Family Treatment for Eating Disorders
The causes of eating disorders are both complex and difficult to determine. There are recognised hereditary factors and dynamics within families that contribute to the onset of an eating disorder such as Anorexia Nervosa, Bulimia Nervosa or other illnesses under the umbrella of Eating Disorders. Since eating disorders have their greatest onset proportionately in adolescence – that is, when a person is still nearly completely reliant on the family unit for their well-being – the National Institute for Health and Care Excellence (NICE) in the U.K. recommend eating disorders be treated, where possible and medically appropriate on an outpatient basis. This puts the bulk of the responsibility of care onto the family. Even after the sometimes tortuous route to a proper diagnosis, many factors contribute to the rate of success of eating disorder treatment. One of these very important factors is the family dynamic and involvement.
An approach first pioneered in the U.S. in the 1980s, and then expanded upon at the Maudsley Hospital in the U.K. has come to be widely accepted after research shed much light on the family dynamic within eating disorders. With backing from on-going research, Family Based Treatment (FBT) or the Maudsley Approach delivers hope of cure, but requires deep and sustained commitment from primary caregivers.
A 2013 study from the Journal of Eating Disorders of the impact of interpersonal relationships in Anorexia Nervosa (AN) supported earlier findings that, indeed, the family can contribute to the:
1) onset of eating disorders through inherited vulnerabilities such as a strong eye for detail and a weakened ability to shift attention between one task and another.
2) maintenance of eating disorders in that the above traits made them more likely to react to a child’s eating disorder with criticism, hostility and overprotection.
Indeed, before the general acceptance of FBT, parents were often seen only as part of the problem and not the solution. Recent studies have shown that when family are directly involved in treatment, the likelihood of cure is vastly increased. For example, in the Maudsley Approach to AN, the practical road to recovery is broken down into three phases, all of which include regular counselling sessions as a family unit. This approach is deemed appropriate only for those less than 19 years of age who have suffered AN for three years or less. It is also applicable to and has been adapted for other eating disorders.
Phase 1 – Weight Restoration (weekly counselling sessions approximately 1-11 sessions).
This first phase relies heavily on helping children return to a healthy weight. A specially trained therapist instructs parents in non-critical sympathy and understanding of their child’s illness. The family dynamic and typical interactions are observed firsthand by the counsellor as they prepare and eat a family meal. From there, recommendations are made as to how to help their child.
This can be a burdensome and time-consuming exercise that requires deep commitment and united persistence on the part of parents or caregivers. It is sometimes the case that a parent will have to scale back or take a leave of absence from their job in order to fulfil the demanding schedule of being ever-present for their child. Underpinning the success of this phase of treatment is the imperative that parents are not to blame children in any way for their predicament. It is a counsellor’s role to help ensure parents work through their own feelings of responsibility or hostility towards their child, to ensure success.
Phase 2 – Returning Control over Eating to the Adolescent (fortnightly counselling sessions, approximately 5 sessions).
This phase begins as the young person meets parental expectations of food intake and gains physical weight and mental health. Parents are instructed to encourage their child to take more responsibility for their eating and actively negotiate trial periods when the young person is in control. With steady weight gain and less persuasion from parents needed, the young person is ready for Phase 3.
Phase 3 – Establishing Healthy Adolescent Identity (monthly counselling sessions, approximately 4 sessions)
The final phase focuses on the impact that AN has had on the young person. The goal is in returning to a healthy identity free of AN. A stable weight is achieved and with continued therapy a goal of returning to regular adolescent development is pursued.