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Dodge E, Baudinet J, Austin A, Eisler I, Le Grange D, Dimitropoulos G. Family therapy for emerging adults with anorexia nervosa: Expert opinion on evidence, practice considerations, and future directions. EUROPEAN EATING DISORDERS REVIEW 2024. [PMID: 39154324 DOI: 10.1002/erv.3129] [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: 02/07/2024] [Revised: 06/28/2024] [Accepted: 08/02/2024] [Indexed: 08/19/2024]
Abstract
Various forms of eating disorder focused family therapy (FT-ED) have been developed and evaluated for adolescents. FT-ED for adolescent anorexia nervosa (AN) focuses on empowering parents/carers with the knowledge and skills required to facilitate recovery for their child. The recent trend and increased awareness of the period between adolescence and adulthood during ages 18-25, known as 'emerging adulthood', has brought into question whether the traditional treatment approach for adults with AN, that is, individual therapies, is the most appropriate approach for this age group. This paper briefly outlines the current forms FT-ED for emerging adults with AN and examines the evidence for each. We then present considerations for tailoring FT-ED for emerging adults with AN across three broad domains: structure and set-up, process, and content. Finally, we present suggestions on how to troubleshoot common pitfalls that may be encountered, such as reluctance to include parents in treatment. Future research should examine which forms of FT-ED are best for which emerging adults and families and under what contexts. There is also a need to explore the incorporation of technology into sessions with families who live apart.
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Affiliation(s)
- Elizabeth Dodge
- Eating Disorder Outpatient Service, South London & Maudsley NHS Foundation Trust, London, UK
| | - Julian Baudinet
- Centre for Research in Eating and Weight Disorders (CREW), Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Maudsley Centre for Child and Adolescent Eating Disorders, South London and Maudsley NHS Foundation Trust, London, UK
| | - Amelia Austin
- The Mathison Centre for Mental Health Research & Education, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Ivan Eisler
- Centre for Research in Eating and Weight Disorders (CREW), Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Maudsley Centre for Child and Adolescent Eating Disorders, South London and Maudsley NHS Foundation Trust, London, UK
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago (Emeritus), Chicago, Illinois, USA
| | - Gina Dimitropoulos
- The Mathison Centre for Mental Health Research & Education, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Rienecke RD, Trotter X, Jenkins PE. A systematic review of eating disorders and family functioning. Clin Psychol Rev 2024; 112:102462. [PMID: 38941693 DOI: 10.1016/j.cpr.2024.102462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 06/19/2024] [Accepted: 06/19/2024] [Indexed: 06/30/2024]
Abstract
The purpose of the current review was to address four questions: 1) Are there differences in family functioning or family environment among patients with different eating disorder (ED) diagnoses? 2) Are there differences in the perception of family functioning or family environment among different family members? 3) Is family functioning or family environment related to ED symptomatology? 4) Does family functioning or family environment change as a result of ED treatment? and 4a) If so, does this impact ED treatment outcome? Although most studies found no differences among ED diagnostic groups, those that did generally found worse family functioning among those with binge/purge symptoms than among those with the restricting subtype of anorexia nervosa. Differences in perceptions of family functioning among family members were found, with patients generally reporting worse functioning than their parents. Worse family functioning was generally found to be related to worse ED symptoms. The variety of treatment approaches and different assessments of outcome made it somewhat unclear whether family functioning consistently improves with ED treatment. More research is needed on family functioning and EDs, particularly in understudied groups such as males, and those with ED diagnoses other than anorexia nervosa or bulimia nervosa.
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Affiliation(s)
- Renee D Rienecke
- Eating Recovery Center/Pathlight Mood & Anxiety Center, USA; Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL, USA.
