The value of including families in the treatment of anorexia nervosa

Abstract

The aim of this paper is to consider family and wider carer involvement in the treatment of anorexia nervosa, and how this can be used to add value to services. We discuss widely adopted interventions involving the family that have been manualised and studied in trials that have outcome measures that are of relevance to illness costs. The therapeutic targets of these interventions range from a focus on feeding to the wellbeing of the whole family. The theoretical models that underpin interventions involving the family/wider carers include both intra and interpersonal processes, with the exception of family‐based therapy, which in its original form holds an agnostic stance towards aetiology. Although formal evaluation of the cost effectiveness of these interventions is minimal, there is evidence that involving the family can reduce bed use and improve the wellbeing of both patients and family members. Moreover, for the most part, these interventions are acceptable to patients and carers. Finally, we consider how these approaches can be disseminated and scaled up more widely into services.

Coping With Adolescents Affected by Anorexia Nervosa: The Role of Parental Personality Traits

“…The first interesting aspect of this study is the investigation of parental coping strategies in adolescents with a diagnosis of AN. Adolescence is the lifetime period when usually AN starts ( Volpe et al, 2016 ); thus, it is ideal to assess the parental reactions to the illness before further psychosocial impairment occurs ( Treasure et al, 2020 ). Remarkably, family-based treatments are highly recommended in the first phase of the illness ( Lock, 2015 ), highlighting the importance of studying how parents cope with the illness of patients in adolescence.…”

“…Anorexia nervosa (AN) is a complex psychiatric illness with a severe impact on physical and social domains ( Monteleone et al, 2019 ; Treasure et al, 2020 ). Social functioning is reduced both before and after illness onset ( Cardi et al, 2018a ): people with AN describe their illness with the word “isolation” ( McKnight and Boughton, 2009 ) and show the low quality of relationships with peers before symptoms develop ( Cardi et al, 2018b ), while a wide range of alterations in social cognitive processes has been found in the acute phase of the illness ( Monteleone et al, 2018 , 2020 ) and partially after recovery ( Oldershaw et al, 2011 ).…”

“…However, the parents also experience a wide range of emotional and behavioral reactions to the onset of AN symptoms in their relative and this may have a negative impact on the illness course ( Treasure and Nazar, 2016 ). Dysfunctional parental coping strategies range from critical, hostile, and overcontrolling behaviors to accommodation to the eating disorder (ED) rules and avoidance of the illness ( Treasure et al, 2020 ). According to a recent study ( Parks et al, 2018 ), the mothers of adolescents with EDs adopt self-sufficient problem-focused strategies more than mothers of healthy adolescents and this may result in hostility and overinvolvement.…”

Value of treatment for eating disorders

“…Services in Europe are commonly divided into those that cater for children and adolescents (as described by Herpertz-Dahlman et al, 2021) and those that cater for adults (Treasure, Parker et al, 2021). However, most of the conditions now subsumed under the umbrella of eating disorder straddle this division and people can be lost in the gap between services ).…”

“…The inclusion of families and social support in treatment has been shown in both adolescent and adult settings to reduce bed use both in the initial admission and during follow up. This does not come at the expense of a greater burden for families (Treasure, Parker et al, 2021).…”