Treatment for Anorexia in Adolescence

Recommendations for treatment for Anorexia Nervosa in Adolescence

If your child is under 18 and has had the Eating Disorder of Anorexia for less than three years than I would highly recommend something called The Maudsley Method. The Maudsley method is relatively new and the success rate is unlike anything we have ever seen for the treatment of Anorexia.

PRINCIPLES OF MAUDSLEY

• The cause of Anorexia is unknown
• No blame should be placed on the parents or the child
• The eating disorder is like an alien or demon that possesses your child leaving them powerless to fight the illness on his or her own.
• Food is medicine
• It is the families job, usually the parents, to reefed their child
• Sibling support, if there is a sibling, is very important The sibling should not be helping directly with the refeeding but can help by providing emotional support to the adolescent.
• The parents must present a unified front to fight the illness that has taken over their child
• The cause is unknown and not a focus, but Anorexia can be viewed as a regression to an earlier stage of development. Anorexia is viewed as a reaction to feeling unable to manage the developmental demands of adolescence.
• Anorexia Nervosa is extremely serious. Anorexia has the highest mortality rate of any psychiatric illness. It is just as life threatening as having cancer.
• Anorexia robs people of health, happiness, independence, reaching their full potential. In addition, anorexia often robs people of their life.
• After three years of living with the illness, the recovery rate is poor. Therefore, the family should intervene quickly.
• The lower the weight, the more control anorexia has over your child.
• Adolescents with Anorexia are unable to think rationally about the disorder and therefore the parents must take over.
• That when your child is at a low weight it is unrealistic to expect individual talk therapy to work.
• One or both parents should be available at every meal or snack to serve their child and see that she/he eats it.
• The parents should expect that it will be a difficult process. Not only is it hard to make the amount of time needed available for your child, but also your child will likely resist the refeeding process.

MORE ABOUT MAUDSLEY

• This is a family based approach to treatment.
• The Anorexia is viewed a serious illness that affects the whole family.
• The nutritionist and therapist make suggestions but ultimately the parents are considered the experts on how to refeed their child.

The three phases of Maudsley

• Refeeding Sessions (1-11) the family meets with the therapist one time per week. In this stage, the parents have complete control of the refeeding. This means that one or both parents will prepare the meals and snacks and sit with their child while they eat them. This may mean parents taking off time from work or having your child stay home from school. Refeeding will usually include three meals and three snacks a day. The focus is on empowering the parents to reefed their child.
• Negotiations (Session 11-16) The family meets with the therapist every 2 to three weeks. In this stage, the adolescent has gained back some of their weight and is at a minimum of 87% of their ideal body weight. At this stage there is some sense of relief over the adolescent’s health. There is a clear distinction between the Adolescent and the Eating disorder. The therapist encourages the family to examine the relationship between Adolescence and the development of the eating disorder. The therapist continues to discuss the difference between the needs and of the illness (The eating disorder voice) and the needs and desires of the adolescent. At the beginning of this stage, some of the control over the eating is given back to the Adolescent. By the end of this stage, the goal is for the adolescent to demonstrate they are ready to regain full control over food and weight.
• Adolescent Issues and Termination Session (17-20) the therapist meets with the family every 4 to 6 weeks. - The therapist discusses the stages of Adolescence with the family. Adolescent issues and strategies for problem solving are discussed. The parents are encouraged to reconnect as a couple and to focus on their relationship. Issues involving termination of treatment are addressed. The therapist helps the family figure out how to communicate, now that the eating disorder is no longer the main focus of their interaction.

The Maudsley method, done in a outpatient setting, is only indicated for adolescents who have had the illness less than three years and are able to live at home with their parents. These factors give parents more control and more leverage to fight the illness. After three years it is extremely difficult to see a clear distinction between the person and the eating disorder. Therefore the treatment options for adults do not include the Maudsley method.