Clinical Research Division, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City 14370, Mexico.
Eating Disorders Clinic at Clinical Services Division, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City 14370, Mexico.
Int J Environ Res Public Health. 2022 Aug 3;19(15):9522. doi: 10.3390/ijerph19159522.
Anorexia nervosa (AN) is a complex eating disorder where involvement of family plays a central role in first line treatment in adolescents, but which is not so for adults where poor response to treatment is frequent. Given the reluctance of some patients to receive treatment, we set out to explore the hypothesis that certain family dynamics may be involved in the maintenance of the disorder.
We aimed to understand what is underlying in the cases of patients who present clinical improvement with their parents, but not the ones who received a parent-focused psychotherapeutic intervention. We conducted a mixed methods study. On the one hand we performed a case series of 14 patients who dropped out of treatment while their parents actively attended the intervention, and on the other hand, we followed the evolution of the parents of those patients reluctant to continue treatment, through non-participant observation.
We present preliminary evidence where we found the parent-focused psychotherapeutic intervention was able to elicit a reflective function of the parents. We also observed that the intervention modified certain family dynamics that could be related to maintaining factors of the disorder. In patients, we found that in parallel to the assistance of their parents to psychotherapeutic treatment, and even when they were receiving no intervention, they showed significant clinical improvement of symptomatology and global functioning; we observed 9 of 14 of them who voluntarily decided to return to pharmacological treatment.
This parent-focused intervention elicited changes in reflective functioning of participant parents; the intervention produced favorable changes in family dynamics, which we believe is probably related to improvement of global functioning, symptomatology, and insight of patients.
神经性厌食症（AN）是一种复杂的进食障碍，家庭的参与在青少年的一线治疗中起着核心作用，但在成年人中并非如此，因为他们对治疗的反应往往不佳。鉴于一些患者不愿意接受治疗，我们提出了一个假设，即某些家庭动态可能与该疾病的维持有关。
我们旨在了解在父母积极参与治疗的情况下，患者临床状况有所改善，但那些接受以父母为中心的心理治疗干预的患者却没有改善的原因。我们进行了一项混合方法研究。一方面，我们对 14 名在父母积极参与治疗时退出治疗的患者进行了病例系列研究；另一方面，我们通过非参与观察来跟踪那些不愿意继续治疗的患者的父母的演变。
我们提供了初步证据，表明以父母为中心的心理治疗干预能够引发父母的反思功能。我们还观察到，干预改变了某些可能与疾病维持因素有关的家庭动态。在患者中，我们发现，与父母对心理治疗的帮助平行，甚至在他们没有接受干预的情况下，他们的症状和整体功能都有显著的临床改善；我们观察到 14 名患者中有 9 名自愿决定重新接受药物治疗。
这种以父母为中心的干预引发了参与者父母的反思功能的变化；干预产生了有利于家庭动态的变化，我们认为这可能与患者的整体功能、症状和洞察力的改善有关。
