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Background and aims: Internet addiction (IA) has been identified as a major public health problem that is more prominent in adolescents and young adults. Some researchers have indicated certain advantages of family-based therapy over other treatments in participants with IA, but no conclusive evaluation has been reported. The present meta-analysis aims to review the efficacy of family-based therapy on Internet addiction in adolescents and young adults. Methods: Relevant articles published from 1996 to February 15th, 2024, were searched from 14 databases, including three Chinese databases. A total of 19,590 articles were identified using a combination of three sets of search terms (Internet addiction, family therapy, and adolescents). Only RCTs and nonrandomized controlled trials were included. Results: 18 studies, most of which were conducted in Asian countries, were included in the final data analysis. The overall severity of Internet addiction in the family-based therapy group was significantly lower than that in the control group. However, significant heterogeneity was detected. Subgroup analysis showed a beneficial effect of family-based therapy when compared with non-intervention and when added to another psychological or behavioural therapy in psychiatric patients with co-medication. Few studies have examined secondary outcomes or follow-up effects. Discussion and Conclusions: Family-based therapy is most effective in reducing the severity of Internet addiction when combined with other therapies, especially medication treatments in psychiatric patients. It might also be helpful to relieve depression and enhance family functions, which needs further evidence. More studies following up on the post-intervention effects are recommended in the future.

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Binge eating disorder (BED) is a behavioral disorder characterized by chronic and compulsive overeating. It is the most prevalent eating disorder in the USA, affecting almost 3% of the US population. In this study, we describe a case of BED in an adolescent Caucasian female who could not obtain specialized treatment because of financial constraints and saw a child and adolescent psychiatrist for medication management. Her treatment plan combined bupropion with family therapy and resulted in successful alleviation of her symptoms, allowing her to achieve a better quality of life. This case shows how pragmatism by PCPs can help manage patients who cannot obtain specialized care for their BED.

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Anorexia Nervosa is the most deadly mental illness due to the high mortality and relapse rates after reaching remission. The systematic review investigated the effectiveness of two empirically validated interventions (Family-Based Therapy [FBT] and Adolescent-Focused Therapy [AFT]) for an adolescent or young adult living with Anorexia Nervosa to reach partial or full remission and expected weight ratios. Twelve studies published between 1994 and 2015 were evaluated and indicated that FBT resulted in significant weight gain and higher partial and full remission rates than AFT, demonstrating its superiority in treating AN in adolescents and young adult samples, in one instance, at least up to 4 years. Despite FBT and AFT delivery, a significant proportion of participants did not achieve their target weight or full remission, indicating that both treatments may not be effective in all circumstances.

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Eating disorders (EDs) are known to be associated with high mortality and often chronic and severe course, but a recent comprehensive systematic review of their outcomes is currently missing. In the present systematic review and meta-analysis, we examined cohort studies and clinical trials published between 1980 and 2021 that reported, for DSM/ICD-defined EDs, overall ED outcomes (i.e., recovery, improvement and relapse, all-cause and ED-related hospitalization, and chronicity); the same outcomes related to purging, binge eating and body weight status; as well as mortality. We included 415 studies (N=88,372, mean age: 25.7±6.9 years, females: 72.4%, mean follow-up: 38.3±76.5 months), conducted in persons with anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), other specified feeding and eating disorders (OSFED), and/or mixed EDs, from all continents except Africa. In all EDs pooled together, overall recovery occurred in 46% of patients (95% CI: 44-49, n=283, mean follow-up: 44.9±62.8 months, no significant ED-group difference). The recovery rate was 42% at <2 years, 43% at 2 to <4 years, 54% at 4 to <6 years, 59% at 6 to <8 years, 64% at 8 to <10 years, and 67% at ≥10 years. Overall chronicity occurred in 25% of patients (95% CI: 23-29, n=170, mean follow-up: 59.3±71.2 months, no significant ED-group difference). The chronicity rate was 33% at <2 years, 40% at 2 to <4 years, 23% at 4 to <6 years, 25% at 6 to <8 years, 12% at 8 to <10 years, and 18% at ≥10 years. Mortality occurred in 0.4% of patients (95% CI: 0.2-0.7, n=214, mean follow-up: 72.2±117.7 months, no significant ED-group difference). Considering observational studies, the mortality rate was 5.2 deaths/1,000 person-years (95% CI: 4.4-6.1, n=167, mean follow-up: 88.7±120.5 months; significant difference among EDs: p<0.01, range: from 8.2 for mixed ED to 3.4 for BN). Hospitalization occurred in 26% of patients (95% CI: 18-36, n=18, mean follow-up: 43.2±41.6 months; significant difference among EDs: p<0.001, range: from 32% for AN to 4% for BN). Regarding diagnostic migration, 8% of patients with AN migrated to BN and 16% to OSFED; 2% of patients with BN migrated to AN, 5% to BED, and 19% to OSFED; 9% of patients with BED migrated to BN and 19% to OSFED; 7% of patients with OSFED migrated to AN and 10% to BN. Children/adolescents had more favorable outcomes across and within EDs than adults. Self-injurious behaviors were associated with lower recovery rates in pooled EDs. A higher socio-demographic index moderated lower recovery and higher chronicity in AN across countries. Specific treatments associated with higher recovery rates were family-based therapy, cognitive-behavioral therapy (CBT), psychodynamic therapy, and nutritional interventions for AN; self-help, CBT, dialectical behavioral therapy (DBT), psychodynamic therapy, nutritional and pharmacological treatments for BN; CBT, nutritional and pharmacological interventions, and DBT for BED; and CBT and psychodynamic therapy for OSFED. In AN, pharmacological treatment was associated with lower recovery, and waiting list with higher mortality. These results should inform future research, clinical practice and health service organization for persons with EDs.

