Randomized Clinical Trial Comparing Family-Based Treatment With Adolescent-Focused Individual Therapy for Adolescents With Anorexia Nervosa | Adolescent Medicine | JAMA Psychiatry | JAMA Network
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1.
Hoek  H Review of epidemiological studies of eating disorders.  Int Rev Psychiatry 1993;5 (1) 61- 74doi:10.3109/09540269309028295Google Scholar
2.
Hoek  HWvan Hoeken  D Review of the prevalence and incidence of eating disorders.  Int J Eat Disord 2003;34 (4) 383- 396PubMedGoogle Scholar
3.
Hoek  HWvan Harten  PNHermans  KMKatzman  MAMatroos  GESusser  ES The incidence of anorexia nervosa on Curaçao.  Am J Psychiatry 2005;162 (4) 748- 752PubMedGoogle Scholar
4.
van Son  GEvan Hoeken  DBartelds  AIvan Furth  EFHoek  HW Time trends in the incidence of eating disorders: a primary care study in the Netherlands.  Int J Eat Disord 2006;39 (7) 565- 569PubMedGoogle Scholar
5.
Rome  ESAmmerman  S Medical complications of eating disorders: an update.  J Adolesc Health 2003;33 (6) 418- 426PubMedGoogle Scholar
6.
Sullivan  PF Mortality in anorexia nervosa.  Am J Psychiatry 1995;152 (7) 1073- 1074PubMedGoogle Scholar
7.
Herzog  DBGreenwood  DNDorer  DJFlores  ATEkeblad  ERRichards  ABlais  MAKeller  MB Mortality in eating disorders: a descriptive study.  Int J Eat Disord 2000;28 (1) 20- 26PubMedGoogle Scholar
8.
Herzog  DBNussbaum  KMMarmor  AK Comorbidity and outcome in eating disorders.  Psychiatr Clin North Am 1996;19 (4) 843- 859PubMedGoogle Scholar
9.
Casper  RCHedeker  DMcClough  JF Personality dimensions in eating disorders and their relevance for subtyping.  J Am Acad Child Adolesc Psychiatry 1992;31 (5) 830- 840PubMedGoogle Scholar
10.
Anderluh  MBTchanturia  KRabe-Hesketh  STreasure  JL Childhood obsessive-compulsive personality traits in adult women with eating disorders: defining a broader eating disorder phenotype.  Am J Psychiatry 2003;160 (2) 242- 247PubMedGoogle Scholar
11.
Godart  NTFlament  MFPerdereau  FJeammet  P Comorbidity between eating disorders and anxiety disorders: a review.  Int J Eat Disord 2002;32 (3) 253- 270PubMedGoogle Scholar
12.
Godart  NTFlament  MFLecrubier  YJeammet  P Anxiety disorders in anorexia nervosa and bulimia nervosa: co-morbidity and chronology of appearance.  Eur Psychiatry 2000;15 (1) 38- 45PubMedGoogle Scholar
13.
Bulik  CMBerkman  NDBrownley  KASedway  JALohr  KN Anorexia nervosa treatment: a systematic review of randomized controlled trials.  Int J Eat Disord 2007;40 (4) 310- 320PubMedGoogle Scholar
14.
Russell  GFSzmukler  GIDare  CEisler  I An evaluation of family therapy in anorexia nervosa and bulimia nervosa.  Arch Gen Psychiatry 1987;44 (12) 1047- 1056PubMedGoogle Scholar
15.
Le Grange  DEisler  IDare  CRussell  G Evaluation of family treatments in adolescent anorexia nervosa: a pilot study.  Int J Eat Disord 1992;12 (4) 347- 357doi:10.1002/1098-108X(199212)12:4<347::AID-EAT2260120402>3.0.CO;2-WGoogle Scholar
16.
Eisler  IDare  CHodes  MRussell  GDodge  ELe Grange  D Family therapy for adolescent anorexia nervosa: the results of a controlled comparison of two family interventions.  J Child Psychol Psychiatry 2000;41 (6) 727- 736PubMedGoogle Scholar
17.
Robin  ALSiegel  PTMoye  AWGilroy  MDennis  ABSikand  A A controlled comparison of family versus individual therapy for adolescents with anorexia nervosa.  J Am Acad Child Adolesc Psychiatry 1999;38 (12) 1482- 1489PubMedGoogle Scholar
18.
Gowers  SGClark  ARoberts  CGriffiths  AEdwards  VBryan  CSmethurst  NByford  SBarrett  B Clinical effectiveness of treatments for anorexia nervosa in adolescents: randomised controlled trial.  Br J Psychiatry 2007;191427- 435PubMedGoogle Scholar
19.
Lock  JAgras  WSBryson  SKraemer  HC A comparison of short- and long-term family therapy for adolescent anorexia nervosa.  J Am Acad Child Adolesc Psychiatry 2005;44 (7) 632- 639PubMedGoogle Scholar
20.
Fitzpatrick  KMoye  AHostee  R  et al.  Adolescent focused therapy for adolescent anorexia nervosa.  J Contemp Psychother 2009;40 (1) 31- 39doi:10.1007/s10879-009-9123-7Google Scholar
