Family therapy and eating disorders in young female patients: state of the art

Background and objective Eating disorders essentially affect females in their adolescence and early adulthood. Lifetime prevalence of anorexia nervosa and bulimia nervosa are respectively 0.9% and 1.5% 1. Due to the complexity of their pathogenesis, multidisciplinary approaches are required. Family Therapy is commonly recommended and implemented with adolescents with eating disorders. Nevertheless, a general agreement on the most effective approaches has not yet been reached. This article aims to review the main scientific evidence concerning family-based therapy in eating disorders, to clarify its efficacy and pertinence in improving patients' symptoms and family relationship. Methods We searched the Medline database using eating disorders, anorexia nervosa, bulimia nervosa and family therapy as general keywords. Two authors separately reviewed papers satisfying all inclusion criteria. Patients were female adolescents and young adults aged between 12 and 22 years. Studies involving adult patients older than 22 years were excluded to minimize sample heterogeneity. Moreover, we excluded case reports, commentaries, studies published before 1987 or those with unclear methodology, as well as studies with less than 20 patients. Results 18 studies respected inclusion criteria and were included in this analysis. Available evidence regarded anorexia nervosa almost exclusively; reviewed studies showed higher efficacy of familytherapy in some subgroups, i.e., younger patients and those with a short duration of illness. Evidence on bulimia nervosa is still lacking. Many controversies exist, especially on the role of family- based therapy during the early phases of treatment. Peculiar personality traits preclude its applicability and mandate for other types of intervention such as Cognitive Behaviour Therapy or Individual Supportive Therapy. Conclusions Data concerning the efficacy of family- based therapy applied to anorexia nervosa seem to be promising, but future research will need to focus on larger samples and possibly, on highquality designs. With respect to bulimia nervosa, evidence is still poor and controversial. Current data do not enable us to formalize a correct analysis. Future research should clarify any specific role of family based- therapy in treating this complex disorder.