Skip to main content
SpringerLink
Log in

Family therapy in the treatment of adolescent anorexia nervosa: Current research evidence and its therapeutic implications

  • Original Research Paper
  • Published:
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity Aims and scope Submit manuscript

Abstract

From the outset, the systemic and family movement has expressed an interest in eating disorders, more specifically anorexia nervosa, establishing causal links between family functioning and aetiology and advocating family therapy as the treatment of choice for this disorder. Because of high consistency between its explanatory and therapeutic dimensions, this model continues to dominate our conceptualizations and clinical practice, in spite of a lack of empirical support. This article summarizes present empirical evidence concerning both family functioning (explanatory dimension) and the effectiveness of family therapy (therapeutic dimension) in anorexia nervosa, and describes resulting changes in theoretical and clinical perspectives. A model of evidence-based family therapy is presented and several unresolved issues are raised. Overall, this overview of the literature supports the use of therapeutic models that are more flexible and normative, less guilt-inducing, more diversified (eclectic and integrative), and more rooted in the empirical literature.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Minuchin S., Rosman B.L., Baker L.: Psychosomatic families: Anorexia nervosa in context. Cambridge, Harvard University Press, 1978.

    Google Scholar 

  2. Selvini-Palazzoli M.: Self-starvation: From the intrapsychic to the transpersonal approach to anorexia nervosa. New York, Jason Aronson, 1978.

    Google Scholar 

  3. Charcot J.M.: De l’isolement dans le traitement de l’hystérie (17th lecture). Recorded by M. Gilles de la Tourette. Progrès Médical, February 28, 1885.

    Google Scholar 

  4. Jeammet P.: L’anorexie mentale. Encyclopédie Médico-Chirurgicale, 37350 A15, 1984.

    Google Scholar 

  5. Sanchez-Cardenas M., Mammar N., Venisse J.-L., Renaud M.: Isolement et/ou séparation psychique dans les prises en charge de patients anorexiques. Neuropsychiatrie de l’Enfance, 42, 564–569, 1994.

    Google Scholar 

  6. Liebman R., Sargent J., Silver M.: A family systems orientation to the treatment of anorexia nervosa. J. Am. Acad. Child Psychiatry, 22, 128–133, 1983.

    Article  CAS  PubMed  Google Scholar 

  7. Minuchin S.: Families and family therapy. Cambridge, Harvard University Press, 1974.

    Google Scholar 

  8. Eisler I.: Family models of eating disorders. In: Szmukler G., Dare C., Treasure J. (Eds), Handbook of eating disorders: Theory, treatment and research. London, Wiley, 1995, pp. 155–176.

    Google Scholar 

  9. Eisler I.: The empirical and theoretical base of family therapy and multiple family day therapy for adolescent anorexia nervosa. J. Fam. Ther., 27, 104–131, 2005.

    Article  Google Scholar 

  10. Cook-Darzens S.: Thérapie familiale de l’adolescent anorexique: Une approche systémique intégrée. Paris, Dunod, 2002.

    Google Scholar 

  11. Castro J.: Perceived rearing practices and anorexia nervosa. Clin. Psychol. Psychother., 7, 320–325, 2000.

    Article  Google Scholar 

  12. Erol A., Yazici F., Toprak G.: Family functioning of patients with an eating disorder compared with that of patients with obsessive-compulsive disorder. Comprehensive Psychiatry, 48, 47–50, 2007.

    Article  PubMed  Google Scholar 

  13. Scholz M., Rix M., Scholz K., Gantchev K., Thömke V.: Multiple family therapy for anorexia nervosa: Concepts, experiences and results. J. Fam. Ther., 27, 132–141, 2005.

    Article  Google Scholar 

  14. Cook-Darzens S., Doyen C., Falissard B., Mouren M.-C.: Self-perceived family functioning in 40 French families of anorexic adolescents: Implications for therapy. Eur. Eating Disord. Rev., 13, 223–236, 2005.

    Article  Google Scholar 

  15. Dancyger I., Fornari V., Scionti L., Wisotsky W., Sunday S.: Do daughters with eating disorders agree with their parents’ perception of family functioning? Comprehensive Psychiatry, 46, 135–139, 2005.

