Recovery prospects fade when
family therapy is delayed.
Reprinted from Eating Disorders Review
November/December 2011 Volume 22, Number 6
©2011 Gürze Books
Drs. Janet Treasure and Gerald Russell recently revisited the original “Maudsley Model” of family therapy versus individual therapy for anorexia nervosa (AN). They note that family therapy was more effective in teens who had been ill for a short time. According to the authors, however, this was only part of the story (Br J Psychiatry 2011; 199:5).
The authors note that the outcome of AN is predicted by body mass index, physical risk, age and duration of illness, and that recovery from the disease becomes much less likely the longer the illness has persisted. Treatment is more likely to succeed if the illness is recognized early, before weight loss becomes more protracted and severe.
Noting that the National Institute for Health and Clinical Excellence has only partly endorsed the evidence for effectiveness of family therapy for AN, randomized controlled trials since 2004 have added new information. When Drs. Treasure and Russell did an analysis of earlier studies, they found some evidence that family therapy may be more effective than individual supportive therapy in patients with a shorter duration of illness, suggesting that unless effective treatment is given within the first 3 years of the onset of the illness, the outcome is poor.
What causes inadequately treated AN to persist? According to the authors, starvation and stress are key factors that promote persistence of the illness.