Family functioning in two treatments for adolescent anorexia nervosa

Abstract

Objective Family functioning impairment is widely reported in the eating disorders literature, yet few studies have examined the role of family functioning in treatment for adolescent anorexia nervosa (AN). This study examined family functioning in two treatments for adolescent AN from multiple family members’ perspectives. Method Participants were 121 adolescents with AN ages 12–18 from a randomized-controlled trial comparing family-based treatment (FBT) to individual adolescent-focused therapy (AFT). Multiple clinical characteristics were assessed at baseline. Family functioning from the perspective of the adolescent and both parents was assessed at baseline and after one year of treatment. Full remission from AN was defined as achieving both weight restoration and normalized eating disorder psychopathology. Results In general, families dealing with AN reported some baseline impairment in family functioning, but average ratings were only slightly elevated compared to published impaired functioning cutoffs. Adolescents’ perspectives on family functioning were the most impaired and were generally associated with poorer psychosocial functioning and greater clinical severity. Regardless of initial level of family functioning, improvements in several family functioning domains were uniquely related to full remission at the end of treatment in both FBT and AFT. However, FBT had a more positive impact on several specific aspects of family functioning compared to AFT. Discussion Families seeking treatment for adolescent AN report some difficulties in family functioning, with adolescents reporting the greatest impairment. While FBT may be effective in improving some specific aspects of family dynamics, remission from AN was associated with improved family dynamics, regardless of treatment type.

Are family relations connected to the quality of the outcome in adolescent anorexia nervosa? An observational study with the Lausanne Trilogue Play

“…These latter patients in fact showed less conflictual dyadic interactions with parents, although triadic interactions were the most deficient and problematic. Reinstate a physiological adolescent development trajectory would be in these cases more difficult but it can be considered a pivotal aim to be targeted in the recovery process, because severe anorexia and more marked psychiatric problems appeared to be closely linked (Ciao et al, ; Wallis, Miskovic‐Wheatley, et al, ). We believe that such a goal can be more easily achieved using both an individual approach to support the adolescent and a family or parental one, in order to help parents in accepting and enhancing the adolescent's changes as well as in tackling the eventual premorbid family and parental issues, which may have prevented those changes (Godart et al, ; Wallis, Miskovic‐Wheatley, et al, ).…”

“…It is also clear that self‐report questionnaires capture the family components' perceptions and viewpoints, which may largely differ from the observers' ratings of the family interactions (Balottin, Nacinovich, Bomba, & Mannarini, ). However, two (Ciao et al, ; Wallis, Miskovic‐Wheatley, et al, ) out of three studies (Ciao et al, ; Wallis, Rhodes, et al, ; Wallis, Miskovic‐Wheatley, et al, ) following the cited systematic review (Holtom‐Viesel & Allan, ) applied only self‐report measures, whereas one study applied an ad hoc qualitative interview (Wallis, Rhodes, et al, ). Moreover, few studies applied observer‐rated measures along with the self‐report ones, and demonstrated that the families of patients with anorexia perceived their functioning to be better than the observers' ratings (Gowers & North, ; Wallin & Hansson, ).…”

How adolescents with anorexia nervosa and their parents perceive family functioning?

“…Eisler et al, 2003;Le Grange and Eisler, 2008;Lock et al, 2006) Family functioning has been measured both as a unitary construct reflecting the general functioning of the family as a whole and as a set of several aspects, such as flexibility, cohesion, and communication. Existing evidence suggests that there is a substantial agreement within family members dealing with AN in perceiving an impairment of the general family functioning and a strong dissatisfaction with family life (Casper and Troiani, 2001;Ciao et al, 2015;Cook-Darzens et al, 2005;Emanuelli et al, 2004;McDermott et al, 2002;Szabo et al, 1999); on the other hand, when considering specific dimensions of family functioning, significant differences are found between girls with AN and their parents, even though research shows variable and sometimes conflicting results (Ciao et al, 2015;Holtom-Viesel and Allan, 2014).…”

Psychosocial Well‐being of Siblings of Adolescents with Anorexia Nervosa

“…Qualitative research suggests that families are concerned about the impact of AN and FBT on siblings (Withers et al, ); however, there has been no quantitative study of sibling well‐being within an FBT programme. Of importance, there is evidence that family functioning actually improves during FBT (Ciao, Accurso, Fitzsimmons‐Craft, Lock, & Le Grange, ). Thus, an alternative possibility is that sibling well‐being could likewise improve during FBT.…”