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BACKGROUND: Psychotherapy is considered central to the effective treatment of eating disorders-focusing on behavioural, psychological, and social factors that contribute to the illness. Research indicates psychotherapeutic interventions out-perform placebo, waitlist, and/or other treatments; but, outcomes vary with room for major improvement. Thus, this review aims to (1) establish and consolidate knowledge on efficacious eating disorder psychotherapies; (2) highlight select emerging psychotherapeutic interventions; and (3) identify knowledge gaps to better inform future treatment research and development. METHODS: The current review forms part of a series of Rapid Reviews published in a special issue in the Journal of Eating Disorders to inform the development of the Australian-government-funded National Eating Disorder Research and Translation Strategy 2021-2031. Three databases were searched for studies published between 2009 and 2023, published in English, and comprising high-level evidence studies (meta-analyses, systematic reviews, moderately sized randomised controlled studies, moderately sized controlled-cohort studies, and population studies). Data pertaining to psychotherapies for eating disorders were synthesised and outlined in the current paper. RESULTS: 281 studies met inclusion criteria. Behavioural therapies were most commonly studied, with cognitive-behavioural and family-based therapies being the most researched; and thus, having the largest evidence-base for treating anorexia nervosa, bulimia nervosa, and binge eating disorder. Other therapies, such as interpersonal and dialectical behaviour therapies also demonstrated positive treatment outcomes. Emerging evidence supports specific use of Acceptance and Commitment; Integrative Cognitive Affective; Exposure; Mindfulness; and Emotionally-Focused therapies; however further research is needed to determine their efficacy. Similarly, growing support for self-help, group, and computer/internet-based therapeutic modalities was noted. Psychotherapies for avoidant/restrictive food intake disorder; other, and unspecified feeding and eating disorders were lacking evidence. CONCLUSIONS: Currently, clinical practice is largely supported by research indicating that behavioural and cognitive-behavioural psychotherapies are most effective for the treatment of eating disorders. However, the efficacy of psychotherapeutic interventions varies across studies, highlighting the need for investment and expansion of research into enhanced variants and novel psychotherapies to improve illness outcomes. There is also a pressing need for investigation into the whole range of eating disorder presentations and populations, to determine the most effective interventions.

Evaluating the efficacy of treatment options for eating disorders (EDs) is important and necessary to inform both treatment guidelines and clinical practice. However, treatment outcomes in studies, and in clinical practice, can vary widely. Therefore, this review aimed to pool evidence related to a wide range of psychological treatments to help better understand what gaps in treatment need to be addressed. Using a rapid review method, three academic databases were searched, and 281 articles were identified and analysed. Results indicated that cognitive-behavioural approaches had the most evidence for well-defined EDs (such as anorexia nervosa, bulimia nervosa, and binge eating disorder). However, little research was found on other types of EDs. There was emerging evidence that provided support for self-help, group, and computer/internet-based therapies. Overall, the findings highlighted that more research is required on novel eating disorder treatments beyond what is currently available and being used as 'gold standard'.

