A supportive network of loved ones can mean the difference between getting stronger and prolonged suffering for people with psychological disorders, and anorexia nervosa is no exception. A growing body of evidence from Stanford University School of Medicine supports including family members in a patient’s recovery.
The most recent Stanford study, published in JAMA Psychiatry, shows that family-based therapies (FBTs) are more effective than individual therapies for treating teen anorexia patients.
Why Family-Based Therapy?
Anorexia goes much deeper than feeling dissatisfied when looking in the mirror. From starvation to over-exercising, the disorder takes a physical, emotional, and psychological toll on patients. But research indicates that family support can help a patient confront their body image issues on multiple levels.
“The family is such a critical influence on the child, but more than that, past work looking at FBT has shown it to be more effective than individual psychological therapy,” said Dr. Stewart Agras, a professor emeritus of psychiatry and behavioral sciences at Stanford and the lead author of the study.
The family shapes a child’s perspective in a number of ways, and parents can use this influence to encourage a healthy, body-positive outlook and lifestyle.
“An individual is intrinsically part of a family system. Therefore, in treating a person with anorexia, it is imperative to understand what part family members play in the disordered eating environment,” said licensed clinical social worker Maria Baratta, Ph.D., who was not involved in the study. “Once that is established, the therapist can begin to address what needs to change on the part of the family system.”
Which Treatment Type Is Better?
In the latest study, teen patients took part in one of two family-based therapies for treating anorexia. One focused on helping patients eat and gain weight at home, while the other focused on resolving difficult family dynamics.
Both forms of treatment resulted in similar weight gain in patients, but also presented some striking differences. Patients who received feeding-focused therapy experienced more rapid weight gain in the early phase of the study.
The family-dynamics therapy proved especially helpful for patients with severe symptoms of obsessive-compulsive disorder (OCD), an upside that even Agras found surprising. He thinks this could be because OCD symptoms are intertwined with broader family issues that might provoke obsessive-compulsive behaviors.
Most families preferred the feeding therapy. Cost was their chief reason — less hospital time translated into fewer hospital fees. Feeding-focused therapy cost as little as half as much as the family-dynamics therapy.
But whatever the treatment type, it’s a family’s coordinated intervention that can ultimately change a patient’s situation.
“For a long time, people blamed families for causing anorexia and thought they should be left out of treatment,” said Dr. James Lock, Ph.D., a professor of psychiatry and behavioral sciences at Stanford and a co-author of the study, in a press release. “But this study suggests that, however you involve them, families can be useful, and that more focused family treatment works faster and more cost-effectively for most patients.”
What About Patients Without Supportive Families?
While a family’s support has proven invaluable for many patients with anorexia, it is important to remember that not everyone has these resources.
“Family relationships are always complicated. Sometimes a relationship is so toxic that involving that family member in the treatment might provide an additional stressor for the patient — something that they're not in a position to handle at the time,” Baratta said.
No matter who takes part in a patient’s treatment, Agras stresses the need to identify the disorder early to foster long-term remission.
“We don’t really have any evidence-based therapy for the more chronic version of anorexia nervosa, and therefore ... it’s important to treat it in adolescence to try and have fewer chronic cases,” Agras said. As he notes, chronic anorexia can lead to death from malnutrition.
Fortunately, this study and the research it was built on offer hope for young anorexia patients. A family’s concern for their child’s well-being has an impact and is as vital to recovery as conventional medical care.