In keeping with the adult literature, cross-sectional studies of children and adolescents consistently report associations with eating pathology. There is some evidence from prospective studies that insecure attachment may be a risk factor for the development of eating pathology in adolescence. The literature on mentalization and eating pathology suggests that adolescents with anorexia nervosa may have difficulties in recognizing emotions. Further research using clinical samples and well-validated measures of attachment and mentalization are required to shed further light on this area.

Eating disorder-focused family therapy has emerged as the strongest evidence based treatment for adolescent anorexia nervosa supported by evidence from nine RCTs, and there is increasing evidence of its efficacy in treating adolescent bulimia nervosa (three RCTs). There is also emerging evidence for the efficacy of multi-family therapy formats of this treatment, with a recent RCT demonstrating the benefits of this approach in the treatment of adolescent anorexia nervosa. In this article we critically review the evidence for eating disorder-focused family therapy through the lens of a moderate common factors paradigm. From this perspective, this treatment is likely to be effective since it provides a supportive and non-blaming context that one, creates a safe, predictable environment that helps to contain anxiety generated by the eating disorder, two, promotes specific change early on in treatment in eating disorder related behaviors, and three provides a vehicle for the mobilization of common factors such as hope and expectancy reinforced by the eating disorder expertise of the multidisciplinary team. In order to improve outcomes for young people, there is a need to develop an improved understanding of the moderators and mediators involved in this treatment approach. Such an understanding could lead to the refining of the therapy, and inform adaptations for those families who do not currently benefit from treatment.

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