Family-based treatment for anorexia?

Eh I'm not an expert in the field, but I think that method only works for a small, small, special subset of anorectics. It would only work for very young, very dependant kids with no history of family conflicts or serious trust issues. When you consider that anorexia often develops out of family conflicts, etc, I don't think that method would work.
Here's a website about the Maudsley method...and there is a message board on there too: http://maudsleyparents.org/

Great topic!

The Tx of AN in general (one of my research areas) is quite complex, and I think this method would crash and burn with 90% of them. Enmeshment and familiar conflict are often a large contributing factors to the development of an ED, so for some...this would add fuel to the fire and often further ingrain the ED.

I need to run out and get my stuff for my peach bread pudding, but when I come back....I'll expound on my answer, it will be quite lengthly, so you've been warned. 😀

-t

First off.....this method can work, but I think only the very tame cases, and the ones that aren't rooted in the traditional pathology, but more in the societal pressures, etc. I would never recommend it, but some do. Some people try it when other methods fail, though I have concerns about the implementation. Personally, I think any model that is centric on one area is problematic. Many treatments look at mainly behavioral models, and then ignore the deeper rooted pathology. Other models are supportive, but lack structure, etc.

Frankly, reading this article I kept thinking, "SAFETY!!" Parents acting as pseudo-nurses, no real intensive therapy, lack of supportive groups, detached meds management, lack of daily (or more) medical contacts, etc. There isn't nearly enough structure. Parents can try and love as much as they can, but there is a real gap between what a parent can provide, and what a team of trained specialists can provide. Even within the profession, there is a huge gap in education and training in regard to eating disorder Tx, so pardon me if I doubt a lay person's ability to properly care for a person with an ED (ignoring the duel relationship, etc)

One of the biggest mistakes people make is that they think it is about the food. IT ISN'T. If you focus on the food, guess what....you are treating a symptom and not the root problem(s). The re-feeding process should be done in a hospital or in-patient unit....PERIOD. The medical issues related to re-feeding are far too great to have it happen any other way. True re-feeding won't be for someone at 83%, so if you are dealing with a low-weight anorexic, they are at <65-70%. If the re-feeding is done incorrectly, the person can have serious medical consequences. Gain too little, gain too much, imbalances, cardiac issues, etc.

The familiar roles in families of anorexics are frequently dysfunctional, and adding more layers to that through this method.....it seems pretty counter-intuitive.

Research has found that a number of methods are successful during the re-feeding process, but most/all methods start to fail post-re-feeding (I forgot my citation, I just read it a couple weeks ago...ugh) I believe the failure is due to not properly addressing the underlying pathology, and concentrating on the behavioral issues. A multi-discipinary team approach and long-term care models have shown some success. For many, this is a life-long struggle, and trying a quick fix is not really realistic.

-t

I work at a treatment center for adolescent girls with eating disorders and we use the Maudsley method in conjunction with CBT/behavioral milieu therapy and family therapy.

It would only work for very young, very dependant kids with no history of family conflicts or serious trust issues.

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Actually, these kids come with plenty of family conflict/issues and it works for them. As long as you don't *only* use Maudsley -- there is so much behind an eating disorder besides food.

The article raises some concerns for me in how it presents the treatment. There was little discussion of the role of the dietitian, psychiatrist, pediatrician, and therapist she mentioned briefly. From the tone of the article, these parents did everything themselves. In my experience with families using Maudsley, their team is readily available and supportive of the parents. As T4C notes, re-feeding syndrome needs to be monitored extremely closely in an inpatient setting. If nothing else, dehydration is usually so severe that continuous IV fluids are required for at least several days, if not weeks. Potassium, calcium, magnesium, and phosphorous need to be monitored daily at the beginning (less frequently as stabilization occurs), and are often given IV. Heart rates are bradycardic and dip into the 20s.. diuresis starts within a week or so.. Although the author indicates an ICU stay, she doesn't say for how long or what was done, other than the threat of a NG tube (which really should be an absolute last resort). I'm wondering how much of her story we're missing- to what point did the hospital stabilize her? To 100% of ideal body weight? 90%? 80%? It is possible she was discharged at a "safe" weight and kept on a weight-gaining meal plan until she reached her goal.

I'm interested that she mentions the Lock and LeGrange NIH study, as one of the study sites is in my city, and I routinely refer patients from my service over there for the clinical trial. (I work with Adolescent Medicine at a Level 1 pediatric teaching hospital- we have an inpatient re-feeding protocol on a medical floor, and outpatient follow-up with Adol Med and coordination of care with community psychiatrists, therapists, and dietitians.) I have a copy of the research design on my hard drive, and I can tell you that the study REQUIRES medical management by a collaborating pediatrician and regular lab work. It follows American Academy of Pediatrics guidelines that inpatient hospitalization (under the service of one of the collaborating peds) is a requirement at <75% ideal body weight. BFT is being compared vs more traditional family therapies to determine efficacy. It's the first large-scale study of its kind. In addition to age, they're also looking at family structure (ie, single-parent vs dual-parent homes) as a variable. Maudsley can obviously be very draining, so it may turn out that it's not ideal for a single parent.

