Family therapy for those diagnosed with anorexia nervosa

Anorexia nervosa (AN) is a disorder characterised by deliberately maintained low body weight and distorted body image. Those with AN have many medical and psychological complications and the risk of dying from the disease is relatively high.

One form of intervention commonly utilised to treat patients with AN is family therapy. Although there are a number of different forms of family therapy, the current review of 13 trials indicated that the therapy most often tested in trials is family based therapy. The trials included in the review had limitations in the reporting of trial conduct and meaningful outcomes. Overall there was some evidence to suggest family therapy may be effective compared to treatment as usual. However, there is not enough evidence to determine whether family therapy is effective compared to other psychological interventions for rates of remission. There were no differences in relapse rates, symptom scores, weight measures, or the number of drop outs between those treated with family therapy versus any other comparison group. Mortality was not measured or reported sufficiently to determine whether it is reduced for those treated with family therapy compared to other interventions. There were very little data about general or family functioning.

Authors' conclusions: 

There is some evidence to suggest that family therapy may be effective compared to treatment as usual in the short term. However, this is based on few trials that included only a small number of participants, all of which had issues regarding potential bias. There is insufficient evidence to be able to determine whether family therapy offers any advantage over other types of psychological interventions, or whether one type of family therapy is more effective than another. The field would benefit from a large, well-conducted trial.

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Background: 

Anorexia Nervosa (AN) is characterised by distorted body image and deliberately maintained low body weight. The long term prognosis is often poor, with severe medical, developmental and psychosocial complications, high rates of relapse and mortality. Different variants of family therapy have been commonly used for intervention.

Objectives: 

To evaluate the efficacy of family therapy compared with standard treatment and other treatments.

Search strategy: 

The Cochrane Collaboration Depression, Anxiety and Neuroses Controlled Trials Register (CCDANCTR) was searched until August 2008; MEDLINE, PsycInfo and EMBASE and ClinicalTrials.gov were searched up to January 2008. A conference abstract book and included studies reference lists were searched. All lead authors of included studies were also contacted.

Selection criteria: 

Randomised controlled trials (RCTS) of interventions described as 'family therapy' compared to any other intervention or other types of family therapy were eligible for inclusion. 

Patients of any age or gender with a primary clinical diagnosis of anorexia nervosa (AN) were included.

Data collection and analysis: 

Two review authors selected the studies, assessed quality and extracted data. We used a random effects meta-analysis. Relative risk was used to summarise dichotomous outcomes and both the standardised mean difference and mean difference to summarise continuous measures.

Main results: 

13 trials were included, the majority investigating family based therapy, or variants. Reporting of trial conduct was generally inadequate. The full extent of the risk of bias is unclear. 

There was some evidence (from two studies, 81 participants) to suggest that family therapy may be more effective than treatment as usual on rates of remission, in the short term (RR 3.83 95% CI 1.60 to 9.13). Based on one study (30 participants) there was no significant advantage for family therapy over educational interventions (RR 9.00 95% CI 0.53, 153.79) or over other psychological interventions (RR 1.13 95% CI 0.72 to 1.76) based on four studies (N=149).

All other reported comparisons for relapse rates, cognitive distortion, weight measures and dropouts yielded non-significant results.

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