Outcomes, Predictors and the Qualitative Experience of a Day Program and Family Based Treatment in Adolescents with Anorexia Nervosa

Abstract

Anorexia nervosa (AN) is characterised by self-induced weight loss, a fear of weight gain, and a disturbance in the perception of one’s body image. It can severely affect physical, social, and emotional development and is also one of the most serious and chronic illnesses to affect adolescents and young adults. There has been a shift from treating patients with AN in inpatient settings towards outpatient based treatments. While there is considerable evidence to support the effectiveness of adult day programs for treating individuals with eating disorders, the use of adolescent day programs is an emerging area. The first study reviewed the outcomes of day program attendance in 39 adolescents with AN and the potential predictors of treatment outcome and drop-out. The results provide support for the effectiveness of day program treatment in adolescents, in terms of improving weight, core eating disorder cognitions and behaviours, and general psychosocial functioning. Findings also suggested the relevance of pre-treatment weight and patient age in impacting on outcome, and pre-treatment weight on completion rates. In contrast to the limited research around adolescent day programs, a growing evidence base suggests that Family Based Treatment (FBT) should be the first line outpatient treatment for adolescents with AN. The second study aimed to review the impact of length of treatment on rates of cognitive change and outcomes, and predictors of outcome and drop-out in a ‘real world’ sample of 45 adolescents with AN. The study found support for the notion that completion of all three phases of FBT regardless of the number of sessions, leads to weight restoration, return of menstruation, and improvements in core eating disorder cognitions and behaviours, and general psychosocial functioning. The study also suggested a role for expected body weight and severity of eating disordered cognitions on drop-out rates. The third study aimed to investigate the effectiveness of FBT (n = 45) compared with a day program (n = 39) for adolescents with AN, given that a key deficiency in the research is that there have been no clinical trials comparing the effectiveness of FBT with day programs. The findings suggest differences between the two treatment modalities with lower drop-out rates from day program, but improved outcomes in FBT for weight, menses and core eating disorder cognitions and behaviours at completion. The final study aimed to provide a qualitative investigation into the family experience, including the sibling perspective, of having an adolescent with AN participate in both day program treatment and FBT as this has not been a focus of previous studies. The study was preliminary in nature and due to the small sample size it has been included in Appendix A. Three adolescents, their parents and siblings provided feedback regarding their experiences of participating in both treatment modalities. Their responses indicated that overall each family member considered both treatment modalities to be beneficial in unique and overlapping ways, with most reporting wanting a combination of both treatments. Overall the results from the four studies suggest that day program and FBT are effective treatments for adolescents with AN in terms of improving physical factors and eating disordered cognitions and behaviours, with a number of factors impacting on treatment outcome and drop-out. Families also found components of both treatments to be beneficial. Clinical implications of the findings and future research directions are discussed.