AUTHOR=Bellocci Amanda , Monnetti Giulia , Schepisi Luigi , Basili Emanuele , Manfrida Gianmarco , Tortorelli Daniela 

TITLE=Systemic relational therapy for eating disorders: analysis of family characteristics by means of the SCORE-15

JOURNAL=Frontiers in Child and Adolescent Psychiatry

VOLUME=Volume 4 - 2025

YEAR=2025

URL=https://www.frontiersin.org/journals/child-and-adolescent-psychiatry/articles/10.3389/frcha.2025.1669051

DOI=10.3389/frcha.2025.1669051

ISSN=2813-4540

ABSTRACT=IntroductionThe present study, using the SCORE-15 assessment tool, aimed to explore and compare family functioning and therapeutic progress in a group of families with adolescents diagnosed with eating disorders (EDs), compared to a group of families with adolescents presenting other forms of psychopathology. The objective was to analyze the evolution of family functioning throughout the course of therapy, identifying specific characteristics and differences between the two groups. We hypothesized that the sample of families with children diagnosed with EDs (Group A) would present significantly higher initial SCORE-15 scores than the control group (Group B), indicating greater difficulties in communication, relationships, and problem management. We also anticipated variability in scores among members of the same family, particularly between parents and the symptomatic adolescent. Furthermore, therapists' perceptions of the usefulness of therapy and of the degree of family improvement were also investigated.MethodA retrospective analysis was conducted on a sample of 11 families (Group A) who sought family therapy for an adolescent child diagnosed with an eating disorder at the CSAPR in Prato between 2014 and 2024. Family functioning characteristics were assessed using scores from the SCORE-15 instrument. Group A was compared with a control sample (Group B), consisting of 10 families who initiated family therapy due to other forms of psychopathology in their children during the same time period. The data were analyzed using SPSS Statistics (Statistical Package for the Social Sciences, version 23.0) software. After conducting a descriptive analysis of the demographic variables and constructs of interest in the sample, a comparative analysis of the scores of the participants in the two groups was performed using a Student's t-test. Additionally, an analysis of the change in scores over the course of therapy was performed using a Friedman test.ResultsBoth groups showed improvement in family functioning over the course of therapy, as indicated by lower SCORE-15 scores. Initially, adolescents in Group A perceived family functioning as more problematic than their fathers did. However, they showed significant improvements during the early phases of treatment, particularly in the Family Difficulties subscale. In Group B, improvement was more evenly distributed among fathers, mothers, and adolescents, with no significant differences in perception. A comparison of the two groups revealed that Group A had a more critical initial condition, especially according to the self-reports of the adolescents, who scored higher than their peers in Group B across all SCORE-15 dimensions. Satisfaction with the therapeutic process increased in both groups, particularly among the fathers and adolescents. However, the mothers, despite having higher initial expectations, showed a less linear pattern of change. Therapists positively evaluated the usefulness of therapy and the potential for family change in both clinical conditions.ConclusionsThe study confirms that, at the outset of therapy, families with adolescents diagnosed with eating disorders (EDs), perceive family functioning as more problematic, particularly from the adolescents' perspective. As we hypothesized, Group A reported higher and more heterogeneous SCORE-15 scores among family members, especially between fathers and adolescents. Nevertheless, both groups benefited from the therapeutic process, showing significant improvements in the quality of relationships and in the management of family difficulties. These results underscore the relevance of a systemic-relational approach in cases of eating disorders and the importance of actively involving the entire family system, paying particular attention to the adolescent's relational experience. The SCORE-15 is confirmed to be a valid and sensitive tool for monitoring change and guiding clinical intervention in family therapy.