*7.3.1 Family-based approaches*

Family dynamics are an important factor in the etiology of AN. The first studies in this area suggested family characteristics such as overinvolvement or inability to solve conflicts; however, family-based approaches put families as part of the solution, not the source of the problem. These approaches originated from the Maudsley Hospital in London and focused on the family system as a whole. Several randomized control trials proved the efficacy of family-based treatments in adolescents with AN [92]. At a basic level, this kind of therapy analyzes predisposing and maintaining family dynamics of anorexia and then plans the treatment procedure accordingly. A three-step treatment plan is conducted that is almost a yearlong [93]. The first level focuses on families' parenting skills and whether decisions related to eating are under family control. They learn how to help their child to gain weight. The aim of the second level is to empower patients to gain control over their eating behaviors when they reach the normal weight range. Finally, the last level focuses on individualization and developing healthy social relations both between parent and child but also in peer relations too. Behavior change is central to this model. A family-based approach is also proposed for adult patients. The Maudsley Model of Anorexia Nervosa Treatment for Adults (MANTRA) involves caregivers in both formulation and administration during the treatment process [94]. This motivational and client-oriented cognitive interpersonal model is developed specifically for AN patients. It focuses on eating related problems and symptoms but also obsessive and anxious-avoidant personality traits that are central to the maintenance of AN.
