Is Your Child’s Anorexia Treatment Up to Date?
Experts say families are part of the cure, not the problem
For more than 100 years, doctors and therapists have struggled to find effective treatments for anorexia. There are still few good treatment options for adults, but there are promising new approaches to adolescent treatment. That’s good news, since early treatment during adolescence offers the best chances for full recovery. According to an article in Stanford Medicine, the longer anorexia goes untreated, the harder it is to recover.
Many factors contribute to anorexia, including genes, environment, peer pressure and emotional problems, according to the National Association of Mental Illness.
But for a long time much of the blame was placed on parents, according to the Stanford Medicine article, and as a result they weren’t involved in treatment.
“All you have to do is search ‘anorexia’ online and you will find a lot of blaming of parents,” says James Lock, MD, PhD, professor of psychiatry and behavioral sciences at the Stanford University School of Medicine and director of the Child and Adolescent Eating Disorder Program at Lucile Packard Children’s Hospital. “In fact, we don’t have any substantive evidence that families cause anorexia.”
Getting parents involved in treatment
Rather than blaming parents, doctors should actively involve them in their child’s treatment, Lock says. Growing evidence supports this approach according to Stanford Medicine. A study published in JAMA Psychiatry in 2014 found that family-based treatment (FBT), an intensive outpatient program for adolescents with anorexia, is the preferred treatment method for these kids.
In some cases — those involving severe malnutrition or a psychiatric emergency, for example — children with anorexia may need to be hospitalized, according to the Mayo Clinic. But if a child does not have an acute medical or psychiatric condition, outpatient family based treatment has been proven to be just as effective as — if not more than — residential programs, the Mayo Clinic notes. And, according to Stanford Medicine, it’s a lot cheaper.
“In the past we’ve taken kids away from their families and put them in hospitals with the idea that the children would get better and go home,” says Lock. “They learn to eat in those settings, but not at home or in school.” So once they are discharged, he says, the children often relapse. Today, family involvement with teen patients is considered essential.
What about medication? The Food and Drug Administration (FDA) has not approved any medications for treating anorexia for one good reason — they don’t work. “There’s no evidence that any medication helps with anorexia nervosa in a systematic way,” says Lock. If a child suffers from another psychiatric disorder (such as depression or obsessive compulsive disorder), antidepressants or another medication may be prescribed, according to the International Journal of Eating Disorders.
How family-based treatment works
Family-based treatment is based on the “Maudsley method” developed by practitioners at the Maudsley Hospital in London. “Fundamentally, the process is about changing behavior,” says Lock. “We focus on facilitating learning and behavioral change with both the parents and the child.”
FBT usually entails about 20 family therapy sessions over a period of six to twelve months.
According to Mayo Clinic, the first goal of treatment is getting the child back to a healthy weight and teaching him or her proper nutrition. This may take months. Parents take the lead in gently but firmly guiding their children to make good eating choices. Often one parent will have to take time off work to ensure the child is getting sufficient nutrition at home.
Siblings are also involved. “Everyone in the family is affected when someone has anorexia,” says Lock. “Siblings play a role in being helpful and supporting their sister or brother with anorexia, just as if they had cancer or a bone fracture.”
Once the patient has gained weight and is eating without conflict, treatment focuses on getting parents to gradually hand over control of eating to their child. In the final stage, the family assesses what they have learned as a result of having struggled with anorexia, and on challenges for the future.
“When anorexia is in a family, everyone feels powerless — patients, parents, and siblings,” says Lock. “So it’s really reassuring when the whole family comes to understand the illness. Then they don’t feel so powerless.”
Unfortunately, outside of big cities and specialized treatment facilities, many therapists treating anorexia are not trained in FBT. Lock and his colleagues are working on new approaches to expand training to improve patient access to quality FBT wherever they live.
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