Family Therapies Effectively Treated Anorexia in Teens

Teens with anorexia recovered faster with parent intervention than with therapy to resolve family conflicts, but both were effective

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) Families play an important role in mental health — and that role may be key to treating teens with anorexia, a new study suggests.

Between 0.5 and 0.7 percent of adolescent girls have anorexia, reports the Stanford University Medical Center. Past Stanford research found that family therapy was twice as effective as one-on-one therapy in treating it.

But new research looked at which type of family therapy was most effective. The Stanford researchers found that therapy that taught parents how to teach their children to eat normally (family-based) was more effective than therapy that targeted family strain (systemic).

"The take-away message for parents is that, first, there is good treatment available for their child who is struggling with anorexia," said Stewart Agras, MD, professor of psychiatry and behavioral sciences at Stanford and the lead study author, in a press release. "Second, the preferred treatment is family-based therapy in which parents help their child regain weight."

"The love and approval of parents is critical in recovery for teens struggling in all sorts of ways, not just eating disorders," said Charlotte Howard, PhD, a licensed psychologist practicing in Austin, TX.

"The healing power of parents' understanding what their child is going through and being able to join him or her emotionally, not just intellectually, is astounding," said Dr. Howard, who was not involved in this study. "Many great parents give generously to their children, but overlook some key ingredients that they never received growing up themselves. A good family therapist can help parents realize and fill in these gaps and create immense positive transformation in their children."

This "preferred treatment," called family-based therapy (FBT), wasn't more effective than the other family treatment, systemic family therapy (SyFT) — the teens had similar recovery rates, but FBT worked more quickly and was roughly half the cost of SyFT.

Anorexia is an eating disorder marked by patients falsely believing they need to lose weight. They do so by eating too little and, in some cases, exercising too much. Anorexia is deadly. It's also tied to one of the highest suicide rates of any mental disorder. 

Study author James Lock, MD, PhD, said he thinks parents can disrupt the false thinking and damaging behaviors children with anorexia often engage in.

"We think that parents are able to disrupt the maintaining behaviors of anorexia long enough that the thoughts and cognitions that go with the disease diminish," he said in a press release. "At that point, the cognitions themselves have very little staying power."

To reach these conclusions, the authors of the recent research studied 164 teens with anorexia. About 90 percent of the patients were girls.

At six sites across the US and Canada, patients had a series of 16 one-hour therapy sessions during a nine-month time frame. Some had FBT. Others had SyFT.

The groups had similar recovery rates at the end of the therapy. Those who had FBT recovered at a rate of 33.1 percent, while 25.3 percent of those who had SyFT recovered. The rates were even closer at the one-year follow-up — 40.7 and 39 percent, respectively.

The key difference was in how quickly the patients recovered. The patients who had FBT gained weight much more quickly than the SyFT group and spent fewer days on average in the hospital.

And spending fewer days in the hospital likely contributed to the lower overall treatment costs for the FBT group. On average, treatment costs per patient were $8,963 for the FBT group and $18,005 for the SyFT group.

Despite varying costs and recovery speeds, both treatments were effective after both nine months and a one-year follow-up. The bottom line? Family therapies worked, the study authors found, and early treatment was important.

"The longer anorexia goes on, the more difficult it is to treat," Dr. Agras said. "A great many people live chronically restricted lives because of this disease — they plan their days around undereating and overexercise — and quite a few die. The idea is to treat the disorder in adolescence to prevent more adults from becoming anorexic."

This study was published Sept. 24 in JAMA Psychiatry.

The National Institute of Mental Health funded the research. Some study authors received funds from private or public organizations involved in publishing and health care.

Review Date: 
September 24, 2014
Last Updated:
September 29, 2014