Back one last time with evidenced-based research to support family-based therapy as the intervention of choice in most instances. As MOST eating disorders start in adolescence or the teen years, this information is critical to get into the hands of families. It is also critical that families ask for it as only then will clinicians begin to offer it on a more widespread basis.
The Wall Street Journal
OCTOBER 5, 2010
Parental Role Aids Anorexia Recovery
By SHIRLEY S. WANG
Anorexia patients' families, once considered partly to blame for adolescents succumbing to the dangerous eating disorder, are increasingly being incorporated into the solution.
In the strongest evidence to date to suggest families should be involved in treatment, a 121-patient study published Monday found that a therapy in which parents remain present at each meal until an anorexic child eats appears to be more effective in fostering recovery than when a child works solely with a therapist.
The so-called Maudsley model—developed at Maudsley Hospital in London more than 20 years ago—calls for parents to take charge of feeding a severely underweight child, "making it impossible not to eat," said Daniel Le Grange, one of the study's authors and director of the Eating Disorders Program at the University of Chicago.
Patients with anorexia nervosa, a sometimes deadly disorder, often refuse to eat because of a fear of gaining weight and develop abnormally low body weight as a result. The condition was once thought to be related to a patient's desire for independence and it was believed that treatment required separation from parents.
Even now, a popular criticism of the Maudsley method is that it "runs roughshod" over adolescents' need to develop independence, according to Dr. Le Grange.
While anorexia tends to develop in teenage girls, the illness can also affect males and people of other ages.
The study, conducted by researchers at the University of Chicago and Stanford University, showed that one year after treatment ended, patients who received family therapy were more likely to reach and stay in recovery compared with those treated one-on-one by a therapist.
The difference in effectiveness became more pronounced over time. At the end of the year-long treatment regimen, about 42% of patients in the family-therapy group were considered in remission—that is, within 5% of their healthy body weight—compared with 23% of those in the individual-therapy group, though the difference wasn't deemed statistically significant. But 12 months later, nearly half those in the family-treatment group were in full remission, which was significantly better than the 23% in the professional-therapist group.
The study appeared in the Archives of General Psychiatry.
"This is additional evidence that involvement of the family can be a very effective way in helping kids overcome their problems," said B. Timothy Walsh, an eating-disorder researcher and professor of psychiatry at the New York State Psychiatric Institute, Columbia University Medical Center, who wasn't involved with the study.
When Rina Ranalli began using the Maudsley approach for her then-13-year-old daughter in September 2008, she was skeptical. But Ms. Ranalli and her husband tag-teamed to sit with her through three meals and three snacks daily. For the first two months "it was hell," said Ms. Ranalli, who said she told her daughter over and over, "This is your food, this is your medicine, this is what you're eating, no question."
By November, her daughter was gaining weight consistently, the meals weren't as prolonged and Ms. Ranalli started "seeing sparks" of her daughter's personality again. The girl was able to reach her target weight by January.
"It's just a very difficult thing to endure emotionally," said Ms. Ranalli, a stay-at-home mother in Chicago, but "when you can actually be part of the solution, it empowers you."
Write to Shirley S. Wang at email@example.com