A randomized controlled trial of adjunctive family therapy and treatment as usual following inpatient treatment for anorexia nervosa adolescents

Nathalie Godart, Sylvie Berthoz, Florence Curt, Fabienne Perdereau, Zoé Rein, Jenny Wallier, Anne-Sophie Horreard, Irène Kaganski, Réjane Lucet, Frédéric Atger, Maurice Corcos, Jacques Fermanian, Bruno Falissard, Martine Flament, Ivan Eisler, Philippe Jeammet
PLoS ONE. 2012-01-04; 7(1): e28249
DOI: 10.1371/journal.pone.0028249

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1. PLoS One. 2012;7(1):e28249. doi: 10.1371/journal.pone.0028249. Epub 2012 Jan

A randomized controlled trial of adjunctive family therapy and treatment as
usual following inpatient treatment for anorexia nervosa adolescents.

Godart N(1), Berthoz S, Curt F, Perdereau F, Rein Z, Wallier J, Horreard AS,
Kaganski I, Lucet R, Atger F, Corcos M, Fermanian J, Falissard B, Flament M,
Eisler I, Jeammet P.

Author information:
(1)Department of Adolescents and Young Adults Psychiatry, Institut Mutualiste
Montsouris, Paris, France.

Research on treatments in anorexia nervosa (AN) is scarce. Although most of the
therapeutic programs used in ‘real world practice’ in AN treatment resort to
multidisciplinary approaches, they have rarely been evaluated.
OBJECTIVE: To compare two multidimensional post-hospitalization outpatients
treatment programs for adolescents with severe AN: Treatment as Usual (TAU)
versus this treatment plus family therapy (TAU+FT).
METHOD: Sixty female AN adolescents, aged 13 to 19 years, were included in a
randomized parallel controlled trial conducted from 1999 to 2002 for the
recruitment, and until 2004 for the 18 months follow-up. Allocation to one of
the two treatment groups (30 in each arm) was randomised. The TAU program
included sessions for the patient alone as well as sessions with a psychiatrist
for the patient and her parents. The TAU+FT program was identical to the usual
one but also included family therapy sessions targeting intra-familial dynamics,
but not eating disorder symptoms. The main Outcome Measure was the Morgan and
Russell outcome category (Good or Intermediate versus Poor outcome). Secondary
outcome indicators included AN symptoms or their consequences (eating symptoms,
body mass index, amenorrhea, number of hospitalizations in the course of
follow-up, social adjustment). The evaluators, but not participants, were blind
to randomization.
RESULTS: At 18 months follow-up, we found a significant group effect for the
Morgan and Russell outcome category in favor of the program with family therapy
(Intention-to-treat: TAU+FT :12/30 (40%); TAU : 5/29 (17.2%) p = 0.05; Per
Protocol analysis: respectively 12/26 (46.2%); 4/27 (14.8%), p = 0.01). Similar
group effects were observed in terms of achievement of a healthy weight (i.e.,
BMI≥10(th) percentile) and menstrual status.
CONCLUSIONS: Adding family therapy sessions, focusing on intra-familial dynamics
rather than eating symptomatology, to a multidimensional program improves
treatment effectiveness in girls with severe AN.
TRIAL REGISTRATION: Controlled-trials.com ISRCTN71142875.

DOI: 10.1371/journal.pone.0028249
PMCID: PMC3251571
PMID: 22238574 [Indexed for MEDLINE]

Conflict of interest statement: Competing Interests: The authors have declared
that no competing interests exist.

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