Relation between increasing attachment security and weight gain: a clinical study of adolescents and their parents at an outpatient ward.

PURPOSE: We wanted to evaluate the impact of a relational focus in the treatment of adolescent ED-patients and their parents at an intensive outpatient ward, based on attachment theory, combined with a family approach and psychodynamic principles. Our aim was to investigate the distribution of different attachment styles among the adolescent ED-patients and their parents, and to find out if they could change by the treatment. METHODS: Swedish adolescents (n = 33; 3 boys, 30 girls) and their parents (n = 60; 34 mothers, 26 fathers) participated. MEASURES: Attachment Style Questionnaire (ASQ), Body Mass Index (BMI) and Children's Global Assessment Scale (CGAS) before and after treatment. RESULTS: The adolescents were high on Need for Approval (ASQ4) of the Insecure/Anxious scale before treatment (in contrast to the parents). The patients had a significant decrease in ASQ4 after treatment, which correlated inversely to the increase in BMI but not to CGAS. The mothers showed features of the Secure/Confident style, fathers of the Insecure/Avoidant with elevated Relationships as Secondary (ASQ2). CONCLUSIONS: Treatment with a relational and a family focus has impact on attachment insecurity in adolescent ED-patients and outcomes in terms of BMI. It is important to engage the parents, who need to help the adolescents to separate at that developmental stage. A secure therapeutic context, which enables mentalizations and allows new relational experiences, is essential. The ASQ-instrument is useful in indicating how the treatment of ED-adolescents is proceeding. LEVEL OF EVIDENCE: Level IV: evidence obtained from multiple time series with the intervention.

Adolescent patients with eating disorders and their parents: a study of self-image and outcome at an intensive outpatient program.

PURPOSE: The main aim of this clinical study was to explore how adolescent patients with eating disorders and their parents report their perceived self-image, using Structural Analysis of Social Behavior (SASB), before and after treatment at an intensive outpatient program. Another aim was to relate the self-image of the young patients to the outcome measures body mass index (BMI) and Children's Global Assessment Scale (C-GAS) score. METHODS: A total of 93 individuals (32 adolescents, 34 mothers, and 27 fathers) completed the SASB self-report questionnaire before and after family-based treatment combined with an individual approach at a child and youth psychiatry day care unit. The patients were also assessed using the C-GAS, and their BMI was calculated. RESULTS: The self-image (SASB) of the adolescent patients was negative before treatment and changed to positive after treatment, especially regarding the clusters self-love (higher) and self-blame (lower). A positive correlation between change in self-love and in C-GAS score was found, which rose significantly. Increased self-love was an important factor, explaining a variance of 26 %. BMI also increased significantly, but without any correlation to change in SASB. The patients' fathers exhibited low on the cluster self-protection. Mothers' profiles were in line with a non-clinical group. CONCLUSIONS: Results indicate that the self-image of adolescent patients change from negative to positive alongside with a mainly positive outcome of the ED after treatment. Low self-protection according to SASB among fathers suggests the need for greater focus on their involvement.