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Gkintoni E, Kourkoutas E, Vassilopoulos SP, Mousi M. Clinical Intervention Strategies and Family Dynamics in Adolescent Eating Disorders: A Scoping Review for Enhancing Early Detection and Outcomes. J Clin Med 2024; 13:4084. [PMID: 39064125 PMCID: PMC11277612 DOI: 10.3390/jcm13144084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Revised: 07/07/2024] [Accepted: 07/10/2024] [Indexed: 07/28/2024] Open
Abstract
Background: This systematic review investigated the impact of familial factors on individuals aged 10-17 who have clinical signs or symptoms of eating disorders. Simultaneously, it scrutinized the involvement of the family in therapy, as well as other forms of intervention. Methods: The PsycINFO, PubMed, and Scopus databases were used to search for research material comprehensively. After applying specific criteria, 46 articles were deemed suitable and included in the systematic review. The study comprised a cohort of 4794 adolescents who received a diagnosis of either Anorexia Nervosa (AN), Bulimia Nervosa (BN), or Binge-Eating Disorder (BED). In addition, controls were utilized for 1187 adolescents, 1563 parents, 1809 siblings, and 11 other relatives. Results: The connection between family factors and eating disorders is primarily determined by the families' level of functioning, satisfaction with the family dynamic, parents' attitudes toward their children, and the role of food within the family system. Family Therapy was the most used psychotherapeutic approach in the treatment of AN. The incidence of reports in BN closely paralleled that of Cognitive-Behavioral Therapy (CBT) models. Articles about (Enhanced) CBT were exclusively associated with BED. Conclusions: Family-based approaches are crucial in comprehending, preventing, and addressing eating disorders in adolescents. Incorporating the study of family dynamics and actively engaging families in the treatment process can significantly enhance recovery rates and decrease the occurrence of relapses.
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Affiliation(s)
- Evgenia Gkintoni
- Department of Education and Social Work, University of Patras, 26504 Patras, Greece;
| | - Elias Kourkoutas
- Department of Primary Education, Research Center for the Humanities, Social and Education Sciences, University of Crete, 74150 Rethymno, Greece;
| | | | - Maria Mousi
- Department of Psychology, University of Crete, 74150 Rethymno, Greece;
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Ellis A, Gillespie K, McCosker L, Hudson C, Diamond G, Machingura T, Branjerdporn G, Woerwag-Mehta S. Meal support intervention for eating disorders: a mixed-methods systematic review. J Eat Disord 2024; 12:47. [PMID: 38644490 PMCID: PMC11034063 DOI: 10.1186/s40337-024-01002-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 04/03/2024] [Indexed: 04/23/2024] Open
Abstract
OBJECTIVE Mealtimes are a period of heightened distress for individuals with eating disorders. Patients frequently display maladaptive coping strategies, such as hiding food and using distraction techniques to avoid eating. The aim of this systematic review is to evaluate the evidence for meal support interventions as a first-line intervention for eating disorders. METHOD Six databases were systematically searched in January 2024. Papers including patients with an eating disorder, and meal support or meal supervision, were examined. Quality appraisal was conducted. RESULTS Ten studies met inclusion criteria. Meal support was conducted individually and in group settings. Two studies examined the practical or interpersonal processes of meal support. Carers and trained clinicians implemented meal support. Individuals across the lifespan were examined. Settings included inpatient units, community clinics, and the home. Studies were heterogeneously evaluated with retrospective chart audits, pre- and post- cohort studies, semi-structured interviews, video analysis, and surveys. DISCUSSION Meal support intervention is potentially suitable and beneficial for patients of various age groups and eating disorder diagnoses. Due to the lack of consistent approaches, it is apparent there is no standardised framework and manualised approach. This highlights the need for the development of a co-designed approach, adequate training, and rigorous evaluation.
