Intensive Family-Based Therapy During an Acute Medical Admission for Anorexia Nervosa

Abstract

Family-based therapy (FBT) is the evidence-based treatment of choice for anorexia nervosa (AN) in adolescents, with numerous studies providing support for its efficacy in the outpatient realm. This case report describes the application of a brief FBT intervention during an inpatient medical admission for an adolescent presenting with medical instability secondary to new onset AN. The intensive, four-session FBT-guided intervention included (a) psychoeducation and illness externalization, (b) parent skills training, (c) meal coaching, and (d) behavioral contracting. Selfreport assessment and anthropometric data collected at pre-, post-, and 5 months following the intervention suggest increase in body mass index (BMI) and percent ideal body weight, increased parental understanding of AN and parental self-efficacy in managing the illness, decreased parent emotional burden of the illness, and decreases in overall adolescent Eating Disorder Examination Questionnaire (EDE-Q) scores. This case report provides preliminary evidence for the acceptability and effectiveness of a brief FBT-based intervention during medical stabilization for adolescents with AN and their families before proceeding to outpatient FBT.

Canadian practice guidelines for the treatment of children and adolescents with eating disorders

“…Eleven additional case reports (number of total patients = 29) are described showing benefit of FBT in terms of weight gain [33,[35][36][37][38][40][41][42][43][44]. Some of these focus on twins [35,42,44], comorbid conversion disorder [43], FBT in a group home setting [38], FBT started on a medical unit [39], and FBT combined with medication [42].…”

“…Anorexia nervosa There were three studies found examining inpatient treatment utilizing a family-based approach, one of which included 37 patients [211], and the other two studies which included one patient each (i.e. case reports) [39,63] (Table 41). Length of stay in hospital was a mean of 20.6 weeks (SD = 13.6, range 3-58) in the first study [211] and 10 days in one case report [39] and unclear in the second case report [63].…”

The effectiveness of contingency management in the treatment of patients with anorexia nervosa: A systematic review

“…This approach of combining contingency management with other intervention techniques can be found in some included articles. Geller et al () combined a contingency programme with family therapy, Matthews and Peterson () treated a patient with AN with sessions of psychoeducation and meal coaching during her inpatient stay and released her with an outpatient contingency contract. Hauserman and Lavin () describe an outpatient who was on a contingency contract negotiated with the physician and received individual psychotherapy.…”

“…Notably, Bhanji and Thompson (1974) and Bhanji (1975) report about the same 11 cases and are therefore only counted once for the total number of patients. All of the included case reports and case series outline a positive short-term effect of contingency management for weight gain (Abel et al, 1987;Agras, Barlow, Chapin, Abel, & Leitenberg, 1974;Azerrad & Stafford, 1969;Bachrach, Erwin, & Mohr, 1965;Bhanji, 1975;Bhanji & Thompson, 1974;Blue, 1979;Boey, 1985;Bruch, 1974;Cinciripini, Kornblith, Turner, & Hersen, 1983;Geller, Kelly, Traxler, & Marone Jr, 1978;Hauserman & Lavin, 1977;Martin & Mclaughlin, 1975;Matthews & Peterson, 2016;Monti, Mccrady, & Barlow, 1977;Munford, 1980;Munford, Tarlow, & Gerner, 1984;Perkin & Surtees, 1976;Stumphauzer, 1969).…”

“…When assessed, the long-term effects varied greatly. Some case reports indicated that patients had maintained (Blue, 1979;Munford, 1980) or further increased (Geller et al, 1978;Matthews & Peterson, 2016;Perkin & Surtees, 1976) their weight at follow-up. Whereas, some of the long-term follow-up assessments lack positive reports: Patients were lost to follow-up assessment, and for the remaining patients, information about weight maintenance was inconclusive (Bhanji, 1975;Bhanji & Thompson, 1974), weight maintenance after discharge remained in the underweight range (Boey, 1985), or one of two patients maintained weight at 2-year follow-up, but the other patient was rehospitalized (Cinciripini et al, 1983).…”