Family Therapy for Adolescent Anorexia Nervosa

There is very limited research to guideline clinicians, patients and their family members in choosing the best treatments for anorexia nervosa and other eating disorders.  So when a well-designed and informative study is published it is noteworthy and important to review.   James Lock and colleagues summarized their findings from a randomized trial of family therapy versus individual therapy in a randomized controlled trial for adolescents with anorexia nervosa in the October 2010 issue of Archives of General Psychiatry.

This study found family-based therapy superior to individual-based therapy for these adolescents.  The elements of family therapy for anorexia in the study were outlined as:

• Phase one- “absolve the parents from the responsibility of causing the (eating) disorder” as well as being positive by complimenting positive elements of their parenting style and behavior—families were encouraged to work out a plan suited to their family for restoring the weight of the child
• Phase two-return responsibility for weight and eating to the adolescent using an age-appropriate method
• Phase three-establish a healthy adolescent-parent relationship pattern

This therapy was provided in twenty session lasting one hour per session over a one year period of time. 

Full remission of the eating disorder was accomplished in 49% of the family therapy group compared to only 22% of the individual therapy group.

So why was family therapy more effective in this adolescent population with anorexia nervosa?  The authors don’t discuss this issue much in the comment section of the manuscript.  They note that the family therapy method acts by “empowering parents to directly address behaviors maintaining weight loss in their children”.

This parent led approach may be specifically appropriate in anorexia nervosa, a disorder that appears more frequently in middle and upper class families (one of the few mental disorders showing this pattern).   It is noteworthy that the parents in this study had an average of 16 to 18 years of education and might be more effective than less well-educated parents in taking on a direct role taught by expert therapists in the management of anorexia related behaviors and interpersonal problems.

The family therapy method used in this study has been published in a book: Lock J, Le Grange D, Agras WS, Dare C. Treatment Manual for Anorexia Nervosa: A Family-Based Approach. New York, NY: Guilford Publications, Inc; 2001.   A link to this book on Amazon.com is here.


Baby duck in flowers courtesy of Yates Photography.


Lock J, Le Grange D, Agras WS, Moye A, Bryson SW, & Jo B (2010). Randomized clinical trial comparing family-based treatment with adolescent-focused individual therapy for adolescents with anorexia nervosa. Archives of general psychiatry, 67 (10), 1025-32 PMID: 20921118