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Affiliation(s)
- Aleshia Ellis
- Gold Coast Hospital and Health Services, 1 Hospital Boulevard, Southport, QLD, 4215, Australia
| | - Kerri Gillespie
- Gold Coast Hospital and Health Services, 1 Hospital Boulevard, Southport, QLD, 4215, Australia
| | - Laura McCosker
- Gold Coast Hospital and Health Services, 1 Hospital Boulevard, Southport, QLD, 4215, Australia
| | - Carly Hudson
- Bond University, 14 University Drive, Robina, QLD, 4226, Australia
| | - Gideon Diamond
- Gold Coast Hospital and Health Services, 1 Hospital Boulevard, Southport, QLD, 4215, Australia
| | | | - Grace Branjerdporn
- Gold Coast Hospital and Health Services, 1 Hospital Boulevard, Southport, QLD, 4215, Australia.
- Bond University, 14 University Drive, Robina, QLD, 4226, Australia.
| | - Sabine Woerwag-Mehta
- Gold Coast Hospital and Health Services, 1 Hospital Boulevard, Southport, QLD, 4215, Australia.
- Bond University, 14 University Drive, Robina, QLD, 4226, Australia.
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Hagan KE, Matheson BE, Datta N, L’Insalata AM, Onipede ZA, Gorrell S, Mondal S, Bohon CM, Grange DL, Lock JD. Understanding outcomes in family-based treatment for adolescent anorexia nervosa: a network approach. Psychol Med 2023; 53:396-407. [PMID: 33952357 PMCID: PMC8820974 DOI: 10.1017/s0033291721001604] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Family-based treatment (FBT) is the first-line treatment for adolescent anorexia nervosa (AN). Yet, remission is not achieved for about half of adolescents with AN receiving FBT. Understanding patient- and parent-level factors that predict FBT response may inform treatment development and improve outcomes. METHODS Network analysis was used to identify the most central symptoms of AN in adolescents who completed the Eating Disorder Examination (EDE) prior to FBT (N = 409). Bridge pathways between adolescent AN and parental self-efficacy in facilitating their child's recovery from AN were identified in a subset of participants (n = 184). Central and bridge symptoms were tested as predictors of early response (⩾2.4 kg weight gain by the fourth session of FBT) and end-of-treatment weight restoration [⩾95% expected body weight (EBW)] and full remission (⩾95% EBW and EDE score within 1 standard deviation of norms). RESULTS The most central symptoms of adolescent AN included desiring weight loss, dietary restraint, and feeling fat. These symptoms predicted early response, but not end-of-treatment outcomes. Bridge symptoms were parental beliefs about their responsibility to renourish their child, adolescent discomfort eating in front of others, and adolescent dietary restraint. Bridge symptoms predicted end-of-treatment weight restoration, but not early response nor full remission. CONCLUSIONS Findings highlight the prognostic utility of core symptoms of adolescent AN. Parent beliefs about their responsibility to renourish their child may maintain associations between parental self-efficacy and AN psychopathology. These findings could inform strategies to adapt FBT and improve outcomes.
