The Effectiveness of Psychological Treatment for Anorexia Nervosa in Adolescents: A Critical Review of Randomized...

Although international treatment guidelines for eating disorders recommend varying psychological approaches for adolescents with anorexia nervosa (AN), most existing reviews have combined adolescent and adult samples, leaving the overall evidence base for this population poorly defined. This systematic review is the first to synthesize randomized controlled trials (RCTs) of psychological treatments for adolescents with AN across outpatient, inpatient, and day-patient settings.

A systematic search of databases (e.g., PubMed, APA PsycINFO) identified 22 relevant studies through June 2025. Eligible studies focused on adolescents (ages 8-18 years) with AN undergoing psychological treatment.

Evidence from the nine RCTs consistently indicates that family therapy produces significant positive effects on somatic parameters (e.g., weight) and short-term eating-disorder symptoms. In four, mostly underpowered comparative RCTs, outpatient family therapy showed small-to-moderate effect sizes over individual therapy, though these were restricted to outcomes related to medical recovery. For inpatient care, a limited evidence base suggests that shorter inpatient treatment followed by outpatient care may achieve outcomes comparable to extended hospitalization. Psychological modules delivered during inpatient treatment (e.g., Cognitive Remediation Therapy, CBT-Insomnia) showed some improvements confined to narrow symptom domains but did not translate into broader recovery.

The evidence base remains limited, with few RCTs in adolescents with AN and a geographically narrow, demographically homogeneous sample, predominantly girls from Western settings. Family therapy is supported as the first-line treatment, yet substantial uncertainties persist. Larger and more inclusive RCTs are needed to clarify mechanisms of change, long-term outcomes, and the effectiveness of individual-focused approaches.