Family Matters-The Maudsley approach

Living in such an independent society, we assume people's problems are their own. That person needs to deal with the issue and overcome. People dealing with mental disorders are seen in this light as well. That they need to go to therapy to sort out their issues than magically reemerge in society when they are "fixed". and for most disorders, this is not hte case

One of the papers I wrote in college on the topic of eating disorder had broken this commonly held belief. For patients with eating disorders, whether it is anorexia (AN) or bulimia nervosa (BN), there are many different types of therapy one will have. But, in the past 10 years family behavioral therapy (FBT), has gained recognition and has been widely used in the treatment of eating disorders.

With the research I have seen, although they all vary in their percentages, roughly 80% of people with eating disorders report the onset of the disease before the age of 20. A majority of these patients lie between the ages of 11-19. and it is safe to say a majority of the patients in this age range are still living at home. Therefore, their parents are their source of nutrition. They are the providers of the necessities; food and shelter. This is a main reason why FBT is so successful since it is important to educate the parents about their daughters/sons ED because they are essentially in charge of the food supply. This is not a treatment that blames the parents for the ED but rather, therapists will use the family as one of the strongest resources for helping their child to treat their disorder.


FBT, commonly known as the Maudsley Approach, started in London, and recently came to the states. Brought over by Daniel le Grange, it has proved over and over again to be successful, and here is a brief explanation of what this process entails

The Maudsley approact is done in three different steps

Phase I-Weight Restoration-
This phase focuses on the dangers of malnutrition that hte patient with ED is currently suffering from. (hypothermia, growth hormone changes, cardiac dysfunction, and cognitive and emotional changes). Also during this stage, therapist will usually watch the interaction at meal time between the family and child. They learn the interactions to be able to teach them better ways to help their child to eat, normally. The responsibility of mealtime is given more to the parent than to the adolescent. The therapist will teach the parents how to encourage and support their child during mealtime and how to talk them through a meal. During my experience at UMHP, having to talk someone through a meal is the hardest, but most gratifiying experience. But, after 5 hours of trying to get a patient to finish their ensure, it can get frustrating, and for parents who have to do this everyday, 3 or more times a day, learning how to deal with their frustrations is imperative. Therapist will work with parents to make sure that the parent remains focus. Each meal can be a HUGE obstacle for someone with an eating disorder, and it takes lots of energy on both the parents and the childs part to attempt to finish it. "the Maudsley Approach adheres to the tenet that the adolescent is not to blame for the challenging eating disorder behaviors, but rather that these symptoms are mostly outside of the adolescent’s control". Keeping this in mind, it will help the interaction between the child and parent during meal time, to be a lot more successful.

Phase 2- Returning the power to the patient
now that the patient understands the demand for food consumption that was imposed by their parent, they have gained some weight, and a change in the interaction of the family, phase II can start. This phase basically is when the transfer of power is starting to be given back to the patient. During phase 1, the issue of weight gain was brought up, but now other family issues will be discussed during treatment. It is hard to discuss difficult family issues when the patient is going thru the refeeding process since their mental abilities are not normal. Their moods are often erratic due to starvation, as well as being able to properly process what is going on. Now that their are at a healthier weight, their mood and mental processing is being restored to they are able to more successfull handle complex situations. Also during this stage, the patient will attempt to take power and control over their eating abilities, perhaps going out to the movies with friends, even if the parents are afraid they will choose not to eat, or binge while they are away. The patient is learning how to be in control of their meals, sometimes they succeed and sometimes they fail, but overall, they are trying to learn how to be in control of everyday situations that occur in life.

Phase 3- Establishing healthy adolescent identity
Phase III is initiated when the adolescent is able to maintain weight above 95% of ideal weight on her/his own and self-starvation has abated. I have heard a lot of girl say during their treatment, that their only identity is with their eating disorder. "I am anorexic" or "i am bulimic". Their eating disorder was not only a disorder, but is who they were. This phase teaches them that they are so much more. They teach them a healthy adolescent identity that they might have lost or might have never had due to their eating disorder. Therapist will try and support their personal autonomy, teach them and their parents appropriate personal boundaries, and in a whole, teach the family and patient to live a closer to normal life.

This entire process is a lot harder than just a 3 step program. This is process usually will take up to a hear to get through. And although most patients will recover form their disorder, the relapse rate for eating disorders in general is extremely high, over 50%. Although FBT and other treatments are proven successful at restoring weight gain and abstaining from ED tendencies, there had not been enough being done to find permanent or long term recovery methods for people with ED. Most of the memoirs I have read about ED and people I have spoken to say that they will with with ED for their entire life, but being able to maintain and control it is possible. Although they will live healthier lives without ED tendencies, the thoughts are still there and can be extremely stressful. I hope that with further funding and research that eventually there will be a treatment with longstanding result thats will free people with ED from their ED thoughts.

Bulimia-quick course

Out of the family of eating disorders, Bulimia is not the most commonly discussed in our society. Most people assume that the reason why people purge (throwup) is because they ate too much and are afraid to gain weight. Therefore, they head to the toliet, stick their finger down their throats, and vomit until their bile or marker comes up
*sidenote: a marker can be characterized as a food someone eats at the beginning of hte meal, something distinguishable in color like nacho cheese doritos, so when they see it come up when they purge they know their stomach is almost emptied.
Although this is the case sometimes, it is not the case all the time. People with bulimia do not only purge because they are afraid to gain weight. They also arent necessarily trying to lose weight. They are just trying to maintain. Also Most people don't know, but even by purging, calories are still being absorbed by the body.
Bulimics are usually triggered by emotions. What I mean by this is that they will become so overwhelmed with emotions (depression, anxiety, anger, etc), they will literally purge their emotions. They have said to feel immediate gratification, but shame and guilt settle in shortly after. This loss of control over their emotions is dealt with in therapy by teaching them how to effectively cope with emotions, and not letting them control them. Sometimes they just dont know any other way to deal with lots of emotions but to purge.
Usually people who purge do so in solidarity, because shame, guilt, and embarassment is a common emotion for bulimics, so avoiding other people knowing is important. Purging can occur once a week or several times a day depending on the severity of the disorder
Bulimia is harder to detect than anorexia since most bulimics tend to be of normal or above normal weight. Anorexics are more detectable due to their emaciated looking bodies. Although bulimia is not as detectable does not mean it is not as damaging as anorexia. Some of the consequences of bulimia are erosion of the esophagus, gerd, weak enamel, electrolyte imbalance, low potassium, heart problems, and a lot others.
Bulimia is not only classified by throwing up. But abusing laxatives, dieuretics, enemas, and over excercising are all considered purging.
There is a lot more i could write about but I hope this will give everyone a better understanding of what characterizes a Bulimic and that one doesnt have to weight 70 lbs to have an eating disorder.