21.
Dare  CEisler  I Family therapy for anorexia nervosa.  In: Garner  DM, Garfinkel  P, eds.  Handbook of Treatment for Eating Disorders. New York, NY: Guilford Press; 1997:307-324Google Scholar
22.
Dare  CEisler  IRussell  GTreasure  JDodge  L Psychological therapies for adults with anorexia nervosa: randomised controlled trial of out-patient treatments.  Br J Psychiatry 2001;178216- 221PubMedGoogle Scholar
23.
Eisler  ISimic  MRussell  GFDare  C A randomised controlled treatment trial of two forms of family therapy in adolescent anorexia nervosa: a five-year follow-up.  J Child Psychol Psychiatry 2007;48 (6) 552- 560PubMedGoogle Scholar
24.
Lock  JCouturier  JAgras  WS Comparison of long-term outcomes in adolescents with anorexia nervosa treated with family therapy.  J Am Acad Child Adolesc Psychiatry 2006;45 (6) 666- 672PubMedGoogle Scholar
25.
Centers for Disease Control and Prevention CDC Growth Charts for the United States: Development and Methods.  Atlanta, GA: Centers for Disease Control and Prevention; 2002
26.
Alison  D Handbook of Assessment Methods for Eating Behavior and Weight-Related Problems.  Thousand Oaks, CA: Sage; 1995
27.
Efron  B Forcing a sequential experiment to be balanced.  Biometrika 1971;58 (3) 403- 417doi:10.1093/biomet/58.3.403Google Scholar
28.
Bravender  TBryant-Waugh  RHerzog  DKatzman  DKreipe  RDLask  BLe Grange  DLock  JLoeb  KMadden  SNicholls  DO’Toole  JPinhas  LRome  ESokol-Burger  MWallen  UZucker  NWorkgroup for Classification of Eating Disorders in Children and Adolescents, Classification of child and adolescent eating disturbances.  Int J Eat Disord 2007;40(suppl)S117- S122PubMedGoogle Scholar
29.
Roberto  CASteinglass  JMayer  LEAttia  EWalsh  BT The clinical significance of amenorrhea as a diagnostic criterion for anorexia nervosa.  Int J Eat Disord 2008;41 (6) 559- 563PubMedGoogle Scholar
30.
Metropolitan Life Insurance Company, 1983 Metropolitan height and weight tables.  Stat Bull Metropol Life Insur Co 1983;641- 9Google Scholar
31.
Lock  JLe Grange  DAgras  WSDare  C Treatment Manual for Anorexia Nervosa: A Family-Based Approach.  New York, NY: Guilford Publications, Inc; 2001
32.
Couturier  JLock  J What is remission in adolescent anorexia nervosa? a review of various conceptualizations and quantitative analysis.  Int J Eat Disord 2006;39 (3) 175- 183PubMedGoogle Scholar
33.
Couturier  JLock  J What is recovery in adolescent anorexia nervosa?  Int J Eat Disord 2006;39 (7) 550- 555PubMedGoogle Scholar
34.
Swenne  I Weight requirements for return of menstruations in teenage girls with eating disorders, weight loss and secondary amenorrhoea.  Acta Paediatr 2004;93 (11) 1449- 1455PubMedGoogle Scholar
35.
Swenne  I Weight requirements for catch-up growth in girls with eating disorders and onset of weight loss before menarche.  Int J Eat Disord 2005;38 (4) 340- 345PubMedGoogle Scholar
36.
Golden  NHJacobson  MSSchebendach  JSolanto  MVHertz  SMShenker  IR Resumption of menses in anorexia nervosa.  Arch Pediatr Adolesc Med 1997;151 (1) 16- 21PubMedGoogle Scholar
37.
Modan-Moses  DYaroslavsky  ANovikov  ISegev  SToledano  AMiterany  EStein  D Stunting of growth as a major feature of anorexia nervosa in male adolescents.  Pediatrics 2003;111 (2) 270- 276PubMedGoogle Scholar
38.
Couturier  JLLock  J Denial and minimization in adolescents with anorexia nervosa.  Int J Eat Disord 2006;39 (3) 212- 216PubMedGoogle Scholar
39.
Fairburn  CGCooper  I The eating disorder examination.  In: Fairburn  CG, Wilson  GT, eds.  Binge Eating: Nature, Assessment, and Treatment.12th ed. New York, NY: Guilford Press; 1993Google Scholar
40.
Cooper  ZCooper  PJFairburn  CG The validity of the eating disorder examination and its subscales.  Br J Psychiatry 1989;154807- 812PubMedGoogle Scholar
41.
Passi  VABryson  SWLock  J Assessment of eating disorders in adolescents with anorexia nervosa: self-report questionnaire versus interview.  Int J Eat Disord 2003;33 (1) 45- 54PubMedGoogle Scholar
42.
