I love that Halmi picked the word "perplexities" for this otherwise droll title:
The Perplexities of Conducting Randomized, Double-Blind, Placebo-Controlled Treatment Trials in Anorexia Nervosa Patients The word choice alerts you to something important. Something that came up in the excellent
overview of research given by Dr. Lock and Dr. Kaye at the recent NEDA conference in Austin: "In contrast to studies of adults, randomized, controlled trials for anorexia nervosa family studies have dropout rates of 10% to 20%" For adult studies the average dropout rate is 40%.
When people talk about the fact there is is so little research to support various treatment approaches, consider it in context. There is little research AT ALL.
Eating disorders, especially anorexia, are anosognosic and egosyntonic - the victim understands only a fraction of what is happening and what they do understand falsely seems to be going their way. Adult patients resist beginning treatment, not to mention being randomized into studies, and they also drop out of treatment not because they don't need it, but because it is a symptom of the illness to do so.
The difference, when family is involved in the treatment, is you have people who are not living under the dictates of the illness able to keep the process going. Children and adolescents (and dependent adults) don't have a choice if their parents are on board: appointments will be kept, recommendations will be heard.
This also makes the very optimistic findings on Family-Based Maudsley treatment more significant. And adds another perplexity: why, when the
Journal of Clinical Child & Adolescent Psychology makes it very clear: "At this time, the evidence base is strongest for the Maudsley model of family therapy for anorexia nervosa." that most families are neither offered FBT/M nor are we told it exists.
The word choice alerts you to something important. Something that came up in the excellent overview of research given by Dr. Lock and Dr. Kaye at the recent NEDA conference in Austin: "In contrast to studies of adults, randomized, controlled trials for anorexia nervosa family studies have dropout rates of 10% to 20%" For adult studies the average dropout rate is 40%.
When people talk about the fact there is is so little research to support various treatment approaches, consider it in context. There is little research AT ALL.
Eating disorders, especially anorexia, are anosognosic and egosyntonic - the victim understands only a fraction of what is happening and what they do understand falsely seems to be going their way. Adult patients resist beginning treatment, not to mention being randomized into studies, and they also drop out of treatment not because they don't need it, but because it is a symptom of the illness to do so.
The difference, when family is involved in the treatment, is you have people who are not living under the dictates of the illness able to keep the process going. Children and adolescents (and dependent adults) don't have a choice if their parents are on board: appointments will be kept, recommendations will be heard.
This also makes the very optimistic findings on Family-Based Maudsley treatment more significant. And adds another perplexity: why, when the Journal of Clinical Child & Adolescent Psychology makes it very clear: "At this time, the evidence base is strongest for the Maudsley model of family therapy for anorexia nervosa." that most families are neither offered FBT/M nor are we told it exists.