I think it's important to remember that Maudsley has been developed as a tool to work with children and younger adolescents, rather than older adolescents and adults. I'm not sure that there's been any pretense that it would be effective with the latter populations.. Ultimately, the point of BFT/Maudsley is really to align patient and family against the disorder, not promote conflict between patient and family. In true Maudsley treatment, parents will be given training in how to effect change in the eating behavior by being supportive and minimizing the nagging we so often see. In an 8 y/o -or a 12 y/o, even- it SHOULD be the parents who are responsible for meal planning, preparation, and supervision no matter if the child has disordered eating or not. This is the age group where choice in the matter is limited. As they move into high school, kids start making more of the choices (meals out with friends, etc) so Maudsley is not as effective. Certainly it is not a cure-all, but it does have promise for its target population.

michalita said:

I work at a treatment center for adolescent girls with eating disorders and we use the Maudsley method in conjunction with CBT/behavioral milieu therapy and family therapy.



Actually, these kids come with plenty of family conflict/issues and it works for them. As long as you don't *only* use Maudsley -- there is so much behind an eating disorder besides food.

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^^Yes, but that article (I only skimmed it) seemed like it only used Maudsley, as do many parents on the Maudsley Parents forum. And I think I said serious family issues...I think using Maudsley with a mother and father who had sexually molested their daughter would be almost counter-intuituve as opposed to a kid who had to deal with "normal" family conflicts of divorce and such. ...but I don't work with such a population, so I don't know.

danzgymn,

Oh yeah, I have no idea what the effectiveness of the method would be without all the other supports and interventions my program offers. Obviously it's only appropriate in certain situations and with proper external supports.

pingouin said:

As T4C notes, re-feeding syndrome needs to be monitored extremely closely in an inpatient setting. If nothing else, dehydration is usually so severe that continuous IV fluids are required for at least several days, if not weeks. Potassium, calcium, magnesium, and phosphorous need to be monitored daily at the beginning (less frequently as stabilization occurs), and are often given IV. Heart rates are bradycardic and dip into the 20s.. diuresis starts within a week or so.. Although the author indicates an ICU stay, she doesn't say for how long or what was done, other than the threat of a NG tube (which really should be an absolute last resort).

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You hit my concerns on the head. I too have worked inpatient, and dehydration, unstable labs, pulse deficits, peripheral edemas, etc are all common concerns for pts in the 60's and 70's (of ideal body weight). I wouldn't want the pt outside of a medical setting with any combination of those things. Simple things like dehydration can really complicate things if the person is at a low weight.

I would be interested in reading more up on that study you mentioned. I can see SOME benefit at younger ages, but I'd be concerned it would reinforce many of the problems that contributed to the ED in the first place.

-t

Um, hi. Unfortunately, I know next to nothing about eating disorders and have nothing to add. I just wanted to say that I am really enjoying reading your responses. I wish we had more threads where clinicians/researchers shared their experiences - it's fascinating!

amy203 said:

Um, hi. Unfortunately, I know next to nothing about eating disorders and have nothing to add. I just wanted to say that I am really enjoying reading your responses. I wish we had more threads where clinicians/researchers shared their experiences - it's fascinating!

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That is something I'd like to see more of in the forum, in addition to more research discussions. I can try and post more about my experiences if I think they are relevant. This is my area of study for my clinical work and research (specifically low-weight anorexics), so I can talk about this stuff all day/night and not get bored.

-t

I think it is incorrect. If you get the patient back to a healthy weight, that doesn't alleviate any of those Sx's. Starvation can contribute to irritability, cognitive impairment, and the like....but the pathology is still going to stick around if not addressed, regardless if starvation is present or not.

-t

^^^^ Agreed.

Often, the rituals and seeming need to control are manifested in many ways outside of eating: hygiene, schoolwork, extra-curricular activities, interpersonal relationships (ie people-pleasing). It is rare that I see a kid who has a sense of moderation- most of our patients are super-achievers in at least one area. Anxiety runs rampant (OCD included) in our population, as does depression. Truthfully, we tend to see an upswing in anxiety symptoms as re-feeding progresses: now that their brains have better nutrition, their cognitive function returns and more energy can be expended on obsessive thinking.

Eating Disorders are outside my realm of comfort. I typically refer these patients away once they are identified. What I do know from clinical practice is that beyond just the eating/wieght issues there tend to several other pathological behaviors. Reading the article I did not see some of things that are important, to me as a clinician such as making sure the pt is medically stable with frequent check ups by an MD/Nursing staff. What kind of support did this family have. I was a little dissappointed in the article in that it did not explore some of these other areas, it was a great article for starting a good topic thread.

