Group family psychotherapy during relapse. Case report of a novel intervention for severe and enduring anorexia nervosa

Laura González-Macías, Alejandro Caballero-Romo, María García-Anaya

DOI: https://doi.org/10.17711/SM.0185-3325.2021.006

Abstract


Background. Anorexia nervosa is a complex and highly variable disorder. Preventing patients from becoming resistant to treatments is fundamental since an important percentage develops a severe and enduring disorder; and because relapse is highly associated with psychiatric comorbidity, poor prognosis, and serious medical consequences due to malnutrition. Contemporary treatments for anorexia nervosa support the benefits of involving the family in treatment, and although the gold standard of family psychotherapy offers an excellent option for anorexia nervosa, that intervention is aimed at early stages, and therapeutic options for later stages of the disorder are reduced and not clearly established.

Objective. Expose the therapeutic effect of the protocol for severe and enduring cases of anorexia nervosa at relapse, used at the Clinic of Eating Behavior of the National Institute of Psychiatry, Ramón de la Fuente Muñiz, whose theoretical foundation is systemic therapy.

Method. To develop this case report, we carried out an in-depth review of the clinical records, and of the clinic attendance records of the case presented here. CARE clinical case report guidelines format were used.

Results. The case shows how a young woman, diagnosed with anorexia nervosa with clinical signs of severe and enduring anorexia nervosa (SE-AN), was able to achieve symptomatic remission after her parents, but not her, were administered the protocol for SE-AN.

Discussion and conclusion. Here we present an emblematic case showing the importance of getting the parents involved in the treatment of anorexia nervosa.

Keywords


Anorexia nervosa; family psychotherapy; relapse; chronicity; maintaining factors

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References


Allan, E., Le Grange, D., Sawyer, S. M., McLean, L. A., & Hughes, E. K. (2018). Parental expressed emotion during two forms of family-based treatment for adolescent anorexia nervosa. European Eating Disorders Review, 26(1), 46-52. doi: 10.1002/erv.2564

Bruch, H. (1978). The Golden Cage, (3a. Ed.). Cambridge, Massachusetts: Harvard University Press.

Ciao, A. C., Accurso, E. C., & Wonderlich, S. A. (2016). What do we know about severe and enduring anorexia nervosa? In S., Touyz, D., Le Grange, J. H., Lacey, & P., Hay, (Eds.). Managing Severe and Enduring Anorexia Nervosa. A clinician’s guide, (1st. Ed), (p. 299). New York City: Routledge.

Dawson, L., Rhodes, P., & Touyz, S. (2014). The recovery model and anorexia nervosa. Australian & New Zealand Journal of Psychiatry, 48(11), 1009-1016. doi: 10.1177/0004867414539398

Duclos, J., Dorard, G., Cook-Darzens, S., Curt, F., Faucher, S., Berthoz, S., … Godart, N. (2018). Predictive factors for outcome in adolescents with anorexia nervosa: To what extent does parental Expressed Emotion play a role? PLoS ONE, 13(7), e0196820. doi: 10.1371/journal.pone.0196820

Eisler, I., Dare, C., Hodes, M., Russell, G., Dodge, E., & Le Grange, D. (2000). Family therapy for adolescent anorexia nervosa: The results of a controlled comparison of two family interventions. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 41(6), 727-736. doi: 10.1017/S0021963099005922

Fairburn, C. G., Cooper, Z., & Shafran, R. (2003). Cognitive behaviour therapy for eating disorders: A “transdiagnostic” theory and treatment. Behaviour Research and Therapy, 41(5), 509-528. doi: 10.1016/S0005-7967(02)00088-8

Fonagy, P., & Target, M. (1997). Attachment and reflective function: their role in self-organization. Development and Psychopathology, 9(4), 679-700. doi: 10.1017/s0954579497001399

Golan, M. (2013). The journey from opposition to recovery from eating disorders: Multidisciplinary model integrating narrative counseling and motivational interviewing in traditional approaches. Journal of Eating Disorders, 1, 19. doi: 10.1186/2050-2974-1-19

Goldner, E. (1989). Treatment refusal in anorexia nervosa. International Journal of Eating Disorders, 8(3), 297-306. doi: 10.1002/1098-108x(198905)8:3<297::aid-eat2260080305>3.0.co;2-h

Hamburg, P., Herzog, D. B., Brotman, A. W., & Stasior, J. K. (1989). The treatment resistant eating disordered patient. Psychiatric Annals, 19(9), 494-499. doi: 10.3928/0048-5713-19890901-11

Lafrance Robinson, A., Dolhanty, J., Stillar, A., Henderson, K., & Mayman, S. (2016). Emotion-focused family therapy for eating disorders across the lifespan: A pilot study of a 2-day transdiagnostic intervention for parents. Clinical Psychology & Psychotherapy, 23(1), 14-23. doi: 10.1002/cpp.1933

Le Grange, D., Hoste, R. R., Lock, J., & Bryson, S. W. (2011). Parental Expressed Emotion of Adolescents with Anorexia: Outcome in Family-Based Treatment. Internal Journal of Eating Disorders, 44(8), 731-734. doi: 10.1002/eat.20877

Lecomte, A., Zerrouk, A., Sibeoni, J., Khan, S., Revah-Levy, A., & Lachal, J. (2019). The role of food in family relationships amongst adolescents with bulimia nervosa: A qualitative study using photo-elicitation. Appetite, 141, 104305. doi: 10.1016/j.appet.2019.05.036

Liebman, R., Minuchin, S., & Baker, L. (1974). The role of the family in the treatment of anorexia nervosa. Journal of the American Academy of Child Psychiatry, 13(2), 264-274. doi: 10.1016/S0002-7138(09)61315-7