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Early-onset depression contributes significantly to the global health burden and has long-term negative effects. This meta-analysis collates and examines the effectiveness of family-based interventions, where family members are involved in the treatment of depression in children and adolescents. A literature search was performed up to 8th March 2023. Randomised controlled trials of family-based interventions were included for participants aged 3-18 years with a diagnosis of major depressive disorder or dysthymia, according to the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association, 2013) or with a score above a cut-off on a standardised self-report depression measure. The overall effect size for treatment versus active control was g = 0.22 (95% confidence interval [CI]: -0.05-0.50) (nine studies; 659 participants), and for treatment versus non-active control it was g = 0.46 (95% CI: -0.09-1.01) (four studies; 385 participants). Effect sizes were not statistically significant, and heterogeneity was high, ranging between I2 = 64.3-81.1%. Subgroup analysis comparing attachment-based family therapy with family therapy using other theoretical frameworks did not yield a significant difference between the two. The effects of family-based therapies were larger than those in the comparison groups, but family-based therapy did not demonstrate a significant treatment benefit compared to the controls. More randomised controlled trials are warranted, considering that evidence for other psychotherapies for depression in children and adolescents, indicates modest effects. Family-based therapy may be an alternative for children and adolescents whose needs are not addressed by these treatments.

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Introduction: Childhood obesity is a chronic disease that requires multidisciplinary and specialist intervention to address its complex pathophysiology, though access to treatment is limited globally. Evaluating the impact of evidence-based interventions implemented in real-world clinical settings is essential, in order to increase the translation of research into practice and enhance child health outcomes. In Ireland, the National Model of Care for Obesity highlighted the need to develop and improve healthcare services for children and adolescents with obesity. Aims: This study aims to evaluate the impact of a family-based, Tier 3 multi-disciplinary child and adolescent obesity outpatient service (www.w82go.ie) on standardized body mass index (BMI-SDS). Methods: Following referral by pediatricians, patients were assessed by a pediatric multidisciplinary team (physiotherapist, dietician, and psychologist) and personalized obesity treatment plans were developed. Anthropometric and demographic information were recorded at baseline and final visit. Descriptive statistics were used to explore distribution, central tendency and variation in the demographic data, change in BMI-SDS over time was assessed using a t-test, and multiple linear regression analysis was used to investigate the association of demographic factors on the change in BMI-SDS. Results: The overall mean BMI-SDS reduction across the whole cohort (n = 692) was -0.17 (95% CI = -0.20, -0.13; P < 0.001). Younger age at admission and longer duration of treatment were associated with greater BMI-SDS reduction but there was no significant association between change in BMI-SDS and any of the other parameters (deprivation score, treatment type, sex, obesity category at admission or presence of comorbid condition). Conclusion: Engagement in a specialist Tier 3 pediatric obesity service was associated with reductions in BMI-SDS in children and adolescents with obesity.

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Outdoor therapy and family-based therapy are suggested to be promising interventions for the treatment of mental health problems. The aim of the present scoping review was to systematically map the concept, content, and outcome of combining family- and outdoor-based therapy for children and adolescents with mental health problems. The Joanna Briggs Institute methodology and PRISMA guidelines were applied. Eligible qualitative and quantitative studies were screened, included, and extracted for data. Seven studies were included. Findings from these studies indicated that family-based outdoor therapy programs have a positive impact on family- and peer relationships, adolescent behavior, mental health, self-perceptions (self-concept), school success, social engagement, and delinquency rates. However, participant characteristics, study design, and content and mode of delivery of the interventions varied substantially, hence preventing detailed comparison of outcomes across studies. In addition, most of the studies included few participants and lacked population diversity and comparable control groups. Although important ethical concerns were raised, such as non-voluntary participation in some of the programs, there was a lack of reporting on safety. This review indicates that a combination of family- and outdoor-based therapy may benefit mental health among children and adolescents, but due to the limited number of studies eligible for inclusion and high levels of heterogeneity, it was difficult to draw firm conclusions. Thus, future theory-based studies using robust designs are warranted.