| | - Xanthe Trotter
- School of Psychology and Clinical Language Sciences, University of Reading, Reading RG6 6ES, United Kingdom
| | - Paul E Jenkins
- School of Psychology and Clinical Language Sciences, University of Reading, Reading RG6 6ES, United Kingdom
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Gilsbach S, Borzikowsy C, Herpertz-Dahlmann B. Lost in between-the transition process from a child and adolescent eating disorder service to adult mental health services in the German health care system. EUROPEAN EATING DISORDERS REVIEW 2024; 32:547-556. [PMID: 38303544 DOI: 10.1002/erv.3070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 01/19/2024] [Accepted: 01/23/2024] [Indexed: 02/03/2024]
Abstract
INTRODUCTION In young adults with anorexia nervosa (AN), the process of transition from a child and adolescent mental health service (CAMHS) to an adult mental health service (AMHS) has been recognized as critical, and many patients fear falling through the gap between the two types of service. As reports about the transition process in emerging adults with AN are scarce, the present study aimed to explore the problems and experiences of this age group. METHOD We screened our registry for patients with AN who had been treated as inpatients during childhood and/or adolescence and come of age during the last 3 years. Thirty-two female patients [mean age 20.3 (1.2) y.] agreed to participate in a semistructured personal or telephone interview assessing their demographic and clinical data, whether they had finalised the transition, and their wishes and experiences regarding the transition process. RESULTS Only approximately one-third of the participants had already undergone the transition. Nearly 60% of the former patients were still cared for by a CAMHS, and only 12.5% had stopped treatment for AN. Approximately 60% were exclusively or additionally cared for by their general practitioner. More than 50% of the participants still lived with their parents. Approximately 90% of the participants who remained in a CAMHS expressed concerns about transitioning, mostly about losing their trusted therapist and the assumption of personal responsibility. CONCLUSION Patients with AN often delay the transition from a CAMHS to an AMHS, which they experience as intimidating and overwhelming. Thus, patients should be better prepared for the transition, which should be linked to "developmental readiness" and not to chronological age. Because many patients still live with their family of origin, parents and their family physician should be closely involved in the transition process.
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Affiliation(s)
- Susanne Gilsbach
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH University, Aachen, Germany
| | - Christoph Borzikowsy
- Fachhochschule für Verwaltung und Dienstleistung (FHVD), Campus Altenholz Rehmkamp, Altenholz, Germany
| | - Beate Herpertz-Dahlmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH University, Aachen, Germany
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Pedersen SH, Waage DA, Micali N, Bentz M. Families tackling adolescent anorexia nervosa: family wellbeing in family-based treatment or other interventions. A scoping review. Eat Weight Disord 2024; 29:20. [PMID: 38504003 PMCID: PMC10951015 DOI: 10.1007/s40519-024-01641-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 01/28/2024] [Indexed: 03/21/2024] Open
Abstract
PURPOSE Family-based treatment (FBT) has contributed significantly to the treatment of anorexia nervosa (AN) in young people (YP). However, parents are concerned that FBT and the active role of parents in the task of refeeding may have a negative impact on family relations. The aim of the review is to assess whether families engaged in FBT for AN are more or less impacted in their family wellbeing and caregiver burden, compared to families with a YP diagnosed with AN, who are not undergoing treatment with FBT. METHOD Computerized searches across six databases complemented by a manual search resulted in 30 papers being included in the scoping review. RESULTS The review identified 19 longitudinal studies on change in family wellbeing in families in FBT-like treatments, and 11 longitudinal studies on change in family wellbeing in treatment where parents are not in charge of refeeding. Only three randomized controlled studies directly compare FBT to treatment without parent-led refeeding. CONCLUSION The available research suggests no difference between intervention types regarding impact on family wellbeing. Approximately half of the studies find improvements in family wellbeing in both treatment with and without parent-led refeeding, while the same proportion find neither improvement nor deterioration. As parents play a pivotal role in FBT, there is a need for good quality studies to elucidate the impact of FBT on family wellbeing. Level of evidence Level V: Opinions of authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees.
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Affiliation(s)
- Signe Holm Pedersen
- Child and Adolescent Mental Health Center, Copenhagen University Hospital-Mental Health Services CPH, Copenhagen, Denmark.