    Article  PubMed  Google Scholar 

  16. Emanuelli F., Ostuzzi R., Cuzzolaro M., Baggio F., Lask B., Waller G.: Family functioning in adolescent anorexia nervosa: A comparison of family members’ perceptions. EatingWeight Disord., 9, 1–6, 2004.

    CAS  Google Scholar 

  17. Wallin U.: Eating disorder and the family — a review. Tidsskrift for den Norske Laegeforening, 124, 2251–2253, 2004.

    PubMed  Google Scholar 

  18. Røijen S.: Anorexia nervosa families — a homogeneous group? A case record study. Acta Psychiatr. Scand., 85, 196–200, 1992.

    Article  PubMed  Google Scholar 

  19. Schmidt U., Treasure J.: Anorexia nervosa: Valued and visible. A cognitive-interpersonal maintenance model and its implications for research and practice. Br. J. Clin. Psychol., 45, 343–366, 2006.

    Article  PubMed  Google Scholar 

  20. Dare C.: The family therapy of anorexia nervosa. J. Psychiatr. Res., 19, 435–443, 1985.

    Article  CAS  PubMed  Google Scholar 

  21. Eisler I., Dare C., Russell G.F., Szmukler G., Le Grange D., Dodge E.: Family and individual therapy in anorexia nervosa. Arch. Gen. Psychiatry, 54, 1025–1030, 1997.

    Article  CAS  PubMed  Google Scholar 

  22. Robin A., Siegel P., Koepke T., Moye A., Tice S.: Family therapy vs individual therapy for adolescent females with anorexia nervosa. J. Dev. Behav. Pediatr., 15, 111–116, 1994.

    Article  CAS  PubMed  Google Scholar 

  23. Robin A., Siegel P., Moye A., Gilroy M., Dennis A., Sikand A.: A controlled comparison of family versus individual therapy for adolescents with anorexia nervosa. J. Am. Acad. Child Adolesc. Psychiatry, 38, 1482–1489, 1999.

    Article  CAS  PubMed  Google Scholar 

  24. Lock J., Le Grange D., Forsberg S., Hewell K.: Is family therapy useful for treating children with anorexia nervosa? Results of a case series. J. Am. Acad. Child Adolesc. Psychiatry, 45, 1323–1328, 2006.

    Article  PubMed  Google Scholar 

  25. Eisler I., Simic M., Russell G., Dare C.: A randomised controlled treatment trial of two forms of family therapy in adolescent anorexia nervosa: A five-year followup. J. Child Psychol. Psychiatry, 48, 552–560, 2007.

    Article  PubMed  Google Scholar 

  26. Butzlaff R., Hooley J.: Expressed emotion and psychiatric relapse. Arch. Gen. Psychiatry, 55, 547–552, 2007.

    Article  Google Scholar 

  27. Cook-Darzens S., Doyen C.: Thérapie multifamiliale de l’adolescent anorexique: Une expérience ambulatoire. In: Cook-Darzens S. (Ed.), Thérapies multifamiliales: Des groupes comme agents thérapeutiques. Ramonville Saint-Agne, Erès, 2007, pp. 153–178.

    Google Scholar 

  28. Geist R., Heinmaa M., Stephens D., Davis R., Katzman D.: Comparison of family therapy and family group psychoeducation in adolescents with anorexia nervosa. Can. J. Psychiatry, 45, 173–178, 2000.

    CAS  PubMed  Google Scholar 

  29. Gowers S, Norton K., Halek C., Crisp A.: Outcome of outpatient psychotherapy in a random allocation treatment study of anorexia nervosa. Int. J. Eating Disord., 15, 165–177, 1994.

    Article  CAS  Google Scholar 

  30. Gowers S., Weetman J., Shore A., Hossain F., Elvins R.: The impact of hospitalisation on the outcome of adolescent anorexia nervosa. Br. J. Psychiatry, 176, 138–141, 2000.