Lock, J., & Le Grange, D. (2005). Family-based treatment of eating disorders. International Journal of Eating Disorders, 37(S1), S64-S67. doi: 10.1002/eat.20122

Loeb, K. L., Lock, J., Le Grange, D, & Greif, R. (2012). Transdiagnostic Theory and Application of Family-Based Treatment for Youth with Eating Disorders. Cognitive and Behavioral Practice, 19(1), 17-30. doi: 10.1016/j.cbpra.2010.04.005

Minuchin, S., Baker, L., Rosman, B. L., Liebman, R., Milman, L., & Todd, T. C. (1975). A conceptual model of psychosomatic illness in children. Family organization and family therapy. Archives of General Psychiatry, 32(8), 1031-1038. doi: 10.1001/archpsyc.1975.01760260095008

Minuchin, S., Rosman, B. L., & Baker, L. (1978). Psychosomatic Families: Anorexia Nervosa in Context. Cambridge, Massachusetts and London, England: Harvard University Press.

Moskovich, A. A., Timko, C. A., Honeycutt, L. K., Zucker, N. L., & Merwin, R. M. (2017). Change in expressed emotion and treatment outcome in adolescent anorexia nervosa. Eating Disorders, 25(1), 80-91. doi: 10.1080/10640266.2016.1255111

National Institute for Clinical Excellence. (2004). Eating Disorders. Core interventions in the treatment and management of anorexia nervosa, bulimia nervosa, and related eating disorders. UK: National Institute for Clinical Excellence.

Onnis, L., & Di Gennaro, A. (1987). Alessitimia: una revisione critica. Medicina Psicosomatica, 32, 45-64.

Pace, C. S., Cavanna, D., Guiducci, V., & Bizzi, F. (2015). When parenting fails : alexithymia and attachment states of mind in mothers of female patients with eating disorders. Frontiers in Psychology, 6, 1145. doi: 10.3389/fpsyg.2015.01145

Peris, T. S., & Miklowitz, D. J. (2015). Parental expressed emotion and youth psychopathology: New directions for an old construct. Child Psychiatry and Human Behavior, 46(6), 863-873. doi: 10.1007/s10578-014-0526-7

Rausch Herscovici, C. (2013). Family approaches. In B., Lask & R., Bryant-Waugh (Eds.). Eating Disorders in Childhood and Adolescence, (4th. Ed.), (pp. 239-257). London: Routledge.

Rausch Herscovici, C., & Bay, L. (1990). Aspectos generales. In Anorexia nerviosa y bulimia. Amenazas a la autonomía, (1a. Ed.), (p. 198). Buenos Aires: Paidós.

Reich, G., von Boetticher, A., & Cierpka, M. (2016). Terapia familiar psicodinámica de la anorexia nerviosa. Revista de Psicopatología y Salud Mental del Niño y del Adolescente, 27, 69-75. Retrieved from https://www.fundacioorienta.com/wp-content/uploads/2019/02/Reich-G-R27.pdf

Rhodes, P. (2003). The Maudsley model of family therapy for children and adolescents with anorexia nervosa: Theory, clinical practice, and empirical support. Australian & New Zealand Journal of Family Therapy, 24(4), 191-198. doi: 10.1002/j.1467-8438.2003.tb00559.x

Robinson, P. H. (2009). Severe and enduring eating disorder (SEED): Management of Complex Presentations of Anorexia and Bulimia Nervosa. West Sussex, UK: Wiley-Blackwell.

Schmidt, U., & Treasure, J. (2006). Anorexia nervosa: Valued and visible. A cognitive-interpersonal maintenance model and its implications for research and practice. British Journal of Clinical Psychology, 45(3), 343-366. doi: 10.1348/014466505X53902

Schmidt, U., Wade, T. D., & Treasure, J. (2014). The Maudsley Model of Anorexia Nervosa Treatment for Adults (MANTRA): Development, Key Features, and Preliminary Evidence. Journal of Cognitive Psychotherapy, 28(1), 48-71. doi: 10.1891/0889-8391.28.1.48

Selvini-Palazzoli, M., Cirillo, S., Selvini, M., & Sorrentino, A. M. (1998). Ragazze anoressiche e bulimiche. La terapia familiare. Milano: Raffaello Cortina Editore.

Touyz, S., & Hay, P. (2015). Severe and enduring anorexia nervosa (SE-AN): in search of a new paradigm. Journal of Eating Disorders, 3(1), 26. doi: 10.1186/s40337-015-0065-z

Treasure, J., & Cardi, V. (2017). Anorexia Nervosa, Theory and Treatment: Where Are We 35 Years on from Hilde Bruch’s Foundation Lecture ? European Eating Disorders Review, 25(3), 139-147. doi: 10.1002/erv.2511

Treasure, J., Rhind, C., Macdonald, P., & Todd, G. (2015). Collaborative Care: The New Maudsley Model. Eating Disorders, 23(4), 366-376. doi: 10.1080/10640266.2015.1044351

Treasure, J., Stein, D., & Maguire, S. (2015). Has the time come for a staging model to map the course of eating disorders from high risk to severe enduring illness? An examination of the evidence. Early Intervention in Psychiatry, 9(3), 173-184. doi: 10.1111/eip.12170

Uehara, T., Kawashima, Y., Goto, M., Tasaki, S., & Someya, T. (2001). Psychoeducation for the families of patients with eating disorders and changes in expressed emotion: A preliminary study. Comprehensive Psychiatry, 42(2), 132-138. doi: 10.1053/comp.2001.21215