Anorexia nervosa has one of the highest suicide rates of any psychiatric disorder. Mistakenly believing they are overweight, patients refuse to eat enough to maintain a healthy body weight and often overexercise as well. Since past research has shown treatment involving a patient's family is twice as effective as individual therapy, Stanford School of Medicine researchers decided to investigate the matter further. In a head-to-head comparison, two different family-based approaches effectively combated anorexia nervosa, and so adds weight to the argument that it is best to involve family members in any treatment strategy.

How Are Families Key to Treatment?

The exact cause of anorexia nervosa is unknown, though scientists believe a combination of biological, psychological, and environmental factors contribute to the condition. Since the genetic factors remain murky at best, many doctors look to the emotional and environmental components instead. It is well known that most patients equate thinness with self-worth and certainly the culture as a whole, and many families in particular emphasize thinness.

"For a long time, people blamed families for causing anorexia and thought they should be left out of treatment," said Dr. James Lock, lead author of the study and a professor of psychiatry and behavioral sciences at Stanford. Because family involvement has been proven valuable, Lock and a team of researchers decided to compare two forms of family therapy over a nine-month period in a study of 158 patients conducted at six sites in the United States and Canada. In the first group, 78 teens and their families attended regular family-based treatment (FBT) sessions, in which parents learned how to help their children eat normally and regain weight at home. The systemic family therapy (SyFT) included 80 teens and their families, who attended sessions which attempted to resolve difficult family dynamics. The majority of patients (89 percent) were female, most (79 percent) were white, with one-tenth Hispanic and five percent Asian. Patients ranged in age between 12 and 18, and many suffered from other conditions as well, most commonly major depression, followed by obsessive-compulsive, and anxiety disorders.

At the start of the study, all patients had body weights of at least 75 percent of what was considered ideal. Doctors, then, considered it safe for them to receive outpatient treatment. The success of the treatments was evaluated at the end of the nine-month period and once again a year later.

Both therapies produced similar rates of recovery and similar weight gain in patients, at the end of treatment and at follow-up. However, patients treated with the first approach, which focused on teaching parents to help their children eat normally, gained weight faster and needed less hospitalization. Due to these lowered hospital expenses, this first approach cost about half as much: $8,963 compared to $18,005. However, the family dynamics therapy was more effective for one specific sub-group of patients: those who also had severe symptoms of obsessive compulsive disorder.

“The findings of this study suggest that [family-based treatment] is the preferred treatment for adolescent anorexia because it is not significantly different from SyFT and leads to similar outcomes at a lower cost,” wrote the authors, adding teens with severe obsessive compulsive symptoms receive more benefits from Systemic Family Therapy.

Source: Agras WS, Lock J, Brandt H, et al. Comparison of 2 Family Therapies for Adolescent Anorexia Nervosa A Randomized Parallel Trial. JAMA Psychiatry. 2014.