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Family-based interventions are widely recommended as a first line treatment for children and young people with Anorexia Nervosa. There is clear evidence that model-adherent delivery of specific eating disorder focused family interventions has the potential to help adolescents with Anorexia Nervosa, who have typically engaged in extreme dietary restriction and lost a significant amount of weight over a relatively short period of time. Nevertheless, there remains a significant number of young people with restrictive eating disorders for whom family-based interventions for Anorexia Nervosa prove less effective, suggesting adaptations may be indicated for some. In this paper we provide a rationale and structure for considering a number of possible adaptations to the delivery of family-based therapy for anorexia nervosa specifically intended to enhance its relevance and potential effectiveness for children and adolescents on the autism spectrum; a subgroup known to represent a significant minority in eating disorder populations who have been identified as having relatively poor outcomes. Past research has shown that certain family-based treatments are effective for many children and adolescents who develop Anorexia Nervosa. At the same time this type of treatment approach in its current form does not work for everyone. Recent research has highlighted the overlap between anorexia and autism and the need for the development of adaptations to existing treatments to better meet the requirements of people on the autism spectrum who develop anorexia. With this in mind we propose a number of autism-related adaptations that could be made to family-based treatments for anorexia. We hope that these might be formally tested in the future to see if these adaptations improve outcomes for this group of individuals.

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This article provides an overview of the nutrition requirements for athletes, and gives insight into why this is often an area of confusion for both the athletic community and the general population. In addition, the prevalence of eating disorders and disordered eating in athletes is reviewed, and how and why they may go unnoticed. In addition, a discussion is provided on the harmful effects of unhealthy food behaviors on health and performance, and how to assess and establish a care team for an athlete who is struggling.

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Eating disorders (ED) are serious psychiatric illnesses with one of the highest mortality rate of any psychiatric disorder. The health sequelae of eating disorders are one of the most common causes of medical hospitalizations at freestanding pediatric hospitals in the United States. The economic impact of EDs on health systems and families is substantial. The Society for Adolescent Medicine (SAHM) recommends family-based treatment (FBT) as the first-line approach for adolescents with restrictive eating disorders due to a large body of evidence demonstrating the treatment's efficacy and cost effectiveness. Although FBT was originally developed as an outpatient treatment, the tenets and principles of the treatment have also been used in higher levels of care. This brief report discusses how components of FBT were adapted for a medical inpatient unit at a pediatric hospital in order to integrate empirically based treatment.

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INTRODUCTION: Fidelity is an essential component for evaluating the clinical and implementation outcomes related to delivery of evidence-based practices (EBPs). Effective measurement of fidelity requires clinical buy-in, and as such, requires a process that is not burdensome for clinicians and managers. As part of a larger implementation study, we examined fidelity to Family-Based Treatment (FBT) measured by several different raters including an expert, a peer, therapists themselves, and parents, with a goal of determining a pragmatic, reliable and efficient method to capture treatment fidelity to FBT. METHODS: Each therapist audio-recorded at least one FBT case and submitted recordings from session 1, 2, and 3 from phase 1, plus one additional session from phase 1, two sessions from phase 2, and one session from phase 3. These submitted files were rated by an expert and a peer rater using a validated FBT fidelity measure. As well, therapists and parents rated fidelity immediately following each session and submitted ratings to the research team. Inter-observer reliability was calculated for each item using the intraclass correlation coefficient (ICC), comparing the expert ratings to ratings from each of the other raters (parents, therapists, and peer). Mean scale scores were compared using repeated measures ANOVA. RESULTS: Intraclass correlation coefficients revealed that agreement was the best between expert and peer, with excellent, good, or fair agreement in 7 of 13 items from session 1, 2 and 3. There were only four such values when comparing expert to parent agreement, and two such values comparing expert to therapist ratings. The rest of the ICC values indicated poor agreement. Scale level analysis indicated that expert fidelity ratings for phase 1 treatment sessions scores were significantly higher than the peer ratings and, that parent fidelity ratings tended to be significantly higher than the other raters across all three treatment phases. There were no significant differences between expert and therapist mean scores. CONCLUSIONS: There may be challenges inherent in parents rating fidelity accurately. Peer rating or therapist self-rating may be considered pragmatic, efficient, and reliable approaches to fidelity assessment for real-world clinical settings.