    Article  CAS  PubMed  Google Scholar 

  31. NICE (National Institute of Clinical Excellence): Eating disorders: Core interventions in the treatment and management of anorexia nervosa, bulimia nervosa and related eating disorders. London, National Institute of Clinical Excellence, 2004.

    Google Scholar 

  32. APA (American Psychiatric Association): Practice guideline for the treatment of patients with eating disorders (revised). J. Am. Psychiatr. Assoc., 157, 1–39, 2004.

    Google Scholar 

  33. Lock J., Le Grange D., Agras W., Dare C.: Treatment manual for anorexia nervosa: A family-based approach. New York, Guilford Press, 2001.

    Google Scholar 

  34. Gammer C.: La voix de l’enfant dans la thérapie familiale. Ramonville Saint-Agne, Erès, 2005.

    Google Scholar 

  35. McDaniel S., Campbell T., Hepworth J., Lorenz A.: Family-oriented primary care (2nd ed.). New York, Springer, 2005.

    Google Scholar 

  36. Rolland J.: Families, illness, and disability: An integrative treatment model. New York, Basic Books, 1994.

    Google Scholar 

  37. Walsh F.: Strengthening family resilience. New York, Guilford Press, 1998.

    Google Scholar 

  38. Rolland J.: Mastering family challenges in serious illness and disability. In: Walsh F. (Ed.), Normal family processes. New York, Guilford Press, 1993.

    Google Scholar 

  39. Sanchez-Cardenas M., Mammar N., Vénisse J.-L., Robin D.: Complications of bereavement as seen in infant anorexia and adolescent anorexia nervosa. Int. J. Eating Disord., 17, 39–44, 1995.

    Article  CAS  Google Scholar 

  40. Vanderlinden J., Vandereycken W.: Traumatismes et troubles du comportement alimentaire. Guide diagnostique et thérapeutique. Bruxelles, Satas, 2000.

  41. Onnis L., Giannuzzi M., Romano C.: Un vide à combler: Anorexie et boulimie dans une perspective transgénérationnelle. Cahiers Critiques de Thérapie Familiale et de Pratiques des Réseaux, 38, 135–157, 2007.

    Article  Google Scholar 

  42. Cook-Darzens S.: A “joint family consultation” approach to the initial treatment of early onset anorexia nervosa in a French pediatric hospital. J. Fam. Psychother., 12, 55–77, 2001.

    Article  Google Scholar 

  43. Siméon M., Malvaux P.: Maigrir … sans m’aigrir. Thérapie Familiale, 11, 103–116, 1990.

    Google Scholar 

  44. Godding V., Kruth M., Jamart J.: Joint consultation for high-risk asthmatic children and their families, with pediatrician and child psychiatrists as co-therapists: Model and evaluation. Family Process, 36, 265–280, 1997.

    Article  CAS  PubMed  Google Scholar 

  45. Vandereycken W., Vanderlinden J.: A family-oriented strategy in outpatient treatment. In: Vandereycken W., Kog E., Vanderlinden J. (Eds), The family approach to eating disorders: Assessment and treatment of anorexia nervosa and bulimia. New York, PMA Publishing Corp., 1989, pp. 227–261.

    Google Scholar 

  46. Zeeck A., Hartmann A.: Relating therapeutic process to outcome: Are there predictors for the short-term course in anorexic patients? Eur. Eating Disord. Rev., 13, 245–254, 2005.

    Article  Google Scholar 

  47. Danziger Y., Carel C., Tyano S., Mimouni M.: Is psychotherapy mandatory during the acute refeeding period in the treatment of anorexia nervosa? J. Adolesc. Health Care, 10, 328–331, 1989.

    Article  CAS  PubMed  Google Scholar 

  48. Godart N., Perdereau F., Galès O., Agman G., Deborde A.-S., Jeammet P.: Le contrat de poids lors d’une hospitalisation pour anorexie mentale. Archives de Pédiatrie, 12, 1544–1550, 2005.

    Article  CAS  PubMed  Google Scholar 

  49. Dare C., Eisler I.: Family therapy. In: Szmukler G., Dare C., Treasure J. (Eds), Handbook of eating disorders: Theory, treatment and research. London, Wiley, 1995, pp. 333–349.

