In the first randomized controlled trial for adolescent bulimia nervosa to be completed in the US, researchers show that mobilizing parents to help an adolescent overcome the disorder can double the percentage of teens who were able to abstain from binge eating and purging after six months.
In the September issue of Archives of General Psychiatry, a team based at the University of Chicago Medical Center show that almost 40 percent of participants in family-based treatment had stopped binging and purging compared to only18 percent of those who received supportive psychotherapy, the standard therapy. Six-months after treatment, almost 30 percent of participants who received family-based treatment were still abstinent compared to only 10 percent of participants who received supportive psychotherapy, which focuses on issues underlying the eating disorder.
"Parents are in a unique position to help their adolescents," says study author Dr Daniel le Grange, Associate Professor of Psychiatry and Director of the Eating Disorders Program at the University of Chicago, "yet treatment typically excludes them from the process. Now we have the evidence that we need to bring them back in."
The trial, conducted at the University of Chicago, involved 80 adolescents, aged 12 to 19, with a diagnosis of bulimia nervosa (typically characterized by binge eating and purging) or a strict definition of partial bulimia nervosa.
Forty-one patients were randomly assigned to family-based treatment, and thirty-nine patients were randomly assigned to supportive psychotherapy. Patients from each group made 20 visits to the clinic over a six-month period.
In family-based treatment, parents and at times even siblings attend clinic sessions with the patient. Parents play an active follow-up role at home, encouraging their adolescents to eat as normally as possible, then monitoring them during and after meals to make sure they eat and are not tempted to purge.
"For years parents have been left out of the treatment process," Le Grange said. They often feel guilty about intervening. "But what parent would step aside and play a minimal role in treatment if their child was diagnosed with cancer" Nor should they if a child has an eating disorder. Eating disorders pose serious health hazards."
Although the family-based approach produced superior results, the research team is uncertain whether it was the family involvement or the focus on eating behavior found in family-based treatment that was responsible for the improved outcomes.
"We still have work to do on understanding and treating eating disorders," Le Grange said. "While we're happy for how well this approach has done, obviously abstinence rates between 30 to 40 percent leave considerable room for improvement."
Bulimia nervosa is a disabling eating disorder that occurs in an estimated one to two percent of adolescents. Another two to three percent of adolescents have selected bulimic symptoms that are clinically significant, but do not meet full threshold criteria. Health problems resulting from bulimia can include electrolyte disturbances, parotid gland swelling, and loss of dental enamel.
Dr. le Grange is the co-author of a book for parents who have a teen with an eating disorder titled "Help Your Teenager Beat and Eating Disorder." He has also co-authored two clinician manuals on family-based treatment for anorexia and bulimia nervosa.
This research was supported by a grant from the National Institute of Mental Health. Co-authors include Ross D. Crosby, PhD, Neuropsychiatric Research Institute and the University of North Dakota School of Medicine and Health Sciences, Fargo, ND; Paul J. Rathouz, PhD, University of Chicago, Department of Health Studies, Chicago, IL, and Bennett L. Leventhal, MD, Department of Psychiatry, University of Illinois at Chicago, Chicago, IL.
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