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Background: Manualized Family Based Therapy (FBT) is the treatment of choice for adolescent anorexia nervosa, but it is an outpatient treatment. Very little research has examined whether or how the principles of FBT might be successfully adapted to an inpatient setting, and there is little other evidence in the literature to guide us on how to best treat children and adolescents with eating disorders (EDs) while in hospital. This paper describes and provides treatment outcomes for an intensive inpatient program that was designed for the treatment of adolescents less than 18 years of age with severe anorexia nervosa, based on the principles of FBT. Each patient's family was provided with FBT adapted for an inpatient setting for the duration of the admission. Parents were encouraged to provide support for all meals in hospital and to plan meal passes out of hospital. Methods: A retrospective cohort study was conducted that examined the outcomes of 153 female patients admitted over a 5-year period. Outcome data focused primarily on weight change as well as psychological indicators of health (i.e., depression, anxiety, ED psychopathology). Results: Paired t-tests with Bonferroni corrections showed significant weight gain associated with a large effect size. In addition, patients showed improvements in scores of mood, anxiety, and ED psychopathology (associated with small to medium effect sizes), though they continued to display high rates of body dissatisfaction and some ongoing suicidality at the time of discharge. Conclusion: This study shows that a specialized inpatient program for adolescents with severe EDs that was created using the principles of FBT results in positive short-term medical and psychological improvements as evidenced by improved weight gain and decreased markers of psychological distress.

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BACKGROUND: Maudsley Family Therapy and its manualised version Family-Based Therapy for Anorexia Nervosa (FBT-AN) have accrued the most significant research evidence-base for the treatment of adolescent Anorexia Nervosa (AN). A tradition of seeking augmentations for this treatment has also been established to enhance efficacy. There exists, however, a gap in the uptake of this form of manualised treatment into the "real world" of clinicians who work with adolescent AN. AIMS: This research study investigated the key experiences and identity negotiations of a group of nine Australian clinicians who were interested in contributing to research into ways that Maudsley and FBT-AN might be improved. METHODS: Nine clinicians, who at the time of the interview practised or had previously practised, FBT-AN participated in a semi-structured interview. A critical discursive analysis of interview transcripts generated a thematic map of these therapists' experiences and identity negotiations in their practice of FBT-AN. RESULTS: These therapists experienced the structure of FBT-AN as both a secure map for therapy, yet also constraining at times, in their work with adolescents and their families. Additionally, their professional identities were both invested and troubled by the identity position of themselves as evidence-based practitioners, particularly where evidence-based practice (EBP) meant strict fidelity to the manual and restrained them from tailoring a broader range of therapeutic interventions to an individual adolescent and their family. Within their narratives, these therapists refashioned alternative identity positions around what it meant to be an evidence-based practitioner through listening to and drawing on their clinical expertise of what works in therapeutic practice with an individual adolescent and their family. CONCLUSIONS: These therapists narratives highlight the power of the dominant discourse of EBP that works to privilege the research evidence over other forms of evidence that include clinician expertise and client preferences. The dilemmas faced by these therapists questioned not only the strict application of FBT-AN for adolescent AN across diverse therapeutic contexts, but also the effects of supervisory practices that paralleled this strict fidelity to the model. Further research is needed into therapeutic interventions and supervisory practices that give greater scope for clinicians to draw on their expertise in the flexible tailoring of treatments to the unique needs and preferences of the individual adolescent and their family.

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Current State of Family-Based Prevention and Therapy of Substance-Use Disorders in Children and Adolescents: A Review Adolescence is a vulnerable period for substance use disorders (SUD) as indicated by epidemiological studies. Research demonstrates the family's role for the etiology of SUD and provides a rationale for interventions based on family-associated risk and resilience factors. In this article, we summarize published results for family-based interventions from 2008-2018. Taken together, prevention programs can be effective when they focus on the promotion of broader developmental competencies and familial resources, rather than narrowly addressing substance use. Moreover, programs could benefit from targeting youth and parents as done in the "Strengthening Families Program 10-14"; most existing programs however target parents and do not include the adolescents. Family-based treatment programs with an evidence base are Multisystemic Therapy, Functional Family Therapy, Multidimensional Family Therapy and Brief Strategic Family Therapy. Overall, the effects of family-based interventions are small-to-middle sized but vary significantly across populations. Across the field of family-based interventions, there is a need for more knowledge on effective components and differential effects. The results could be improved by translational research such as on the emerging concept of mindfulness. Moreover, there is a need for implementation research and the effectiveness of service delivery programs on the community level in Germany.

