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J Eat Disord. 2017 Dec 13;5:55. doi: 10.1186/s40337-017-0184-9. eCollection 2017.

How does family functioning effect the outcome of family based treatment for adolescents with severe anorexia nervosa?

Author information

Eating Disorder Service, The Sydney Children's Hospital Network, Westmead Campus, Sydney, Australia.
School of Psychology, The University of Sydney, Sydney, Australia.
Department of Adolescent Medicine, The Sydney Children's Hospital Network, Westmead Campus, Locked Bag 4001, Westmead, NSW 2145 Australia.
Neuropsychiatric Research Institute, Fargo, ND USA.
University of North Dakota School of Medicine and Health Sciences, Fargo, ND USA.



The aim of this research was to investigate the relationship between family functioning, adolescent-parent attachment and remission, as well as changes in these variables over time for adolescents with severe anorexia nervosa treated with family based treatment (FBT). Understanding how families respond to treatment is important because the family will be the ongoing context for psychosocial development in the longer term. The relationship between family functioning and outcome is also an important variable because it is potentially modifiable during treatment and this may improve outcome.


Fifty-seven female adolescents treated with FBT in a randomised controlled trial were assessed at baseline, FBT session 20 and 12-months post FBT session 20. Data on family functioning and adolescent-parent attachment was collected from patients and their parents at each time point. A series of regression analyses were used to determine the relationship between family functioning and comorbidity at baseline, and the relationship with remission status over time. Repeat measure mixed-effects models were used to assess changes in family functioning and attachment quality over time.


Greater adolescent perceived family functioning impairment was positively related to psychiatric comorbidity at the start of treatment. Conversely, better family functioning predicted higher self-esteem and stronger attachment quality. Adolescent's reporting better general family functioning, communication and problem solving were more likely to be remitted at session 20, but not at 12-month follow-up. There was no overall improvement in family functioning for any respondent either during treatment or at follow-up, and no significant relationship between change and remission at either session 20 or follow-up.


The adolescent's perspective on family functioning at the start of treatment impacts on a positive outcome. Addressing family issues earlier in FBT may be important for some patients. Further research is needed in this area to determine how these findings could be integrated into the current FBT model.

Trial registration:

Australian Clinical Trials Register number: ACTRN012607000009415 (


Adolescents; Anorexia nervosa; Attachment; Family based treatment; Family functioning

Conflict of interest statement

Not applicable.This study was approved by the Human Research Ethics Committee of Sydney Children’s Hospital Network, Westmead Campus (2006/114). Participants gave informed written consent.Not applicable.Andrew Wallis is a faculty members of the Training Institute for Child and Adolescent Eating Disorders. Paul Rhodes and Andrew Wallis receive royalties from IP Communications. Stephen Touyz has received fees for serving as consultant to Shire Pharmaceuticals advisory board and receives royalties from Hogrefe Publications, McGraw Hill Pubs and honoraria from Biomed Central.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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