| | - Dorthe Andersen Waage
- Center for Eating and Feeding Disorders Research, Mental Health Center Ballerup, Copenhagen University Hospital - Mental Health Services CPH, Denmark, Ballerup, Denmark
| | - Nadia Micali
- Center for Eating and Feeding Disorders Research, Mental Health Center Ballerup, Copenhagen University Hospital - Mental Health Services CPH, Denmark, Ballerup, Denmark
| | - Mette Bentz
- Child and Adolescent Mental Health Center, Copenhagen University Hospital-Mental Health Services CPH, Copenhagen, Denmark
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Potterton R, Richards K, Allen K, Schmidt U. Eating Disorders During Emerging Adulthood: A Systematic Scoping Review. Front Psychol 2020; 10:3062. [PMID: 32082210 PMCID: PMC7005676 DOI: 10.3389/fpsyg.2019.03062] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 12/26/2019] [Indexed: 01/20/2023] Open
Abstract
Background: Eating disorders (EDs) during the transition to adulthood can derail social, psychological, and vocational development. Effective treatment is of paramount importance, yet young adults' treatment needs are typically less well met than those of adolescents. In recent years, there has been a considerable shift in how developmental psychologists understand the transition to adulthood, with this life-phase reconceptualized as "emerging adulthood" (EA) (~18-25 years). Engagement with burgeoning developmental research is likely key to providing more effective care for young people experiencing EDs. Aims: To review ED research which has utilized the concept of EA, and to assess the usefulness of this concept for ED research and practice. Methods: A systematic scoping review was conducted in accordance with the Joanna Briggs Institute guidelines for scoping reviews. Three databases (Psychinfo, PubMed, Embase) were searched for papers which explicitly focused on EDs during EA. No restrictions as to publication type, language, study design, or participants were applied. Included studies were assessed for developmental "informedness," and findings were qualitatively synthesized. Results: Thirty-six studies (N = 25,475) were included in the review. Most studies used quantitative methodologies, were cross-sectional in design and focused on identifying psychological and social factors which contribute to etiology of EDs. Many studies (N = 22) used well-defined samples of emerging adults (EAs); few studies (N = 8) included developmental measures relevant to EAs. Findings indicate that whilst factors implicated in EDs in adolescence and adulthood are relevant to EAs, EA-specific factors (e.g., identity exploration) may also contribute. Conventional ED services and treatments present difficulties for EAs, whilst those adapted to EAs' needs are feasible, acceptable, and more effective than treatment-as-usual. Directions for future research and clinical implications are discussed. Conclusion: Existing research indicates that the EA concept is relevant for understanding EDs during the transition to adulthood, and ED services should implement adaptations which exploit the opportunities and overcome the challenges of this developmental stage. EA is currently an underused concept in ED research, and future engagement with the developmental literature by both researchers and clinicians may be key to understanding and treating EDs during transition to adulthood.
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Affiliation(s)
- Rachel Potterton
- Section of Eating Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Katie Richards
- Section of Eating Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Karina Allen
- Section of Eating Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- The Eating Disorders Service, Maudsley Hospital, South London and Maudsley NHS Foundation Trust, London, United Kingdom
- School of Psychological Science, The University of Western Australia, Crawley, WA, Australia
| | - Ulrike Schmidt
- Section of Eating Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- The Eating Disorders Service, Maudsley Hospital, South London and Maudsley NHS Foundation Trust, London, United Kingdom
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Murray SB. Updates in the treatment of eating disorders in 2019: a year in review in Eating Disorders: The Journal of Treatment & Prevention. Eat Disord 2020; 28:21-31. [PMID: 32138636 DOI: 10.1080/10640266.2020.1723373] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Empirical evidence continues to suggest that the majority of patients with eating disorders will not fully recover during treatment, and that treatment gains are vulnerable to relapse in the longer term. The urgent need for improved treatment options for those with eating disorders cannot be overstated. This review article provides an overview of treatment-related research findings published in Eating Disorders: The Journal of Treatment & Prevention during 2019. Importantly, this review encapsulates research (i) outlining guidelines in managing the medical risk inherent to the treatment of eating disorders, (ii) examining the treatment of eating disorders in cross-cultural contexts, (iii) expanding treatment research to novel and atypical eating disorder populations, and (iv) augmenting existing treatment approaches for anorexia nervosa and bulimia nervosa in novel contexts. These articles represent important contributions to the ongoing evolution of the treatment of eating disorders. However, further work is needed in precisely identifying the mechanisms of eating disorder psychopathology, such that emerging treatment efforts may be mapped onto specific targets.
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Affiliation(s)
- Stuart B Murray
- Department of Psychiatry and the Behavioral Sciences, University of Southern California, Los Angeles, California, USA
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