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Affiliation(s)
- Kelsey E. Hagan
- Stanford University School of Medicine, Division, Stanford, CA, USA
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | | | - Nandini Datta
- Stanford University School of Medicine, Division, Stanford, CA, USA
| | | | | | - Sasha Gorrell
- Department of Psychiatry and Behavioral Sciences and UCSF Weill Institute for Neurosciences, University of California, San Francisco, USA
| | - Sangeeta Mondal
- Stanford University School of Medicine, Division, Stanford, CA, USA
| | - Cara M. Bohon
- Stanford University School of Medicine, Division, Stanford, CA, USA
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences and UCSF Weill Institute for Neurosciences, University of California, San Francisco, USA
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, IL, USA
| | - James D. Lock
- Stanford University School of Medicine, Division, Stanford, CA, USA
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Giles EM, Cross AS, Matthews RV, Lacey JH. Disturbed families or families disturbed: a reconsideration. Eat Weight Disord 2022; 27:11-19. [PMID: 33721219 PMCID: PMC8860793 DOI: 10.1007/s40519-021-01160-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 01/25/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The relationship between anorexia nervosa (AN) and family disturbance has been a subject of debate since its first description. What began as a clear view of the pathologically disturbed family causing AN has become ever more complex over the decades. OBJECTIVE The aim of this review is to explore the literature to examine the changes and evolution of clinical opinion around family dysfunction and AN over the last 20 years. METHODS A narrative review of heterogeneous studies in peer-reviewed publications sourced from the major databases, including PubMed and ScienceDirect, to illuminate the topic of family distress and AN by highlighting the conflicting and complementary ways it has been studied. RESULTS This review has highlighted the complexity of the relationship between anorectic sufferers and their families. It has explored the literature about parental burden, emotions and cognitive mechanisms together with parental attitudes about weight and shape. It is clear that there is no consistent psycho-social pathology in families which has been shown to be causative. However, over the last twenty years, research has highlighted the distress and family dysfunction caused by having to look after an anoretic child with poor mentalisation skills, insecure attachment and emotion dysregulation. CONCLUSION The area has become clearer over the last 20 years; research suggests a bi-directional relationship between AN and family dysfunction, with difficult dynamics becoming entrenched within the family. This is best addressed, the consensus suggests, by specialist family therapy and carer skills interventions. Longitudinal research is needed to definitively answer the question with rigorous scientific certainty. EMB RATING Level V. LEVEL OF EVIDENCE Level I: Evidence obtained from: at least one properly designed randomized controlled trials; systematic reviews and meta-analyses; experimental studies. Level II: Evidence obtained from well-designed controlled trials without randomization. Level III: Evidence obtained from well-designed cohort or case-control analytic studies. Level IV: Evidence obtained from with multiple time series analysis such as case studies. Dramatic results in uncontrolled trials might also be regarded as this type of evidence. Level V: Opinions of respected authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees.
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Affiliation(s)
| | | | | | - J Hubert Lacey
- Schoen Clinic Newbridge, Birmingham, UK.
- St Georges, University of London, London, UK.
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5
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Young adults' use of emotional food memories to build resilience. Appetite 2017; 112:210-218. [DOI: 10.1016/j.appet.2017.01.036] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 01/20/2017] [Accepted: 01/30/2017] [Indexed: 11/22/2022]
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White HJ, Haycraft E, Madden S, Rhodes P, Miskovic-Wheatley J, Wallis A, Kohn M, Meyer C. Parental strategies used in the family meal session of family-based treatment for adolescent anorexia nervosa: Links with treatment outcomes. Int J Eat Disord 2017; 50:433-436. [PMID: 28393398 DOI: 10.1002/eat.22647] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 10/18/2016] [Accepted: 10/18/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Examine relationships between parental mealtime strategies used in the family meal session of family-based treatment (FBT) and adolescent outcomes at EOT (session 20). METHOD Eighteen families with an adolescent receiving FBT-AN participated. Parental strategies during videoed family meals were assessed using a family mealtime coding system. Change scores were calculated for both adolescent %EBW and EDE scores. RESULTS Increased use of parental direct and non-direct eating prompts during the family meal was associated with greater adolescent weight gain at EOT. Use of parental mealtime strategies was not associated with any significant change in adolescent eating psychopathology at EOT. DISCUSSION Parental verbal eating prompts during the family meal may be effective in promoting short-term weight gain. During the family meal session, parents should be encouraged to maintain a direct focus on their adolescent child's eating behaviour which may assist their child with food consumption and potential weight gain. Further research examining food-based interactions among parents and their adolescent child with AN is needed. © 2016 Wiley Periodicals, Inc.(Int J Eat Disord 2017; 50:433-436).
