Randomized clinical trial comparing family-based treatment with adolescent-focused individual therapy for adolescents with anorexia nervosa

Abstract

Context: Evidence-based treatment trials for adolescents with anorexia nervosa are few.

Objective: To evaluate the relative efficacy of family-based treatment (FBT) and adolescent-focused individual therapy (AFT) for adolescents with anorexia nervosa in full remission.

Design: Randomized controlled trial.

Setting: Stanford University and The University of Chicago (April 2005 until March 2009).

Participants: One hundred twenty-one participants, aged 12 through 18 years, with DSM-IV diagnosis of anorexia nervosa excluding the amenorrhea requirement. Intervention Twenty-four outpatient hours of treatment over 12 months of FBT or AFT. Participants were assessed at baseline, end of treatment (EOT), and 6 months' and 12 months' follow-up posttreatment.

Main outcome measures: Full remission from anorexia nervosa defined as normal weight (≥95% of expected for sex, age, and height) and mean global Eating Disorder Examination score within 1 SD of published means. Secondary outcome measures included partial remission rates (>85% of expected weight for height plus those who were in full remission) and changes in body mass index percentile and eating-related psychopathology.

Results: There were no differences in full remission between treatments at EOT. However, at both the 6- and 12-month follow-up, FBT was significantly superior to AFT on this measure. Family-based treatment was significantly superior for partial remission at EOT but not at follow-up. In addition, body mass index percentile at EOT was significantly superior for FBT, but this effect was not found at follow-up. Participants in FBT also had greater changes in Eating Disorder Examination score at EOT than those in AFT, but there were no differences at follow-up.

Conclusion: Although both treatments led to considerable improvement and were similarly effective in producing full remission at EOT, FBT was more effective in facilitating full remission at both follow-up points.

Trial registration: clinicaltrials.gov Identifier: NCT00149786.

FIGURE 1

CONSORT DIAGRAM

Figure 2

Observed Partial and Full Remission Rates by Treatment Assignment (End of Treatment N=49 (AFT); N=50 (FBT); 6 Month Follow-up N=47 (AFT), N=44 (FBT); 12 Month Follow-up N=49 (AFT), N=45 (FBT))