Dec. 1, 1999 (New York) -- Anorexia nervosa predominantly affects teen-age girls, and can be life threatening. While everyone else may notice the self-starvation, it's often not noticed by the girl herself. Therapy or intervention of some kind is needed but usually the last thing wanted by the sick girl.
Family therapy and individualized therapy with parental involvement have been shown to be effective treatments for adolescent girls in the early stages of anorexia. Now, a new study in the December issue of the Journal of the American Academy of Child and Adolescent Psychiatry shows that family therapy for such patients may be the best and fastest route to greater weight gain as well as more rapid resumption of menstruation.
"Ten years ago, individual therapy was the norm. Then a lot of practitioners started doing family therapy. These days, clinicians typically employ an eclectic combination," lead researcher Arthur L. Robin, PhD, tells WebMD. "We decided to pull those components apart and try to analyze them more carefully." Robin is a professor of psychiatry and behavioral neuroscience at Wayne State University in Detroit.
To look at those compartments, the investigators studied 37 adolescent girls who were beginning to suffer from anorexia. The girls were split into two groups. Girls in one group met weekly with their parents and a therapist; the other girls met with a therapist alone. Both groups were put on a common medical and dietary regimen. Patients were assessed before therapy, after therapy was stopped, and one year later. The girls were checked for body mass index (weight in relation to height), menstruation, eating attitudes, ego functioning, depression, and family interactions.
According to Robin, both family and individual therapy were effective treatments for anorexia, but family therapy rendered faster and greater weight gain. While close to 70% of the girls from both groups reached their target weight by the end of treatment, the girls in family therapy on average showed double the weight gains of the girls in individual therapy. By the one-year follow-up, 80% of those receiving family therapy reached their target weights, as did 70% of those receiving individual therapy. "Girls will gain weight faster and will gain more weight with family therapy," says Robin.
Girls receiving family therapy also resumed menstruation faster than the individual-therapy group.
The therapies were shown to be equally effective when other types of behavior were examined, such as eating attitudes, ability to get along with parents, self-esteem, depression, ego functioning, and desire for thinness, Robin tells WebMD. "My initial hypothesis was that individualized therapy would produce greater changes on ego functioning, depression, and awareness of feelings and so on. That's what individual therapists focus on. I was surprised at the results ... but they could be the result of the measures we used to see changes in ego function."
Families receiving both treatments scored very high at the start of the study on a test that measured the amount of conflict in the family over the girls' eating habits. For both groups, these scores decreased substantially after treatment and were maintained at follow-up. "I thought family therapy would produce a greater change in conflict. Perhaps the family problem is secondary to the starvation rather than being a family dynamic problem. As long as you get the child out of starvation, and it may not matter how you do that, the family problems may resolve," Robin tells WebMD.
So, while family therapy plays a key role, individual therapy still has its place. "In the ideal situation, if you have a young teen-ager with anorexia, a clinician should start off with family therapy to restore weight. As you get to the later stages and approach target weight, individual sessions can help deal with interpersonal and body image issues," Robin says.
Daniel le Grange, PhD, director of the eating disorders program at the University of Chicago Medical Center, tells WebMD, "What is encouraging is that individual therapy seems to be as effective as family therapy for improving eating attitudes, depression, and eating-related family conflicts."
No matter what type of therapy is prescribed, anorexia nervosa is a disease that eludes simple solutions. "It's important to remember that while we were able to help two-thirds or three-fourths, there's another quarter of patients who were helped somewhat but still didn't get to target weight. Even in the early-onset population with all this therapy, there's more to be learned," Robin tells WebMD.
- For teen-age girls with anorexia nervosa, family therapy and individual therapy are equally effective with respect to eating attitudes, depression, and eating-related family conflicts.
- Family therapy is better in some respects, as these patients experienced faster and greater weight gain.