No abstract

Existing randomized controlled trials of family therapy for treatment of bulimia nervosa in adolescence highlight the need for further development of treatments. This article describes the development of multi-family treatment for bulimia nervosa in adolescents aged 13-18. It outlines the theory guiding this development, the areas of need identified by previous studies, and the treatment that has been designed to meet these needs. Particular attention is given to the need to increase communication between family members, strategies to reduce high levels of criticism or hostility, and skills to manage emotion dysregulation and low tolerance for negative emotions. To these ends the program draws on the multi-family treatment for anorexia nervosa, cognitive behavioral therapy techniques, and dialectical behavior therapy.

Ongoing research is needed to identify the active ingredients of family therapy for anorexia.

The written transmission of therapists' expertise in manuals is an important issue which is highlighted in the literature. Manuals are essential for research, training and therapeutic guidance. However, the conceptualisation, design and drafting of therapy manuals have received little attention. Our team conceptualised and designed a 10-monthly session multi-family therapy programme for adolescents suffering from anorexia nervosa. This paper presents the methodology used to evolve from training and theoretical models to designing a programme and drafting the accompanying

Eating disorders are a cause of significant morbidity among students. There is a relatively high prevalence in the student population, with binge eating problems and EDNOS reaching a prevalence of 5% in young women. Yet community studies suggest that more than half of clinical cases go undetected. Binge eating problems are associated with a high level of psychological distress. Anorexia nervosa, while less common, carries a high risk in terms of personal health and safety; it has the highest mortality of all psychiatric disorders both in relation to physical risk and suicidal behaviors.Short duration of illness and early treatment, before the eating disorder has had time to become too entrenched, are good prognostic factors. Without treatment eating disorders tend to run a chronic course with progressively worsening prognosis. Profound weight loss and long duration of illness also carry a bad prognosis. Eating disorders are treatable conditions with the possibility of a full and lasting recovery. It would seem clearly to be in the best interests of students with eating disorders to engage in evidence-based treatments as soon as possible and, for those with more severe illness, to undergo treatment before they proceed with their studies. Obstacles to DiagnosisEarly detection in primary care poses considerable challenges. People with eating disorders often conceal their illness. People with bulimia nervosa and binge eating problems may feel guilty and are