FBT for bulimia in single-parent families

Despite its efficacy in studies, family-based treatment isn't for every family. For single-parent families, FBT can be "ruled out" as a treatment approach because of the time-intensive nature of treatment. Every meal, every snack, every day.

Of course, single-parent families can make it work. The other parent may be nearby and willing to help. Other caring adults can pitch in, or other family members. The parent may be able to take time off of work to care for their sick child until s/he is able to manage better on their own.

But the efficacy of FBT in single- vs. double-parent families hadn't been studied. In the International Journal of Eating Disorders, Daniel LeGrange and the team at the University of Chicago found that single-parent families were able to help their teens with bulimia nervosa as effectively as double-parent families.

Writes LeGrange in the introduction of the paper:

Given the emphasis in FBT on the involvement of the entire family in helping to reduce binge eating and purging behaviors, it could be that single-parent families demonstrate poorer outcomes than two-parent families receiving FBT. Although there is no research indicating that individuals from single-parent families have poorer outcomes in FBT for BN, there are several lines of indirect evidence to suggest that family status may relate to treatment outcomes.

First, single parent families may have less time, fewer social supports, or fewer financial resources than two-parent families. This could predispose single parents toward premature autonomy-granting or decrease their ability to provide adequate parental monitoring.

He also cites unconscious therapist bias against single parents being able to make FBT work, as well as evidence from AN treatment. Single-parent families battling AN benefit from 12 month FBT as opposed to the shorter-course 6 month treatment.

However, LeGrange et al. found:

There were no statistically significant differences between two-parent and single-parent groups on any of the treatment variables at post-treatment or 6-month follow-up...Patients in both groups showed significant reductions in eating disorder behavior and depressive symptoms as well as increases in self-esteem.

Part of the reason that FBT is just as effective in single-parent families is that in dual-parent families, responsibility isn't always shared equally between parents.

The study concluded:

Despite the reliance on parental intervention to reduce bulimic symptoms and normalize eating patterns, the results of this study suggest that FBT is an appropriate and efficacious treatment for single-parent families as well as two-parent families.

Predicting Anxiety Disorders

Anxiety disorders are some of the most common brain diseases amongst adults and teens. Walter Kaye found that an anxiety disorder is the strongest risk factor for an eating disorder. That researchers have found a better way to predict anxiety in teens is important in and of itself, but it might also be able to identify people at a much higher risk for eating disorders.

Says a summary of the research on Science Daily:

Craske and her colleagues are finding that neuroticism — the tendency to experience negative emotions such as fear, anxiety, guilt, shame, sadness or anger — is a powerful predictor of both anxiety and depression. Newly published research from the long-term study highlights a potential mechanism by which neuroticism confers risk. The researchers report that teenagers who are high in neuroticism appear to become unnecessarily anxious in ways that are out of proportion with actual circumstances.

Neuroticism is also a common trait of people with eating disorders, especially those with anorexia nervosa.

Furthermore:

"This is interpreted as neuroticism leading to enhanced anxiety under conditions associated with aversive events but in which negative events themselves are very unlikely," Craske said. "It may represent a failure to distinguish conditions that are safe from conditions in which threatening events are very likely to occur. By translation, these findings suggest that persons with high neuroticism would respond with appropriate fear to actual threatening events, but with additional unnecessary anxiety to surrounding conditions. This type of responding may explain why neuroticism contributes to the development of pervasive anxiety."

Craske and her colleagues report their findings this month in the journal Biological Psychiatry. She hopes the study will reveal the risk factors that predict anxiety, versus depression, and which risk factors are common to both anxiety and depression.

"Anxiety and depression often go hand in hand; we're trying to learn what factors place adolescents at risk for the development of anxiety and depression, what is common between anxiety and depression, and what is unique to each," Craske said.

It would be interesting to see whether this leads to any better predictions of what traits in what people predispose them to eating disorders.

Because many eating disorder prevention efforts are targeted more generally at improving self-esteem and media literacy, and important population at higher risk may be overlooked. Perhaps these teens would benefit from lessons in decreasing perfectionism and increasing resilience. No doubt it would help with anxiety. Might it also help with eating disorders?

Sobering Statistics

A recent story from the News Observer had these startling statistics to remind everyone why early treatment of eating disorders is essential:

• 20 percent of adults overcome their eating disorder, compared with an 80 percent recovery rate among adolescents.

Given that most eating disorders start in adolescence (most estimates range from 13-18 as the peak years of onset, with bulimia generally beginning at a later age than anorexia), most adults have been suffering for years, if not decades. The disease at this point has become entrenched, a part of the sufferer's life.

There are also no researched, effective treatments for adults, in part due to the chronicity, as well as the difficulties in compelling a loved one into treatment for long enough to reach a stable, healthy weight.

In the book "Hunger: An Unnatural History," a famine relief worker said that malnutrition in children is always easier to treat than in adults. Part of it is, he says, the greater resilience of young bodies. But the other part is the simple power of a mother urging her child to eat.

Other statistics from the story:

• 80 percent of eating disorders start out as diets.
• Ten million women in the U.S. have an eating disorder, according to the National Eating Disorders Association.
• 79 percent of deaths from anorexia occur in people who are over the age of 45.