Hebebrand  JHimmelmann  GWHeseker  HSchafer  HRemschmidt  H Use of percentiles for the body mass index in anorexia nervosa: diagnostic, epidemiological, and therapeutic considerations.  Int J Eat Disord 1996;19 (4) 359- 369PubMedGoogle Scholar
43.
Hebebrand  JCasper  RTreasure  JLSchweiger  U The need to revise the diagnostic criteria for anorexia nervosa.  J Neural Transm 2004;111 (7) 827- 840PubMedGoogle Scholar
44.
Hebebrand  JWehmeier  PMRemschmidt  H Weight criteria for diagnosis of anorexia nervosa.  Am J Psychiatry 2000;157 (6) 1024PubMedGoogle Scholar
45.
Orvaschel  HPuig-Antich  JChambers  WTabrizi  MAJohnson  R Retrospective assessment of prepubertal major depression with the Kiddie-SADS-e.  J Am Acad Child Psychiatry 1982;21 (4) 392- 397PubMedGoogle Scholar
46.
Golden  NHKatzman  DKKreipe  REStevens  SLSawyer  SMRees  JNicholls  DRome  ESSociety For Adolescent Medicine, Eating disorders in adolescents: position paper of the Society for Adolescent Medicine.  J Adolesc Health 2003;33 (6) 496- 503PubMedGoogle Scholar
47.
Diggle  PLiang  KZeger  S The Analysis of Longitudinal Data.  Oxford, England: Oxford University Press; 1994
48.
Laird  NMWare  JH Random-effects models for longitudinal data.  Biometrics 1982;38 (4) 963- 974PubMedGoogle Scholar
49.
Meredith  WTisak  J Latent curve analysis.  Psychometrika 1990;55 (1) 107- 122doi:10.1007/BF02294746Google Scholar
50.
Raudenbush  SBryk  A Hierarchical Linear Models: Applications and Data Analysis Methods.  Thousand Oaks, CA: Sage; 2002
51.
Muthén  LMuthén  BO Mplus User's Guide (1998-2008). Version 5.2. Los Angeles, CA: Muthé & Muthén; 2009
52.
Kraemer  HCMorgan  GALeech  NLGliner  JAVaske  JJHarmon  RJ Measures of clinical significance.  J Am Acad Child Adolesc Psychiatry 2003;42 (12) 1524- 1529PubMedGoogle Scholar
53.
Cohen  J Statistical Power Analysis for Behavioral Science. 2nd ed. Hillsdale, NJ: Lawrence Earlbaum; 1988
54.
Kraemer  HCKupfer  DJ Size of treatment effects and their importance to clinical research and practice.  Biol Psychiatry 2006;59 (11) 990- 996PubMedGoogle Scholar
55.
Lane  P Handling drop-out in longitudinal clinical trials: a comparison of the LOCF and MMRM approaches.  Pharm Stat 2008;7 (2) 93- 106PubMedGoogle Scholar
56.
Simpson  HBPetkova  ECheng  JHuppert  JFoa  ELiebowitz  MR Statistical choices can affect inferences about treatment efficacy: a case study from obsessive-compulsive disorder research.  J Psychiatr Res 2008;42 (8) 631- 638PubMedGoogle Scholar
57.
Morgan  HGHayward  AE Clinical assessment of anorexia nervosa: the Morgan-Russell outcome assessment schedule.  Br J Psychiatry 1988;152367- 371PubMedGoogle Scholar
58.
Robin  A Behavioral family systems therapy for adolescents with anorexia nervosa.  In: Kazdin  A, Weisz  J, eds.  Evidence-based Psychotherapies for Children and Adolescents. New York, NY: Guilford Press; 2003:358-373Google Scholar
59.
Lock  J Treating adolescents with eating disorders in the family context: empirical and theoretical considerations.  Child Adolesc Psychiatr Clin N Am 2002;11 (2) 331- 342PubMedGoogle Scholar
60.
Howard  WTEvans  KKQuintero-Howard  CVBowers  WAAndersen  AE Predictors of success or failure of transition to day hospital treatment for inpatients with anorexia nervosa.  Am J Psychiatry 1999;156 (11) 1697- 1702PubMedGoogle Scholar
61.
Carter  JCBlackmore  ESutandar-Pinnock  KWoodside  DB Relapse in anorexia nervosa: a survival analysis.  Psychol Med 2004;34 (4) 671- 679PubMedGoogle Scholar
62.
Walsh  BTKaplan  ASAttia  EOlmsted  MParides  MCarter  JCPike  KMDevlin  MJWoodside  BRoberto  CARockert  W Fluoxetine after weight restoration in anorexia nervosa: a randomized controlled trial.  JAMA 2006;295 (22) 2605- 2612PubMedGoogle Scholar
63.
National Institute for Clinical Excellence (N.I.C.E.) Eating Disorders: Core Interventions in the Treatment and Management of Anorexia Nervosa, Bulimia Nervosa, and Binge Eating Disorder.  London, England: National Institute for Clinical Excellence; 2004
Original Article
October 4, 2010October 2010

