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

Published online by Cambridge University Press:  06 May 2021

Kelsey E. Hagan Open the ORCID record for Kelsey E. Hagan [Opens in a new window] ,
Brittany E. Matheson ,
Nandini Datta ,
Alexa M. L'Insalata ,
Z. Ayotola Onipede ,
Sasha Gorrell ,
Sangeeta Mondal ,
Cara M. Bohon ,
Daniel Le Grange  and
James D. Lock
Kelsey E. Hagan*
Affiliation:
Stanford University School of Medicine, Division, Stanford, CA, USA Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
Brittany E. Matheson
Affiliation:
Stanford University School of Medicine, Division, Stanford, CA, USA
Nandini Datta
Affiliation:
Stanford University School of Medicine, Division, Stanford, CA, USA
Alexa M. L'Insalata
Affiliation:
Stanford University School of Medicine, Division, Stanford, CA, USA
Z. Ayotola Onipede
Affiliation:
Stanford University School of Medicine, Division, Stanford, CA, USA
Sasha Gorrell
Affiliation:
Department of Psychiatry and Behavioral Sciences and UCSF Weill Institute for Neurosciences, University of California, San Francisco, USA
Sangeeta Mondal
Affiliation:
Stanford University School of Medicine, Division, Stanford, CA, USA
Cara M. Bohon
Affiliation:
Stanford University School of Medicine, Division, Stanford, CA, USA
Daniel Le Grange
Affiliation:
Department of Psychiatry and Behavioral Sciences and UCSF Weill Institute for Neurosciences, University of California, San Francisco, USA Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, IL, USA
James D. Lock
Affiliation:
Stanford University School of Medicine, Division, Stanford, CA, USA
*
Author for correspondence: Kelsey E. Hagan, E-mail: kh3081@cumc.columbia.edu
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Abstract

Background

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.

Methods

Network analysis was used to identify the most central symptoms of AN in adolescents who completed the Eating Disorder Examination (EDE) prior to FBT (N = 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 (n = 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).

Results

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.

Conclusions

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.

Keywords

adolescenceanorexia nervosafamily-based treatmentnetwork analysisprognosis
Type
Original Article
Information
Psychological Medicine , Volume 53 , Issue 2 , January 2023 , pp. 396 - 407
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

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