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OBJECTIVE: This article discusses the implementation and preliminary outcomes of a Dialectical Behaviour Therapy (DBT) informed program integrated with Family Based Therapy (FBT) for adolescents with eating disorders within a day hospital program (DHP). METHOD: A retrospective analysis of hospital records between 2013-2015 provided descriptive characteristics of patients. Weight and percentage ideal body weight at admission and discharge, frequency of binge and purge episodes at discharge and readmissions were analysed. RESULTS: Analysis of patient characteristics indicated a broad range of eating disorder and comorbid psychiatric diagnoses among patients. Preliminary outcomes revealed increased weight and percentage of ideal body weight, decreased binge-purge status and few readmissions to the program over the two-year period studied. CONCLUSIONS: The implementation of a DBT informed DHP with integration of FBT is associated with improved patient outcomes. Ongoing challenges with respect to the implementation of DBT include modifying DBT to address varying developmental levels, ages and diagnoses and promoting adherence to the program by patients and families. Limitations include small sample size, uncontrolled chart review and the nature of DHP, which include a variety of components that may influence outcomes. This research will help to inform future implementation of treatment programs for adolescents with eating disorders.

OBJECTIF: Cet article discute de la mise en oeuvre et des résultats préliminaires d'un programme éclairé de thérapie comportementale dialectique (TCD) intégré à la thérapie familiale (TF) pour des adolescents souffrant de troubles alimentaires dans le cadre d'un programme d'hôpital de jour (PHJ). MÉTHODE: Une analyse rétrospective des dossiers de l'hôpital entre 2013 et 2015 a livré les caractéristiques descriptives des patients. Le poids et le pourcentage du poids corporel idéal à l'admission et au congé, la fréquence des épisodes d'hyperphagie et de purge lors du congé et les réadmissions ont été analysés. RÉSULTATS: L'analyse des caractéristiques des patients a indiqué une vaste gamme de troubles alimentaires et des diagnostics psychiatriques comorbides chez les patients. Les résultats préliminaires ont révélé un poids et un pourcentage accrus du poids corporel idéal, un état diminué de l'hyperphagie-purge, et peu de réadmissions dans le programme sur les deux ans de la période de l'étude. CONCLUSIONS: La mise en oeuvre d'un PHJ éclairé par la TCD intégrée dans la TF est associée à de meilleurs résultats chez les patients. Les difficultés actuelles à l'égard de la mise en oeuvre de la TCD consistent à modifier la TCD pour tenir compte des niveaux de développement variés, de l'âge et des diagnostics, et pour promouvoir l'adhésion au programme par les patients et les familles. Les limitations comprennent la petite taille de l'échantillon, un examen des dossiers incontrôlé et la nature du PHJ, qui englobe une variété de composantes susceptibles d'influer sur les résultats. Cette recherche aidera à éclairer la future mise en oeuvre des programmes de traitement pour les adolescents souffrant de troubles alimentaires.

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Although historical descriptions date back to the Hellenistic era, and Gull's naming of anorexia nervosa as a medical disorder to the late 19th century, it is only in the past 50 years that eating disorders have become widely recognized as the prevalent, potentially fatal, complex, and confounding biopsychosocial illnesses we confront today. This paper reviews the considerable advancements in our knowledge of eating disorders during three time periods: the "early years" of the 1960s and 1970s; the "middle years" of the 1980s and 1990s; and the 21st century to date. The recent Diagnostic and Statistical Manual of Mental Disorders, 5th Edition describes six major feeding and eating disorders. This historical focus addresses the interaction of multiple factors contributing to the incidence, primarily of anorexia nervosa and bulimia nervosa, in vulnerable individuals, and efforts to develop effective treatment strategies and programs in a variety of settings. Future challenges are also addressed.

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PURPOSE: To determine the effectiveness of Family-Based Therapy (FBT) as a treatment for Anorexia Nervosa (AN) in adolescents in a Singaporean cohort. FBT has proven effective in studies in the West, but no such study has been done in Asia. METHODS: This is a retrospective analysis of a hospital-based cohort, which included all paediatric patients (≤ 18-years) with AN treated at a tertiary hospital in Singapore between 2011 and 2017 (n = 119). The patients either received manualised FBT (n = 42) or individualized adolescent focussed therapy (non-FBT) (n = 77). Patient characteristics and time to remission were abstracted from patient records. Survival analysis was used to determine median time to remission and remission-free survival rates. Hazard ratios for remission were obtained by cox regression. RESULTS: Patients in the non-FBT group had a significantly longer time to remission compared with the FBT group after adjustment for age, gender, BMI, psychiatric comorbidity, and ethnicity (p = 0.003, HR = 2.523, 95% CI 1.37-4.64). In the FBT group, the median time to remission was 5.0 months (95% CI 3.4-6.6 months); 11 months shorter than the non-FBT group (p < 0.001, 95% CI 7.9-14.1 months). FBT group remission rates were 69% and 90% at 1 and 2 years, respectively. Non-FBT group remission rates were 30% and 57% at 1 and 2 years, respectively. CONCLUSIONS: This study confirms that FBT is an effective treatment strategy for AN in adolescents in the Asian context. FBT can shorten the illness duration, which reduces disruption to schooling and family life at this critical life stage. LEVEL OF EVIDENCE: Level IV, evidence obtained from retrospective review of data before and after the introduction of new intervention.

