EDITORIAL Is Seeking a Panacea for Anorexia Nervosa a Fool’s Errand? Long-Term Outcomes of Family-Based Treatment Kamryn T. Eddy, PhD, AND Emily K. Gray, MD A norexia nervosa (AN) is a complex psy- chiatric disorder whose symptoms are at once sensible and ego-syntonic to the patient and bewildering and alien to the family. Despite considerable advances in the assessment and treatment of eating disorders over the past 3 decades, AN remains enigmatic and—particularly in adults—often resistant to treatment. The adult literature suggests that fewer than half of those with AN will achieve recovery; an additional one third will show improvement but remain symptomatic; and up to one fifth will remain chronically ill. Risk of premature mortality is increased. 1 Adolescent outcomes are generally more favorable, and given that a longer duration of illness is asso- ciated with a more pernicious form of the illness, efforts aimed at early and aggressive intervention are key. Family-based treatment (FBT) is a beacon in the dim landscape of empirically based treat- ments for AN. FBT is a short-term, behaviorally oriented, outpatient intervention designed to engage parents and family members in inter- rupting symptoms, facilitating weight restora- tion, and promoting full recovery. FBT is the best-studied treatment for adolescent AN with the strongest available evidence base, wherein nearly 90% of patients will no longer meet criteria for AN after treatment, and up to half will achieve recovery—normalized weight and no eating-disorder psychopathology—at the end of treatment. 2 However, FBT generates polarized responses among professionals in the eating disorders field. Proponents of FBT cite its empirical backing, short-term outpatient nature, and cost effectiveness. Parents appreciate the absolution of blame, and many are glad to take an active role in their child’s treatment. Some of the most vocal FBT supporters, in fact, are families who have successfully used FBT and celebrated the re-emergence of their adolescent who had previously been lost in the throes of AN. Critics of FBT argue that it is too simplistic a treatment for a disease fraught with psychological and dynamic complexities. The symptom-driven, behaviorally focused, agnostic-to-etiology nature of FBT runs counter to more psychodynamic formulations of the disease and its treatment, and whether its short-term gains (behavioral symp- tom interruption and weight restoration) will be sustained or adequate to facilitate long-term recovery has been questioned. In this issue of the Journal, Le Grange et al. 3 present follow-up data from their randomized controlled clinical trial comparing FBT with adolescent-focused individual treatment (AFT) for adolescent AN at 2 to 4 years after treatment. In their initial report, the investigators found outcomes favoring FBT over AFT, with most patients in the 2 groups no longer meeting weight criteria for AN (89% in FBT and 67% in AFT), and 42% of FBT recipients and only 23% of AFT recipients achieving full recovery, de- fined as at least 95% of expected body weight and Eating Disorder Examination scores within 1 standard deviation of community norms. In the current follow-up, 79 participants (repre- senting 65% of the initial cohort) were reassessed at a mean of 3.26 years after treatment. Although full recovery was mostly sustained and relapse was uncommon, the absolute rate of full recov- ery was less than one-third in the 2 treatment groups. These compelling findings support the dura- bility of treatment gains achieved through FBT (and AFT, for that matter). That those JOURNAL OF THE AMERICAN ACADEMY OF CHILD & ADOLESCENT PSYCHIATRY 1150 www.jaacap.org VOLUME 53 NUMBER 11 NOVEMBER 2014