Anorexia nervosa in adolescence. Course, treatment and family function
Abstract: This dissertation presents a study of 26 adolescent anorexia nervosa patients and their families regarding family function and treatment. Family function was studied at the start of treatment and at two-year follow-up. In a Nordic study, 49 families were studied at the start of treatment, and different sub-groups of families were examined. The 26 patients took part in a randomised controlled study of Body Awareness Therapy (BAT) which is the first published study of a treatment method focusing on distorted body image. The dissertation also presents findings from a multi-centre follow-up study of 111 adolescent anorexia nervosa patients. There is no uniform family pattern in anorexia nervosa, even though the findings show that families with an anorectic adolescent are more enmeshed than control families. Families who were centrifugal and where family members were more distanced in their relation to one another, had the greatest symptom load and can thus be expected to have the greatest difficulties in overcoming the illness. The families changed during treatment towards a more balanced family pattern and those where the patient had recovered were less enmeshed at follow-up. This implies that the therapist should strive to normalise enmeshment, whenever present. Not all patients with anorexia nervosa had a perceptual body image distortion. Those who did, improved their body image with the help of BAT. We could not find any effect of BAT on the general outcome of anorexia nervosa. The course of anorexia nervosa in adolescent patients, treated at five different units for eating disorders. treated predominantly in out-patient care was benign and 70% of the patients recovered within 2-3 years.
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