Eating and Weight Disorders Program, Department of Psychiatry, Mount Sinai School of Medicine, New York, NY 10029, USA.
Eur Eat Disord Rev. 2012 Jan;20(1):e1-16. doi: 10.1002/erv.1071. Epub 2010 Dec 28.
Anorexia nervosa (AN) is characterized by its similarity to anxiety disorders, especially obsessive-compulsive disorder (OCD). Family-based treatment (FBT) has shown promising initial results for treatment of AN in adolescents, yet the precise mechanisms of action are unknown. We present a theoretical argument and model, suggesting that FBT may work via exposure (and habituation) to food and its consumption. First, we review the evidence for pathological anxiety in AN, and suggest a framework for identifying specific anxious triggers, emotions (fear and worry) and avoidance strategies. Second, we briefly review evidence indicating that cognitive-behavioural therapy (CBT) and specifically exposure in its various forms is most effective for treating anxiety disorders in youth. Third, we consider distinct approaches to exposure therapy based on the pattern of triggers, anxious emotions and avoidance. We conclude that the interventions utilized in FBT share clear similarities to exposure with response prevention, a type of exposure therapy commonly used with OCD, and may work via facilitating habituation to food and eating in one's natural environment. We also highlight how parents facilitate this process in between sessions by effectively coaching their children and facilitating naturalistic exposure to food and related triggers. Options for future research are considered.
神经性厌食症 (AN) 的特征与其类似焦虑障碍，尤其是强迫症 (OCD)。基于家庭的治疗 (FBT) 已显示出对青少年 AN 治疗的初步有希望的结果，但确切的作用机制尚不清楚。我们提出了一个理论论点和模型，表明 FBT 可能通过暴露（和习惯化）食物及其消耗起作用。首先，我们回顾了 AN 中病理性焦虑的证据，并提出了一个识别特定焦虑触发因素、情绪（恐惧和担忧）和回避策略的框架。其次，我们简要回顾了表明认知行为疗法 (CBT)，特别是其各种形式的暴露，对治疗青年焦虑症最有效的证据。第三，我们考虑了根据触发因素、焦虑情绪和回避模式的不同暴露疗法方法。我们得出的结论是，FBT 中使用的干预措施与强迫症常用的暴露反应预防疗法有明显的相似之处，并且可能通过促进对食物和自然环境中进食的习惯化来起作用。我们还强调了父母如何通过有效地指导孩子并促进对食物和相关触发因素的自然暴露，在治疗间隙促进这一过程。考虑了未来研究的选择。