Jeff

Co-morbidity is definitely an area that should be explored. MDD is common, as are Axis-II Dx's, the full range of Anxiety Dx's, Bi-polar, PTSD, and OCD/OCPD. I don't know the stats off the top of my head, but I'd be curious to see if there is any research speaking to substance abuse and bulimia. I'd hazard a guess it happens at a higher occurrence than with anorexics.

(Below are just my opinions and musings based on pts I've worked with)

I've found MDD and/or anxiety dx's the most common....though sometimes it is harder to tease out if the anxiousness is primarily ED related, or if there is secondary anxiety, regardless of the presence of the ED symptoms. I believe in treating the person and not just the Dx, so the manifestation is what I'm concerned with, not the strict Dx. The anxiety seems to shoot up as treatment progresses before it goes down, though as insight and coping skills are gained, it typically goes down.

As for Axis-II....more often than you'd think, but I think borderline is over-dx'd, and quite misunderstood in general, especially in regard to this population. The self-harm piece is what gets flagged for the Dx, but I'd argue that it is more closely related to the semi-delusional state of the pt (especially low-weight anorexics), and is merely a maladaptive coping skill, as opposed to a part of a deeper pathology.

I think bi-polar seems to cluster well with bulimia and some ED-NOS, but this is far more anecdotal. PTSD appears frequently, though I think sometimes it is actually sub-clinical PTSD symptomatology. I think the term 'trauma' casts a wide net, and while still quite influential and significant, it isn't truly PTSD. I think the traumatic events can really contribute to the ED development and continuance, though I don't believe it to be the cause in the vast majority of the cases. I think one of the most lasting things I've learned from working with the PTSD in regard to ED, is the amount of pain inflicted from life circumstances coupled with the self-infliction of the person, and the amazing resiliency of many of the survivors. In particular, the sexual and repeated trauma survivors, who were able to work though those events and build an inner-strength that can outlast their ED.

I've seen the OCD/OCPD tendancies to come up mostly around the food rituals and rigid thinking that is associated with certain EDs (which is a rule out for the separate Dx), though I believe sometimes the commonalities of an actual OCD/OCPD Dx can fuel the development of an ED, and it warrants a separate Dx. I believe when the ED develops, OCD tendencies develop in reaction to the rigidity and 'rules' that often accompany the ED. Some of the most interesting delusion-like rationale comes during this time. As the person becomes more ingrained in the rules and delusion-like rationale, the thoughts become more and more distorted. I've had pts in the past who assigned certain times during the week (down to the minute) for certain food, and then certain compensatory behavior based on the exact in-take or interaction with the food, complete with a rationale that to anyone on the outside sounds completely off the wall. The compartmentalization that happens to many pts is amazing, how they can be intact in certain areas, and completely not in other areas. One of the challenges while engaged in therapy is managing those compartments, as the rigidity comes down. I think working in this area is as much art as it is theory, since no two cases are ever the same, and it often takes a reliance on the learned skill to get through where the theory falls short or is incomplete.

-t

This debate has proved very interesting to some parents and sufferers connected to the Maudsley parents' site and to the writer of the original article. I am NOT that author, but I do have contact with her. If members here think that she worked without medical support or is advocating this for others then they are mistaken - as your moderator has said in proper Maudsley treatments (although the exact nature of "Maudsley" could be debated for hours

with families using Maudsley, their team is readily available and supportive of the parents.

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and this team very much includes the medical doctor. I think this should be understood when debating the subject.

Although I can see why some parents might be offended by some of the comments here, as an informed lay person, parent and passionate advocate of the public health system in the UK I'm encouraged that you are debating eating disorders here on this site. They are all too common, life-threatening illnesses, not the choices of a subset of spoilt girls and the more medics who express an interest in how they are treated the better as far as I am concerned. Keep up the good work and keep reading, researching, debating and working to beat eating disorders.

If any of you are interested in following the very lively debate among parents and other concerned parties that reading your discussion has provoked it can be accessed here http://eatingwithyouranorexic.blogspot.com/2008/01/when-psych-students-attack.html

As I'm not actually a medical student (although I was sitting with three of them when I signed in) you may wish to bar me from posting further, but please do consider listening to the voices of parents who have not only lived with these illnesses and helped their children to recover, but researched the latest findings thoroughly.

I can't believe that an SDN thread lead to such a debate in another online community. I encourage everyone who originally posted in this thread to read that discussion.

Well I read it, and call me stupid or "silly" but I can't seem to figure out what their beef is. Nobody said ALL people with EDs have family problems or were sexually abused. In fact I think this thread has painted a pretty hopeful picture of ED treatment.

