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 on full remission. Design Randomized controlled trial. Setting Stanford University and The University of Chicago (April 2005 until March 2009) Participants One hundred and twenty one participants, ages 12 through 18 years with DSM-IV diagnosis of anorexia nervosa except for not requiring ammenorhea. Interventions Twenty four outpatient hours of treatment over 12 months of FBT or AFT. Participants were assessed at baseline, end of treatment (EOT), 6 months and 12 months follow-up post treatment. Main outcome measures Full remission from anorexia nervosa defined as normal weight (>95% of expected gender, age, weight for height) and mean global Eating Disorder Examination (EDE) score within 1 standard deviation of published means. Secondary outcome measures included partial remission rates (>85% of expected weight for height plus those who were fully remitted) and changes in Body Mass Index (BMI) percentile and eating related psychopathology. Results There were no differences in full remission between treatments at EOT. However, at both 6 and 12 month follow-up FBT was significantly superior to AFT on this measure. FBT was significantly superior for partial remission at EOT but not at follow-up. In addition, BMI percentile at EOT was significantly superior for FBT, but this effect was not found at follow-up. Participants in FBT also had greater changes on the EDE at EOT than those in AFT, but there were no differences at follow-up. Conclusions 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. Clinical Trials Registry Effectiveness of Family-Based Versus Individual Psychotherapy in Treating Adolescents With Anorexia Nervosa (NCT00149786)

No abstract

Few of the limited randomized controlled trails (RCTs) for adolescent anorexia nervosa (AN) have explored the effects of moderators and mediators on outcome. This study aimed to identify treatment moderators and mediators of remission at end of treatment (EOT) and 6- and 12-month follow-up (FU) for adolescents with AN (N=121) who participated in a multi-center RCT of family-based treatment (FBT) and individual adolescent focused therapy (AFT). Mixed effects modeling were utilized and included all available outcome data at all time points. Remission was defined as ≥95% IBW plus within 1SD of the Eating Disorder Examination (EDE) norms. Eating related obsessionality (Yale-Brown-Cornell Eating Disorder Total Scale) and eating disorder specific psychopathology (EDE-Global) emerged as moderators at EOT. Subjects with higher baseline scores on these measures benefited more from FBT than AFT. AN type emerged as a moderator at FU with binge-eating/purging type responding less well than restricting type. No mediators of treatment outcome were identified. Prior hospitalization, older age and duration of illness were identified as non-specific predictors of outcome. Taken together, these results indicate that patients with more severe eating related psychopathology have better outcomes in a behaviorally targeted family treatment (FBT) than an individually focused approach (AFT).

No abstract