A therapeutic approach that encourages parents to feed high-calorie meals like milkshakes and macaroni and cheese to their anorexic teens is getting a closer look as part of an National Institutes of Health (NIH)-funded treatment study at six sites nationwide.
For the first time, the Maudsley Approach is being compared with a more established treatment known as Family Systems Therapy. Previous research has shown the Maudsley technique, named after the hospital in London where it was developed in the 1980s, successfully prevented hospitalization and helped adolescents recover their normal weights, with at least 75 percent of patients maintaining their recovery after five years.
“Anorexia is a life-threatening condition. Treating it early is very important since it is during the teenage years that this disorder usually takes hold,” says Katherine Halmi, founder of the Eating Disorders Program at NewYork-Presbyterian Hospital/Westchester Division—one of the study sites—and professor of psychiatry at Weill Cornell Medical College. “Traditionally, patients with anorexia have been treated in a hospital setting or through one-on-one outpatient therapy. While inpatient treatment is still appropriate in acute cases, we have increasingly seen the value of family-oriented outpatient therapy for adolescents.”
In the Maudsley Approach, the anorexic teenager attends therapy sessions together with their parents and siblings. Parents work with the Maudsley therapist to develop ways in which they can monitor their child’s intake, choosing the amounts and types of foods necessary for them to regain to a healthy weight. Siblings are encouraged to act as a support system for their sister or brother. Once patients achieve a healthy weight, they graduate toward taking more responsibility for their intake. At this point, family and developmental issues relevant to the patient maintaining a healthy weight are addressed.
In Family Systems Therapy, families also attend regular therapy sessions, but discussions do not necessarily focus on eating. Instead, family members are free to broadly explore and challenge any problematic communication patterns or stressors within the family unit.
“In Maudsley, food is medicine that restores the body and mind. When the body is starving, the mind also weakens, becoming more susceptible to anorexia’s rigid, often obsessive logic. Supervised feeding helps to break this vicious cycle. With the anorexia in charge, the adolescent really cannot regain the weight on his or her own. Nutritional rehabilitation gives the brain the nutrition it needs to re-establish healthy eating habits,” says Dara Bellace, a clinical psychologist at NewYork-Presbyterian Hospital/Westchester Division and an instructor of psychology in psychiatry at Weill Cornell Medical College.
“This approach does not blame parents, but rather calls on their ability to nurse their child back to health. It requires a strong commitment to be with them for every meal—something that can mean rearranging schedules and taking a tag-team approach to sharing the responsibility,” adds Bellace. “The adolescent must also dedicate themselves to the therapy, understanding that, until they regain the weight, their parents will be feeding them much as they did when they were younger, deciding what and how much they eat and making sure they finish.”
Anorexia nervosa is an eating disorder characterized by extreme low body weight and body image distortion with an obsessive fear of gaining weight. The condition largely affects adolescent females, who make up more than 40 percent of all cases. As much as 3 percent of American girls and women are anorexic. Anorexia carries the highest mortality rate of any psychiatric condition. Previous research by Halmi found that 7 percent of affected women died within 10 years. Contributing causes may include genetics, personality type, hormones, stress, and societal pressures.
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