Stanford University School of Medicine, Division, Stanford, CA, USA.
Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA.
Psychol Med. 2023 Jan;53(2):396-407. doi: 10.1017/S0033291721001604. Epub 2021 May 6.
Family-based treatment (FBT) is the first-line treatment for adolescent anorexia nervosa (AN). Yet, remission is not achieved for about half of adolescents with AN receiving FBT. Understanding patient- and parent-level factors that predict FBT response may inform treatment development and improve outcomes.
Network analysis was used to identify the most central symptoms of AN in adolescents who completed the Eating Disorder Examination (EDE) prior to FBT ( = 409). Bridge pathways between adolescent AN and parental self-efficacy in facilitating their child's recovery from AN were identified in a subset of participants ( = 184). Central and bridge symptoms were tested as predictors of early response (⩾2.4 kg weight gain by the fourth session of FBT) and end-of-treatment weight restoration [⩾95% expected body weight (EBW)] and full remission (⩾95% EBW and EDE score within 1 standard deviation of norms).
The most central symptoms of adolescent AN included desiring weight loss, dietary restraint, and feeling fat. These symptoms predicted early response, but not end-of-treatment outcomes. Bridge symptoms were parental beliefs about their responsibility to renourish their child, adolescent discomfort eating in front of others, and adolescent dietary restraint. Bridge symptoms predicted end-of-treatment weight restoration, but not early response nor full remission.
Findings highlight the prognostic utility of core symptoms of adolescent AN. Parent beliefs about their responsibility to renourish their child may maintain associations between parental self-efficacy and AN psychopathology. These findings could inform strategies to adapt FBT and improve outcomes.
家庭为基础的治疗（FBT）是青少年厌食症（AN）的一线治疗方法。然而，接受 FBT 的大约一半 AN 青少年并未达到缓解。了解预测 FBT 反应的患者和家长因素可能有助于治疗的发展并改善结果。
网络分析用于识别在接受 FBT 之前完成饮食失调检查（EDE）的青少年中 AN 的最核心症状（=409）。在一部分参与者（=184）中确定了青少年 AN 和父母促进孩子从 AN 中恢复的自我效能之间的桥梁途径。核心和桥梁症状被测试为早期反应（FBT 第四次治疗时体重增加≥2.4kg）和治疗结束时体重恢复[≥95%预期体重（EBW）]和完全缓解（≥95%EBW 和 EDE 评分在正常范围的 1 个标准差内）的预测因子。
青少年 AN 的最核心症状包括渴望减肥、饮食限制和感觉肥胖。这些症状预测了早期反应，但不能预测治疗结束时的结果。桥梁症状是父母认为自己有责任给孩子补充营养、青少年在他人面前进食时感到不适以及青少年饮食限制。桥梁症状预测了治疗结束时的体重恢复，但不能预测早期反应或完全缓解。
研究结果突出了青少年 AN 的核心症状的预后价值。父母认为自己有责任给孩子补充营养的信念可能会维持父母自我效能感与 AN 病理之间的关联。这些发现可以为调整 FBT 和改善结果提供信息。