    Google Scholar 

  50. Honig P.: Family approaches: Evidence-based and collaborative practice. In: Lask B., Bryant-Waugh R. (Eds), Eating Disorders in childhood and adolescence (3rd ed.). London, Routledge, 2007, pp. 215–228.

    Google Scholar 

  51. Le Grange D., Binford R., Loeb K.: Manualized familybased treatment for anorexia nervosa: A case series. J. Am. Acad. Child Adolesc. Psychiatry, 44, 41–46, 2005.

    Article  PubMed  Google Scholar 

  52. Robinson P.: Day treatments. In: Treasure J., Schmidt U., van Furth E. (Eds), Handbook of eating disorders (2nd ed.). London, Wiley, 2003, pp. 333–347.

    Google Scholar 

  53. Dare C., Eisler I.: A multi-family group treatment programme for adolescent eating disorder. Eur. Eating Disord. Rev., 8, 4–18, 2000.

    Article  Google Scholar 

  54. Lock J., Agras W.S., Bryson S., Kraemer H.: A comparison of short- and long-term family therapy for adolescent anorexia nervosa. J. Am. Acad. Child Adolesc. Psychiatry, 44, 632–639, 2005.

    Article  PubMed  Google Scholar 

  55. Lock J., Couturier J., Agras W.S.: Comparison of longterm outcomes in adolescents with anorexia nervosa treated with family therapy. J. Am. Acad. Child Adolesc. Psychiatry, 45, 666–672, 2006.

    Article  PubMed  Google Scholar 

  56. Le Grange D., Gelman T.: The patient’s perspective of treatment in eating disorders: A preliminary study. South African J. Psychol., 28, 182–186, 1998.

    Article  Google Scholar 

  57. Krautter T., Lock J.: Is manualized family-based treatment for adolescent anorexia nervosa acceptable to patients? Patient satisfaction at the end of treatment. J. Fam. Ther., 26, 66–82, 2004.

    Article  Google Scholar 

  58. Halvorsen I., Heyerdahl S.: Treatment perception in adolescent onset anorexia nervosa: Retrospective views of patients and parents. Int. J. Eating Disord., 40, 629–639, 2007.

    Article  Google Scholar 

  59. Paulson-Karlsson G., Nevonen L., Engström I.: Anorexia nervosa: Treatment satisfaction. J. Fam. Ther., 28, 293–306, 2006.

    Article  Google Scholar 

  60. Selvini M., Selvini-Palazzoli M., Allegra G., Babando R., Basile P., et al.: Comment se portent les anorexiques traitées par Mara Selvini-Palazzoli et ses équipes entre 1971 et 1987: Une étude quantitative sur les résultats de la thérapie familiale. Thérapie Familiale, 24, 381–402, 2003.

    Article  Google Scholar 

  61. Lim C.: A pilot study of families’ experiences of a multifamily group day treatment program. Unpublished Masters’ Thesis. University of London, 2000.

    Google Scholar 

  62. Rhodes P., Madden S.: Scientist-practitioner family therapists, postmodern medical practitioners and expert parents: Second-order change in the Eating Disorders Program at the Children’s Hospital at Westmead. J. Fam. Ther., 27, 171–182, 2005.

    Article  Google Scholar 

  63. Cook-Darzens S.: Nouvelles tendances dans l’approche familiale de l’anorexie mentale de l’enfant et de l’adolescent. Générations, 29, 51–57, 2003.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Child and Adolescent Psychiatry, Hôpital Robert Debré, Service de Pédopsychiatrie, 48 Boulevard Sérurier, 75019, Paris, France

    S. Cook-Darzens Ph.D, C. Doyen & M. -C. Mouren

Authors
  1. S. Cook-Darzens Ph.D
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. C. Doyen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. -C. Mouren
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to S. Cook-Darzens Ph.D.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Cook-Darzens, S., Doyen, C. & Mouren, M.C. Family therapy in the treatment of adolescent anorexia nervosa: Current research evidence and its therapeutic implications. Eat Weight Disord 13, 157–170 (2008). https://doi.org/10.1007/BF03327502

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF03327502

Key words

Search

Navigation