Previous studies applying the Lausanne Trilogue Play (LTPc), a semi-structured method for observing family dynamics, highlighted dysfunctional interaction patterns in the families of individuals affected by restrictive eating disorders (REDs). Family-centered approaches are considered the first-line treatment for severe cases of REDs in adolescence.

To investigate family functioning in the families of adolescents with severe REDs assessed before and 6 months after a multidisciplinary family treatment program that combined psychodynamic psychotherapy, parental role intervention and triadic or family-centered intervention.

Sixty-seven families of adolescent patients diagnosed with REDs were assessed for eligibility between July 2017 and October 2020. Family functioning was assessed using the clinical version of LTPc. Nutritional counseling and neuropsychiatric monitoring were also provided.

We observed a significant change in the family functioning score for the LTPc phase 2, in which the father interacts with his daughter while the mother acts as a silent observer. This suggests that the fathers, when playing an active role, could improve dyadic family functioning. The treatment was not found to change triadic functioning: a 6-month treatment may not be long enough to modify interactions at the triadic level.

A brief multidisciplinary treatment program may significantly improve family functioning in the families of patients diagnosed with severe REDs. Although appropriate clinical trials are needed to further test the efficacy of this treatment, our study reinforce the concept that treatment programs targeting the individual patient and both the parents should be a first-line approach in adolescents with severe REDs.

The authors declare that they do not have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstrac.

Family-based treatment (FBT) is an efficacious intervention for adolescents with an eating disorder. Evaluated to a lesser degree among adolescents, enhanced cognitive-behavior therapy (CBT-E) has shown promising results. This study compared the relative effectiveness of FBT and CBT-E, and as per manualized CBT-E, the sample was divided into a lower weight [<90% median body mass index (mBMI)], and higher weight cohort (⩾90%mBMI).

Participants (N = 97) aged 12–18 years, with a DSM-5 eating disorder diagnosis (largely restrictive, excluding Avoidant Restrictive Food Intake Disorder), and their parents, chose between FBT and CBT-E. Assessments were administered at baseline, end-of-treatment (EOT), and follow-up (6 and 12 months). Treatment comprised of 20 sessions over 6 months, except for the lower weight cohort where CBT-E comprised 40 sessions over 9–12 months. Primary outcomes were slope of weight gain and change in Eating Disorder Examination (EDE) Global Score at EOT.

Slope of weight gain at EOT was significantly higher for FBT than for CBT-E (lower weight, est. = 0.597, s.e. = 0.096, p < 0.001; higher weight, est. = 0.495, s.e. = 0.83, p < 0.001), but not at follow-up. There were no differences in the EDE Global Score or most secondary outcome measures at any time-point. Several baseline variables emerged as potential treatment effect moderators at EOT. Choosing between FBT and CBT-E resulted in older and less well participants opting for CBT-E.

Results underscore the efficiency of FBT to facilitate weight gain among underweight adolescents. FBT and CBT-E achieved similar outcomes in other domains assessed, making CBT-E a viable treatment for adolescents with an eating disorder.

Treatment Outcome in Eating Disorders; https://clinicaltrials.gov/; NCT03599921.