Family-based treatment with transition age youth with anorexia nervosa: a qualitative summary of application in clinical practice

Gina Dimitropoulos; Victoria E Freeman; Brooke Allemang; Jennifer Couturier; Gail McVey; James Lock; Daniel Le Grange

doi:10.1186/s40337-015-0037-3

Family-based treatment with transition age youth with anorexia nervosa: a qualitative summary of application in clinical practice

J Eat Disord. 2015 Feb 1;3(1):1. doi: 10.1186/s40337-015-0037-3. eCollection 2015.

Authors

Gina Dimitropoulos¹, Victoria E Freeman², Brooke Allemang³, Jennifer Couturier⁴, Gail McVey⁵, James Lock⁶, Daniel Le Grange⁷

Affiliations

¹ Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario Canada ; Eating Disorders Program, University Health Network, 200 Elizabeth Street, Toronto, ON M5G 2C4 Canada.
² Eating Disorders Program, University Health Network, 200 Elizabeth Street, Toronto, ON M5G 2C4 Canada.
³ Sickle Cell and Thalassemia Transition Clinic, The Hospital for Sick children, Toronto, ON Canada.
⁴ Child and Adolescent Psychiatry, McMaster Children's Hospital, Hamilton, Canada.
⁵ Community Health Systems Resource Group, The Hospital for Sick Children, Toronto, ON Canada ; Ontario Community Outreach Program for Eating Disorders, Toronto, ON Canada.
⁶ Department of Psychiatry and Behavioral Sciences, Stanford School of Medicine, Stanford, CA USA.
⁷ Eating Disorders Program Department of Psychiatry and Department of Pediatrics, University of California, San Francisco, CA USA.

Abstract

Background: Family based treatment (FBT) has been empirically investigated in adolescents between the ages of 12 and 19 years of age. Although parental control over eating symptoms and the weight gain process are temporary and necessary due to serious medical complications, FBT may be developmentally inappropriate when working with older adolescents. To date, there are no studies identifying how the principles of this model are used differentially across different stages of adolescence. This study aimed to identify how clinicians informed by FBT employ this model with transition age youth (TAY) (16-21) with an eating disorder.

Methods: Using content analysis, seven individual interviews and six focus groups were conducted with 34 clinicians from specialized Eating Disorder Treatment programs across Ontario, Canada.

Results: Participants consistently reported modifying FBT to increase its developmental appropriateness with TAY in the following ways: working more collaboratively with the patient, increasing individual time spent with the patient prior to the family meeting, providing greater opportunities for the individual to practice eating without parental support and introducing relapse prevention in the latter phase of the treatment.

Conclusions: In all adaptations of the model, participants in focus groups and individual interviews cited the age of the individual with the eating disorder, their level of autonomy and independence in all areas of their lives, and their pending transfer of care from paediatric to adult eating disorder programs as main factors that influenced the modification of FBT with TAY. While adaptations were made across all three phases of FBT, adherence to the model progressively declined over the course of treatment with adaptations increasing significantly in the later phases. Future research is needed to evaluate the effectiveness of an adapted version of FBT with TAY.

Keywords: Adolescents; Anorexia nervosa; Clinicians; Developmental stage; Family support; Family-based treatment; Parents; Qualitative research; Transition; Transition age youth.