Placing the Focus on Perfectionism in Female Adolescent Anorexia Nervosa: Augmented Maudsley Family-based Treatment

Abstract

Anorexia nervosa (AN) is one of the most difficult and costly eating disorders to treat. Maudsley family-based treatment (FBT) is one widely-used treatment that has been called the gold-standard treatment for adolescents diagnosed with AN. However, FBT does not directly address some of the biased belief patterns that may reduce the likelihood of recovery and increase the risk of relapse. Addressing perfectionism has been proposed as a way to enhance the effectiveness of FBT treatment for AN, given that it has been found to be a correlate of greater chronicity of symptoms and predictive of relapse. Three studies were conducted to consider the efficacy of FBT augmented with cognitive behavioural therapy (CBT) to address perfectionism. In the first study, published meta-analyses on FBT were located and described, supplementing them with a systematic search and review of newer published FBT trials. In the next two studies, the feasibility and outcomes of ‘FBT + CBT’ were investigated. The CBT sessions focused on reducing adolescents’ perfectionistic and other self-related maladaptive cognitions and behaviours that could maintain AN. In both studies, eating disorder pathology and perfectionism were measured at four times during treatment, including pre–FBT + CBT treatment, prior to the start of CBT, after the completion of CBT, and post–FBT + CBT treatment.