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Affiliation(s)
- Hannah J White
- Loughborough University Centre for Research into Eating Disorders, Loughborough University, Loughborough, UK
| | - Emma Haycraft
- Loughborough University Centre for Research into Eating Disorders, Loughborough University, Loughborough, UK
| | - Sloane Madden
- Eating Disorder Service, The Children's Hospital, Westmead, Sydney, Australia
| | - Paul Rhodes
- Eating Disorder Service, The Children's Hospital, Westmead, Sydney, Australia
| | | | - Andrew Wallis
- Eating Disorder Service, The Children's Hospital, Westmead, Sydney, Australia
| | - Michael Kohn
- Eating Disorder Service, The Children's Hospital, Westmead, Sydney, Australia
| | - Caroline Meyer
- WMG University of Warwick, Coventry, UK.,University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
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Cook-Darzens S. The role of family meals in the treatment of eating disorders: a scoping review of the literature and implications. Eat Weight Disord 2016; 21:383-393. [PMID: 26932829 DOI: 10.1007/s40519-016-0263-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 02/11/2016] [Indexed: 11/30/2022] Open
Abstract
Family meal research is a fast growing field that has significant implications for the prevention and treatment of eating disorders (ED). Using a scoping review procedure, this article overviewed major historical and clinical trends that have guided the use of family meals or lunch sessions in adolescent ED family therapy over the past 40 years, and synthesized essential findings from current therapeutic family meal research. The relevant body of literature is reported within the framework of three models of family therapy (Maudsley model, family-based treatment, multi-family therapy), with a focus on their specific use of family lunch sessions and related empirical evidence. Although promising, current evidence remains contradictory, tentative and colored by therapists' convictions, resistance and fears. Future research priorities are discussed, including the need for a more direct examination of the impact of the family meal practice on therapeutic change, as well as a better understanding of its active ingredients and of the characteristics of patients/families that may benefit most from it. This review of the literature may help clinicians and family therapists (1) adhere more reliably and confidently to ED-focused treatment protocols that include a strong family meal component, and (2) make more informed decisions regarding the inclusion or exclusion of family meals in their practice. When feasibility or acceptability issues preclude their use, alternatives to family meals are also discussed, including family meal role-plays and drawings, coaching of home-based family meals and manual/DVD-based guidance.
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Affiliation(s)
- Solange Cook-Darzens
- Department of Child and Adolescent Psychiatry, Hôpital Robert Debré, 48 Boulevard Sérurier, 75019, Paris, France. .,, 10 Grande Rue, 60460, Blaincourt, France.
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A new social-family model for eating disorders: A European multicentre project using a case–control design. Appetite 2015; 95:544-53. [DOI: 10.1016/j.appet.2015.08.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 08/07/2015] [Accepted: 08/11/2015] [Indexed: 01/05/2023]
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Abstract
PURPOSE OF REVIEW Research into the efficacy and practice of family therapy for the treatment of adolescent anorexia nervosa has been ongoing for the past 4 decades. Research results continue to highlight the effective role of family therapy for the treatment of anorexia in adolescents. This review aims to present findings and opinions from relevant articles published over the past 12 months, related to the treatment of adolescent anorexia, utilizing family therapy and multi-family therapy. RECENT FINDINGS A number of recent articles continue to explore family therapy for adolescent anorexia, with particular emphasis being placed on attempting to pinpoint those elements of the approaches that may hold significance in relation to recovery from this dangerous illness and the development of new interventions that draw on the evidence to date for a family approach to the treatment of anorexia. SUMMARY Ongoing research is needed to identify the active ingredients of family therapy for anorexia.
