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Mini-Review

Systemische Therapien bei Jugendlichen und Erwachsenen mit Essstörungen

Published Online:October 29, 2019https://doi.org/10.1024/1661-8157/a003351

Abstract

Zusammenfassung. Essstörungen sind schwere psychosomatische Krankheiten mit beträchtlichen psychiatrischen und somatischen Komorbiditäten, verminderter Arbeitsfähigkeit, starker Inanspruchnahme des Gesundheitssystems und hohen Behandlungskosten. Da die Erkrankung typischerweise in der Adoleszenz oder im frühen Erwachsenenalter beginnt und frühe Interventionen erwiesenermassen zu einer besseren Prognose führen, gab es in den vergangenen Jahren viel Therapieforschung zur Behandlung der Essstörungen im Jugendalter. Bei Jugendlichen überwiegt die Wirksamkeit der Familientherapie verglichen mit der Einzeltherapie, die bei Erwachsenen in den internationalen Behandlungsrichtlinien immer noch die beste Evidenz hat. Bei Jugendlichen mit Bulimia nervosa wird ebenfalls die Familientherapie empfohlen. Bei Betroffenen mit Binge eating und Adipositas ist man mit der Forschung betreffend familienbasierter Ansätze noch am Anfang, es gibt aber erste ermutigende Resultate. Dieser Artikel fasst einige systemtherapeutische Ansätze für Familien von Jugendlichen und Erwachsenen mit Essstörungen zusammen, mit Bezug auf die neusten Forschungsergebnisse. Zudem werden Anpassungen der Konzepte an Gegebenheiten des Gesundheitssystems erwähnt, mit dem Ziel, umfassendere Behandlungsangebote für Patienten mit Essstörungen und deren Familien anzuregen.


Systemic Treatment of Eating Disorders

Abstract. Eating disorders (EDs) are deleterious illnesses that are associated with significant psychiatric and medical morbidity and mortality, considerable distress and impairment, marked caregiver burden, and high treatment costs. Because EDs commonly onset in adolescence and young adulthood, and with consistent evidence that early intervention results in the most promising treatment outcomes, an increasing amount of research has been devoted to the treatment of adolescent EDs. Although still less researched in adult presentations of EDs, the historical record of research on adolescent ED treatment over the last half-century principally supports family therapy. Current published clinical guidelines recommend an ED-specific family therapy as the first-line treatment of adolescents with anorexia nervosa (AN) and as a recommended treatment of adolescents with bulimia nervosa (BN). The number of treatment trials for adolescent AN has slowly grown over the last few decades and, more recently, family interventions include protocols extending to new populations and diagnoses, including BN. This narrative review summarizes existing family-based approaches to the treatment of adolescent EDs, integrating recent research findings. This article also includes discussion of methods, both current and proposed, that expand and adapt current family-based approaches in efforts to improve the breadth and scope of ED treatment in adolescence and young adulthood.


Résumé. Les troubles de l’alimentation sont des maladies psychosomatiques graves avec des comorbidités psychiatriques et somatiques importantes, une capacité de travail réduite, une utilisation intensive du système de santé et des coûts de traitement élevés. Comme la maladie débute généralement à l’adolescence ou au début de l’âge adulte et qu’il a été prouvé qu’une intervention précoce permettait d’améliorer le pronostic, de nombreuses recherches ont été menées sur le traitement des troubles de l’alimentation à l’adolescence ces dernières années. Chez les adolescents, l’efficacité de la thérapie familiale l’emporte sur celle de la thérapie individuelle, qui présente toujours les meilleures données probantes chez l’adulte dans les directives internationales en matière de traitement. En revanche, chez les adolescents souffrant d’anorexie mentale, la thérapie familiale est définie comme le traitement de première intention et est également recommandée chez les adolescents présentant une boulimie mentale. Les personnes touchées par l’hyperphagie boulimique et l’obésité en sont encore aux premiers stades de la recherche sur les approches axées sur la famille, mais les premiers résultats sont encourageants. Cet article résume certaines approches thérapeutiques systémiques dans les familles d’adolescents et d’adultes souffrant de troubles de l’alimentation, en se référant aux dernières recherches. En outre, des adaptations des concepts aux conditions du système de santé sont mentionnées, dans le but de stimuler des options de traitement plus complètes pour les patients souffrant de troubles de l’alimentation et leurs familles.

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