Randomized Clinical Trial Comparing Family-Based Treatment With Adolescent-Focused Individual Therapy for Adolescents With Anorexia Nervosa

Author Affiliations

Author Affiliations: Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California (Drs Lock, Agras, and Jo and Ms Bryson); Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, Illinois (Dr Le Grange); and private practice, Bloomfield Hills, Michigan (Dr Moye).

Arch Gen Psychiatry. 2010;67(10):1025-1032. doi:10.1001/archgenpsychiatry.2010.128
Abstract

Context  Evidence-based treatment trials for adolescents with anorexia nervosa are few.

Objective  To evaluate the relative efficacy of family-based treatment (FBT) and adolescent-focused individual therapy (AFT) for adolescents with anorexia nervosa in full remission.

Design  Randomized controlled trial.

Setting  Stanford University and The University of Chicago (April 2005 until March 2009).

Participants  One hundred twenty-one participants, aged 12 through 18 years, with DSM-IV diagnosis of anorexia nervosa excluding the amenorrhea requirement.

Intervention  Twenty-four outpatient hours of treatment over 12 months of FBT or AFT. Participants were assessed at baseline, end of treatment (EOT), and 6 months' and 12 months' follow-up posttreatment.

Main Outcome Measures  Full remission from anorexia nervosa defined as normal weight (≥95% of expected for sex, age, and height) and mean global Eating Disorder Examination score within 1 SD of published means. Secondary outcome measures included partial remission rates (>85% of expected weight for height plus those who were in full remission) and changes in body mass index percentile and eating-related psychopathology.

Results  There were no differences in full remission between treatments at EOT. However, at both the 6- and 12-month follow-up, FBT was significantly superior to AFT on this measure. Family-based treatment was significantly superior for partial remission at EOT but not at follow-up. In addition, body mass index percentile at EOT was significantly superior for FBT, but this effect was not found at follow-up. Participants in FBT also had greater changes in Eating Disorder Examination score at EOT than those in AFT, but there were no differences at follow-up.

Conclusion  Although both treatments led to considerable improvement and were similarly effective in producing full remission at EOT, FBT was more effective in facilitating full remission at both follow-up points.

Trial Registration  clinicaltrials.gov Identifier: NCT00149786

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