual therapy also worked well for many young people in the study, and it may be a better option for some patients and families.
The important thing is to make sure your child gets treatment, as starving the body of food stops organs from working properly. If it goes on too long, it can damage the heart, kidneys, bones, muscles, and other parts of the body. Each year, around 1 in 100 people with anorexia die of problems caused by their disorder.
—Sophie Ramsey, patient editor, BMJ Group
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