Attachment and mentalization as predictors of outcome in family therapy for adolescent anorexia nervosa.

Anorexia nervosa-focussed family therapy (FT-AN) is the first-line treatment for adolescent anorexia nervosa (AN), but the predictors of poor treatment response are not well understood. The main aim of this study was to investigate the role of attachment and mentalization in predicting treatment outcome. The secondary aims of the study were to investigate therapeutic alliance at 1 month as a predictor of outcome, and to test the associations between alliance and baseline attachment and mentalization. 192 adolescents with AN and their parents were recruited as they began family therapy in out-patient specialist eating disorder services. Self-report measures of attachment, mentalization, and emotion regulation were completed at the start of treatment by adolescent patients and one of their parents. Self-reported alliance scores were collected at one month. Higher scores on the Certainty Scale of the Reflective Functioning Questionnaire, completed by parents, which indicate over-certainty about mental states, were the strongest predictor of poor outcome (Odds Ratio: 0.42, CI: 0.20-0.87). Similarly, for adolescents, higher Lack of Clarity scores on the Difficulties in Emotion Regulation Scale, representing being unclear about one's feelings, were predictive of positive treatment outcome (OR: 1.10, CI: 1.00-1.21). Higher alliance scores at 1 month predicted positive outcome, and were associated with attachment security and mentalization. These novel findings suggest that, particularly in parents, a tendency towards excessive certainty about mental states in others may predict poor outcome in FT-AN. Further research is warranted to replicate the finding and characterise families at risk of poor outcome.

'Living in an alternative reality': adolescents' experiences of psychiatric inpatient care.

BACKGROUND: To date minimal research has investigated adolescent psychiatric inpatient care from a service-user perspective. METHOD: Semi-structured interviews were conducted with 10 adolescents with experience of psychiatric inpatient care. Interviews were analysed using the grounded theory method (Glaser & Strauss, 1967). RESULTS: A core category, 'Living in an Alternative Reality', reflected the unusual nature of the hospitalisation experience. Adolescents reported feelings of restriction and disconnection and used various relational and practical strategies to cope with hospitalisation. CONCLUSIONS: Results suggest that psychiatric hospitalisation can cause strong affective reactions in adolescents, and may affect psychological constructs such as identity and self-esteem.