Traveling With Your Anorexic

Traveling With Your Anorexic [image description: photo of person looking out at Machu Picchu]By Lauren Muhlheim, Psy.D. and Therese Waterhous, Ph.D.

Families often ask whether they should proceed with a previously scheduled trip or take a well-deserved “break” during the refeeding process.  We advise that travel during Phase 1 of FBT be avoided if at all possible.  We know several families who have vacationed with a child well along in treatment for anorexia and found their child lost 5 to 10 pounds over the course of a week, erasing months of progress.  Children and young adults with anorexia have difficulty with change; if a child is having difficulty completing meals in the home, it is unlikely that they will be able to do so on vacation, where most meals will be eaten in an unfamiliar setting in the presence of non-family members.

During vacation, parents may be tempted to give in more easily to the anorexic thinking and behaviors because they do not want to upset other diners in a restaurant or because they “don’t want to ruin” the vacation after they’ve invested a lot of money in getting there.  The food may be different than that available at home, or it may be difficult to get the types of foods on which the family has been relying.  Children and young adults with anorexia are inflexible; if the food is different than that to which they are accustomed, they may refuse to eat at all.  Sightseeing often involves a lot of walking, which can burn a lot more calories and require even greater caloric intake to offset.  Many vacations occur in warm climates, where health problems related to malnourishment or dehydration may be magnified.  If families do travel during Phase 1 or Phase 2, they should be cautioned that it may cause a setback and prolong the recovery process. Continue reading “Traveling With Your Anorexic”

Exposure in the treatment of Eating Disorders

Exposure therapy is widely recognized as a necessary (and sometimes sufficient) ingredient of treatment for most of the anxiety disorders including phobias, panic disorder, and obsessive compulsive disorder.  Anxiety is a core psychological feature of anorexia nervosa and bulimia nervosa.  However, instead of being afraid of heights, speaking in public, having a heart attack, or contamination, individuals with eating disorders are primarily afraid of food, eating, and shape and weight.

Both cognitive-behavioral therapy and family based treatment, two empirically validated treatments for eating disorders, employ exposure techniques.  Exposure works through the process of habituation, the natural neurologically-based tendency to get used to things to which you are exposed for a long time.   During exposure, habituation occurs as people acclimate to their fear and come to realize that nothing actually dangerous is occurring. Habituation promotes new learning of safety, tolerance of fear feelings, and extinction of the fear avoidance urge.  Continue reading “Exposure in the treatment of Eating Disorders”

Surviving the first week of re-feeding

Family-Based-Treatment [image description: sugar cookies frosted with the words "Feed," "Love," and "Heal"]Surviving the first week of re-feeding your child using (Maudsley) Family-Based Treatment

In Family-Based Treatment (FBT), figuring out how to get your starving child to eat and gain weight is a daunting task. Parents often feel overwhelmed and helpless when starting out on a re-feeding program. It is important to remember that your child is literally more afraid of the food than of dying of starvation. But food is the medicine, and it is your job to save her (or his) life.

Anorexia makes children do things they would never normally do and an escalation of behavior is common when parents start to stand up to the anorexia. In fact, an escalation during the first week, although unpleasant and often scary, is usually a good sign that parents are not giving in to the anorexia. Consistent confrontation of the anorexia ultimately brings greater compliance as well as weight gain. It is imperative that parents work together and are well aligned; otherwise the anorexia can split them and gain strength. Continue reading “Surviving the first week of re-feeding”

Family-based treatment for adolescent eating disorders

Eating disorders, including Anorexia Nervosa and Bulimia Nervosa, are affecting greater numbers of adolescents and even children and early intervention is critical. If not identified or treated early, eating disorders can become chronic and cause serious or even life-threatening medical problems. Anorexia Nervosa is the most dangerous, with the highest death rate, of any mental illness: between 5% and 20% of people who develop the disease eventually die from it.

Although eating disorders can be notoriously hard to treat, recent research studies have demonstrated some highly successful treatments. For adolescents with anorexia, the treatment of choice is Family-Based Treatment (FBT). It is also referred to as the Maudsley approach (after the hospital in the UK where it was first applied).

Traditionally, parents of children with anorexia were viewed by mental health professionals as intrusive and were instructed to place their children into individual treatment or residential treatment centers. FBT, in contrast, respects the powerful bond between parents and child and empowers the parents to use their love to help their child. It allows the adolescent to remain at home and enlists the support of the family as a resource in helping them battle their eating disorder. The entire family attends every treatment session.

FBT treatment first focuses on helping the child to return to a healthy weight because the more time spent in starvation, the worse the outcome. The parents take responsibility for providing adequate nutrition for their adolescent during family meals. The therapist supports the parents in this challenging task and also creates a climate where there is no blame: the eating disorder is an outside force that must be fought off by the entire family working together. In the second phase of treatment, the parents gradually give the child more control over her (or his) own eating. The final phase of treatment addresses issues of adolescent identity within the family context.

FBT offers a promising alternative to costly inpatient or day hospital programs. Research out of the University of Chicago and Stanford University shows that at the end of a course of FBT, two-thirds of adolescents with anorexia have recovered; 75% to 90% are weight-recovered at a five-year follow-up. This approach has also been successful with adolescents with bulimia and with college students with anorexia and is most effective for families in which the length of illness is less than three years.

In my clinical practice, I provide treatment based on the most recent scientific research available. I provide FBT to adolescents with eating disorders in a course that usually consists of 20 treatment sessions over 6 to 12 months. Family-based therapy is not appropriate for all families. It is rigorous and requires a strong commitment by the family members. However, I find that the partnerships with families who have this commitment to their child’s recovery are very rewarding to me as a therapist. Families who have used this approach are generally very enthusiastic and grateful to have been a part of the solution.

For more information about Maudsley Family-Based Treatment for adolescent eating disorders and/or to find a treatment professional visit:

Drs. Lock and Le Grange who brought this treatment to the U.S. have also written a manual for parents based on this approach:

Help Your Teenager Beat an Eating Disorder, by James Lock, MD, PhD and Daniel le Grange, PhD.