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Lock J, Le Grange D, Agras WS, Fitzpatrick KK, Jo B, Accurso E, Forsberg S, Anderson K, Arnow K, Stainer M. Can adaptive treatment improve outcomes in family-based therapy for adolescents with anorexia nervosa? Feasibility and treatment effects of a multi-site treatment study. Behav Res Ther 2015; 73:90-5. [PMID: 26276704 DOI: 10.1016/j.brat.2015.07.015] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 07/29/2015] [Accepted: 07/30/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Adolescents with Anorexia Nervosa (AN), treated with family-based treatment (FBT) who fail to gain 2.3 kg by the fourth week of treatment have a 40-50% lower chance of recovery than those who do. Because of the high risk of developing enduring AN, improving outcomes in this group of poor responders is essential. This study examines the feasibility and effects of a novel adaptive treatment (i.e., Intensive Parental Coaching-IPC) aimed at enhancing parental self-efficacy related to re-feeding skills in poor early responders to FBT. METHOD 45 adolescents (12-18 years of age) meeting DSM TR IV criteria for AN were randomized in an unbalanced design (10 to standard FBT; 35 to the adaptive arm). Attrition, suitability, expectancy rates, weight change, and psychopathology were compared between groups. OUTCOMES There were no differences in rates of attrition, suitability, expectancy ratings, or most clinical outcomes between randomized groups. However, the group of poor early responders that received IPC achieved full weight restoration (>95% of expected mean BMI) by EOT at similar rates as those who had responded early. CONCLUSIONS The results of this study suggest that it is feasible to use an adaptive design to study the treatment effect of IPC for those who do not gain adequate weight by session 4 of FBT. The results also suggest that using IPC for poor early responders significantly improves weight recovery rates to levels comparable to those who respond early. A sufficiently powered study is needed to confirm these promising findings.
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Affiliation(s)
- James Lock
- Department of Psychiatry and Behavioral Sciences, University School of Medicine, 401 Quarry Road, Stanford, CA 94305, USA.
| | | | - W Stewart Agras
- Department of Psychiatry and Behavioral Sciences, University School of Medicine, 401 Quarry Road, Stanford, CA 94305, USA
| | - Kathleen Kara Fitzpatrick
- Department of Psychiatry and Behavioral Sciences, University School of Medicine, 401 Quarry Road, Stanford, CA 94305, USA
| | - Booil Jo
- Department of Psychiatry and Behavioral Sciences, University School of Medicine, 401 Quarry Road, Stanford, CA 94305, USA
| | | | - Sarah Forsberg
- Department of Psychiatry and Behavioral Sciences, University School of Medicine, 401 Quarry Road, Stanford, CA 94305, USA
| | - Kristen Anderson
- Department of Psychiatry& Behavioral Neuroscience, The University of Chicago, USA
| | - Kate Arnow
- Department of Psychiatry and Behavioral Sciences, University School of Medicine, 401 Quarry Road, Stanford, CA 94305, USA
| | - Maya Stainer
- Department of Psychiatry& Behavioral Neuroscience, The University of Chicago, USA
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Madden S, Hay P, Touyz S. Systematic review of evidence for different treatment settings in anorexia nervosa. World J Psychiatry 2015; 5:147-153. [PMID: 25815264 PMCID: PMC4369544 DOI: 10.5498/wjp.v5.i1.147] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 01/28/2015] [Accepted: 02/12/2015] [Indexed: 02/05/2023] Open
Abstract
AIM: To compare outcomes in anorexia nervosa (AN) in different treatment settings: inpatient, partial hospitalization and outpatient.
METHODS: Completed and published in the English language, randomized controlled trials comparing treatment in two or more settings or comparing different lengths of inpatient stay, were identified by database searches using terms “anorexia nervosa” and “treatment” dated to July 2014. Trials were assessed for risk of bias and quality according to the Cochrane handbook by two authors (Madden S and Hay P) Data were extracted on trial quality, participant features and setting, main outcomes and attrition.
RESULTS: Five studies were identified, two comparing inpatient treatment to outpatient treatment, one study comparing different lengths of inpatient treatment, one comparing inpatient treatment to day patient treatment and one comparing day patient treatment with outpatient treatment. There was no difference in treatment outcomes between the different treatment settings and different lengths of inpatient treatment. Both outpatient treatment and day patient treatment were significantly cheaper than inpatient treatment. Brief inpatient treatment followed by evidence based outpatient care was also cheaper than prolonged inpatient care for weight normalization also followed by evidence based outpatient care.
CONCLUSION: There is preliminary support for AN treatment in less restrictive settings but more research is needed to identify the optimum treatment setting for anorexia nervosa.
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