This study evaluated the impact on family relations of behavioral family systems therapy (BFST) versus ego‐oriented individual therapy (EOIT) as treatments for adolescents with anorexia nervosa. Twenty‐two adolescents meeting DSM‐III‐R anorexia nervosa criteria were randomly assigned to receive approximately 16 months of either BFST or EOIT along with a common medical and dietary regimen. BFST emphasized parental control over eating, cognitive restructuring, and problem‐solving communication training. EOIT emphasized building ego strength, adolescent autonomy, and insight. Measures included body mass index, self‐reported general and eating‐related conflict, and observed general and eating‐related communication. Both treatments produced significant reductions in negative communication and parent‐adolescent conflict, with some differences between conditions and between eating and non‐eating related conflict measures; the improvements in eating‐related conflict were maintained at a 1‐year follow‐up. The study demonstrated that structured therapies for adolescent anorexia do impact family relations, even when the family is never seen as a unit during the therapy. © 1995 by John Wiley & Sons, Inc.