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BACKGROUND: Maudsley Family Therapy (MFT), and its manualised version, Family-Based Therapy (FBT), are the only well-established treatment interventions for adolescent anorexia nervosa (AN), with treatment efficacy primarily measured by improvements in eating behaviours and weight restoration. A crucial component of this therapy is an intensive home-based refeeding intervention that requires a substantial commitment from parents for up to one year. While this treatment works to restore weight in a proportion of adolescents, very little is known about its impacts on family distress, relationships and identity, including in the 40% of families where the adolescent experiences ongoing eating disorder (ED) symptomatology and/or psychological distress during and post-treatment. Specifically, few studies have investigated the impacts of MFT/FBT treatment on family functioning or on how parents negotiate their identities, or who they understand themselves to be, in the context of this treatment intervention. This is a significant omission, given the substantive role assigned to parents to take responsibility for their child's eating restoration in the first treatment phase. This study seeks to address this gap through a qualitative exploration of parents' experiences of MFT/FBT, in cases where treatment was discontinued and/or their child continued to experience psychological distress post-treatment. METHODS: 13 parents participated in in-depth semi-structured interviews that scaffolded between their experiences and ways they negotiated and sustained their identities as parents within the context of MFT/FBT for their child. Interview data was analysed through a framework of critical discursive analysis to generate themes centred on these parents' experiences and identity negotiation. RESULTS: Key findings are that MFT/FBT: (1) provided a map for therapy that initially relieved parents' anxieties for their child and facilitated improvements in family functioning; (2) inadequately addressed parental guilt and blame with a form of externalisation of the illness; (3) perpetuated parental guilt by raising anxiety about AN and allocating responsibility for refeeding their child in phase 1 of the treatment; and (4) when ceased, left these parents struggling with an uncertain future, and fears for the wellbeing of their children. CONCLUSIONS: The structure of MFT/FBT provided initial relief with some improvements in family communication patterns, however, when the adolescent experienced protracted ED symptoms and/or ongoing psychological distress post-treatment, these parents were left with uncertainty as to how to navigate their shifting roles and their child's ongoing struggles. This research highlights the need for treatments for adolescent AN that more comprehensively address both the adolescent and parents' psychological distress and also (re)build their senses of identity that have been challenged by AN and its effects.

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Caregiver burden is common in caregivers of youth with anorexia nervosa (AN) and could impede the successful implementation of family-based therapy (FBT). Thus, it is important to better understand mechanisms by which caregiver burden is developed and maintained. This study aimed to examine the relation between caregiver illness perceptions about AN, symptom severity indicators, and caregiver burden in a sample of medically hospitalized youth with AN. Fifty-one youth with AN (N = 34) or Atypical AN (AAN; N = 17; mean age = 14.85, SD = 1.41; 76% female) and their primary caregivers (N = 47 mothers and N = 4 fathers) completed self-report questionnaires at hospital admission. Collected data included caregiver and youth illness perceptions about AN, caregiver burden, and youth self-reports of psychological symptoms. Physiological data regarding symptom severity included admitting percent of expected body weight (%EBW) and minimum heart rate during admission. Findings indicated that caregiver beliefs about negative consequences of AN were associated with caregiver burden, independent of youth age, sex, illness duration, and diagnosis. Youth reports of symptom severity, %EBW, and low heart rate were not associated with increased caregiver burden. Findings suggest that the subjective experience of having a youth with AN are a greater determinant of caregiver burden than objective indicators of illness severity. Further, these findings provide support for the FBT clinician to strike a balance between providing information about the potential consequences of AN, while instilling hope for recovery and bolstering parent self-efficacy.

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