Journal Article

Understanding outcomes in family-based treatment for adolescent anorexia nervosa: a network approach

Hagan, Kelsey E., Bohon, Cara M., Lock, James D., Onipede, Z. Ayotola, Grange, Daniel Le, Datta, Nandini, Gorrell, Sasha, L'Insalata, Alexa M., Matheson, Brittany E., Mondal, Sangeeta

2023

Overview

Family-based treatment (FBT) is the first-line treatment for adolescent anorexia nervosa (AN). Yet, remission is not achieved for about half of adolescents with AN receiving FBT. Understanding patient- and parent-level factors that predict FBT response may inform treatment development and improve outcomes. Network analysis was used to identify the most central symptoms of AN in adolescents who completed the Eating Disorder Examination (EDE) prior to FBT ( = 409). Bridge pathways between adolescent AN and parental self-efficacy in facilitating their child's recovery from AN were identified in a subset of participants ( = 184). Central and bridge symptoms were tested as predictors of early response (⩾2.4 kg weight gain by the fourth session of FBT) and end-of-treatment weight restoration [⩾95% expected body weight (EBW)] and full remission (⩾95% EBW and EDE score within 1 standard deviation of norms). The most central symptoms of adolescent AN included desiring weight loss, dietary restraint, and feeling fat. These symptoms predicted early response, but not end-of-treatment outcomes. Bridge symptoms were parental beliefs about their responsibility to renourish their child, adolescent discomfort eating in front of others, and adolescent dietary restraint. Bridge symptoms predicted end-of-treatment weight restoration, but not early response nor full remission. Findings highlight the prognostic utility of core symptoms of adolescent AN. Parent beliefs about their responsibility to renourish their child may maintain associations between parental self-efficacy and AN psychopathology. These findings could inform strategies to adapt FBT and improve outcomes.

• Publisher: Cambridge University Press
• Subject: Adolescent / Adolescents / Anorexia / Anorexia Nervosa - therapy / Body image / Body weight / Body weight gain / Body weight loss / Child / Children / Clinical outcomes / Clinical trials / Comorbidity / Diet / Discomfort / Eating disorders / Families & family life / Family Therapy / Healthy food / Humans / Kinship networks / Medical prognosis / Medical treatment / Network analysis / Original Article / Parent attitudes / Parents & parenting / Psychopathology / Remission / Remission (Medicine) / Remission Induction / Self image / Self-efficacy / Symptoms / Teenagers / Treatment Outcome / Treatment outcomes / Weight Gain / Weight loss