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Randomized clinical trial comparing family-based treatment with adolescent-focused individual therapy for adolescents with anorexia nervosa

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Lock, James, Le Grange, Daniel, Agras, W. Stewart, Moye, Ann, Bryson, Susan W., Jo, Booil·2010·Archives of General Psychiatry
DOI 10.1001/archgenpsychiatry.2010.128PMC PMC3038846
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Abstract

CONTEXT: Evidence-based treatment trials for adolescents with anorexia nervosa are few. OBJECTIVE: To evaluate the relative efficacy of family-based treatment (FBT) and adolescent-focused individual therapy (AFT) for adolescents with anorexia nervosa in full remission. DESIGN: Randomized controlled trial. SETTING: Stanford University and The University of Chicago (April 2005 until March 2009). PARTICIPANTS: One hundred twenty-one participants, aged 12 through 18 years, with DSM-IV diagnosis of anorexia nervosa excluding the amenorrhea requirement. Intervention Twenty-four outpatient hours of treatment over 12 months of FBT or AFT. Participants were assessed at baseline, end of treatment (EOT), and 6 months' and 12 months' follow-up posttreatment. MAIN OUTCOME MEASURES: Full remission from anorexia nervosa defined as normal weight (≥95% of expected for sex, age, and height) and mean global Eating Disorder Examination score within 1 SD of published means. Secondary outcome measures included partial remission rates (>85% of expected weight for height plus those who were in full remission) and changes in body mass index percentile and eating-related psychopathology. RESULTS: There were no differences in full remission between treatments at EOT. However, at both the 6- and 12-month follow-up, FBT was significantly superior to AFT on this measure. Family-based treatment was significantly superior for partial remission at EOT but not at follow-up. In addition, body mass index percentile at EOT was significantly superior for FBT, but this effect was not found at follow-up. Participants in FBT also had greater changes in Eating Disorder Examination score at EOT than those in AFT, but there were no differences at follow-up. CONCLUSION: Although both treatments led to considerable improvement and were similarly effective in producing full remission at EOT, FBT was more effective in facilitating full remission at both follow-up points. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00149786.

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  • FBT-M leads to weight restoration to 95% ideal and EDE scores within one SD of normative samples in 40-50% of adolescents.

    “Almost half of the adolescents who receive FBT-M (40% to 50%) restore weight to 95% of ideal for height, age, and sex, and Eating Disorder Examination (EDE) scores are reduced to within one standard deviation of normative samples (Lock et al., 2010).”

    From A Pilot Study of an Acceptance-Based Separated Family Treatment for Adolescent Anorexia Nervosa (2013) · cites this paper as Lock et al., 2010

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Research works printed but not linked: 9

  1. [1]Hoek H Review of epidemiological studies of eating disorders Int Rev Psychiatry 1993 5 61 74
  2. [13]Bulik CM Berkman N Kimberly A Anorexia nervosa: a systematic review of randomized clinical trials Int J Eat Disord 2007 40 310 320 17370290
  3. [20]Fitzpatrick K Moye A Hostee R Adolescent Focused Therapy for Adolescent Anorexia Nervosa Journal of Contemporary Psychotherapy submitted
  4. [21]Dare C Eisler I Garner DM Garfinkel P Family therapy for anorexia nervosa Handbook of Treatment for Eating Disorders 1997 307 324 Guilford Press New York
  5. [38]Couturier J Lock J Denial and minimization in adolescent anorexia nervosa Int J Eat Disord 2006 39 175 183 16485268
  6. [39]Fairburn CG Cooper I Fairburn CG Wilson GT The eating disorder examination Binge eating: Nature, Assessment, and Treatment 1993 Guilford Press New York 12th edition
  7. [52]Cohen J Statistical Power Analysis for Behavioral Science 1988 Lawrence Earlbaum Hillsdale, New Jersey Second Edition ed.
  8. [55]Fitzpatrick K Moye A Hostee R Adolescent Focused Therapy for Adolescent Anorexia Nervosa Journal of Contemporary Psychotherapy in press
  9. [64]National Institute for Clinical Excellence (N.I.C.E.) Core interventions in the treatment and management of anorexia nervosa, bulimia nervosa, and binge eating disorder 2004 British Psychological Society 23346610

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Authors
Lock, J., Le Grange, D., Agras, W. S., Moye, A., Bryson, S. W., & Jo, B.
Affiliations
Stanford Medicine (US)
ORCID
Venue
Archives of General Psychiatry
Publisher
American Medical Association (AMA)
Published
2010-10-04
Volume
67
Issue
10
Pages
1025
ISSN
0003-990X (ISSN-L)
DOI
10.1001/archgenpsychiatry.2010.128
PMC
PMC3038846
OpenAlex
W2113620539
Cited by
866
References
57
Citations by year
2026: 22 · 2025: 50 · 2024: 47 · 2023: 45 · 2022: 50 · 2021: 51 · 2020: 80 · 2019: 46 · 2018: 64 · 2017: 63 · 2016: 54 · 2015: 82 · 2014: 69 · 2013: 56 · 2012: 53
FWCI
49.42
Type
journal article
Language
en
Open access
Locations
  • Archives of General Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute of Mental Health (R01MH070621, K24MH074467, R01MH070620)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
  • Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
  • Health Sciences › Medicine › Psychiatry and Mental health › Child Nutrition and Feeding Issues
Keywords
anorexia nervosa, adolescents, family-based treatment, partial remission, body mass index, Eating Disorder Examination, eating disorder psychopathology, outpatient care, treatment efficacy
MeSH terms
Adolescent, Anorexia Nervosa, Body Weight, Family Therapy, Female, Follow-Up Studies, Humans, Male, Personality Inventory, Psychotherapy, Body Mass Index, Evidence-Based Medicine

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