Maybe I'm misunderstanding. 🙄

marcella said:

As I'm not actually a medical student (although I was sitting with three of them when I signed in) you may wish to bar me from posting further, but please do consider listening to the voices of parents who have not only lived with these illnesses and helped their children to recover, but researched the latest findings thoroughly.

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SDN welcomes current and future professionals, as well as other people who want to make a contribution, so I'm glad you thought enough of our forum to join up and share some of your insight.

As for the topic at hand, I think this is a very healthy discussion (both on here and the link), and I'm glad that there are people out there talking about it. During breaks in my day I've been writing some responses to some of the questions/clarifications. I'll post them up in a bit.

-t

Since most probably don't have blogger accounts, I posted my responses here also, in the event people want to continue this discussion further.

-----------------
Hey all, Therapist4Chnge here, Senior Moderator from SDN. I think it is very important to have places to share ideas and experiences, as no one has an all-encompassing experience. It is also important to understand where people are coming from, because that will greatly influence their perspective on an area.

I've been involved in ED and body image work for the past 7-8 years, and it is my area of research and clinical expertise. I've been fortunate to work in both research and clinical settings (in-patient and out-patient), and I have been able to work closely with individuals and families effected by EDs and related challenges. I actually have an organization that I started awhile back that eventually will provide out-reach education for professionals and community members. StrugglingWithFood

I think where Maudley is effective is in recognizing the importance of family involvement, though other treatment models also include the family, though at different levels of participation. Instead of getting off on my views of Maudley, I'd like to respond to some of the comments/questions here.

Laura: Bruche's writings on the possible family influence on the development of an eating disorder can seem accusatory, though it isn't about blaming but learning how early childhood experiences can influence a person later on in life.

"The older patients described above are a small subset of patients. Most ED patients, especially in AN, are diagnosed as adolescents living at home with less than 3 years of illness."

This is actually incorrect, as there are a great number of adults who struggle with EDs, many of which weren't realized until more recently. There is more of an awareness now in younger people, with some particularly scary trends that are happening very early on (8-12 yr old), though the <18 are not the majority of the population seeking treatment.

Laura: Treatment effectiveness is quite splintered because of the complexity of each individual's situation, so it hard to general a treatment model.

The role of enmeshment is well founded in the literature and in clinical practice, and it definitely needs to be considered in treatment. It obviously isn't a factor in all cases, but it is definitely present in many.
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-t

Anonymous: "Therapist4Change does seem quite hopeless even though s/he is not an older doctor but a mere student "For many, this is a life-long struggle, and trying a quick fix is not really realistic.""

I take a bit of offense to ‘mere student’, as I have more training and experience in this area than most general professionals (going on 8 years), though that is neither here nor there. As for your comments, it isn’t that I’m hopeless, I just understand that for many this *IS* a life-long struggle, and that there is still a great deal of work that needs to be done to properly address treatment and hopefully recovery from EDs. My particular area of interest is in the more severe cases, so a lot of my comments are in regard to those people, and not someone who may be closer to the beginning of their ED and/or less severe presenting symptoms.

Anonymous: "The re-feeding process should be done in a hospital or in-patient unit .... PERIOD" he or she is dreaming. That's not a realistic option, even if it were desirable (which it is not). “

Let me clarify my statement…if someone requires moderate to extensive re-feeding (<70% of their ideal body weight), a hospital or in-patient unit is the best place for them, as medical complications are much more likely to be present. Once the person is medically stable then the remainder of the weight-restoration can be done in a different setting. In a compromised state, adding weight too quickly can be just as problematic (or moreso) than dropping weight….which is why there should be 24/7 care. Not everyone can go this route, so alternative routes are needed, but many people underestimate the risks involved in not handling this part of the process under the close supervision of professionals.

Anonymous: I'm repeating myself, but I'll ask again: if the parents don't take charge of refeeding, who will? Is Therapist4Change saying that if hospital or inpatient refeeding is not available, the sufferer should be left to starve on her own? Please answer.

It depends on the setting, but in an ideal setting a nutritionist and supporting medical staff will be in charge of re-feeding, at least to a point where the person is back to a place where they can better function and take care of themselves. Minors add another level of complexity to the equation, but many of the same challenges are present.

Re-feeding is merely one step in the process, and the in-patient setting provides all of the other support services that out-patient may or may not provide.

As for starving….of course they shouldn’t starve. Many parents struggle for many years trying to help their children (either young or grown), but that often isn't enough. It isn't a failure of the parents, but instead a result of the ED that they need additional support.

I understand not everyone can seek treatment, so other avenues need to be explored. There are support groups, local programs, and related services that can be used, and I hope they *are* used. The family is an important aspect of recovery (particularly for minors), but there are many challenges that come along with what some (myself included) may see as duel relationship roles for the parents.

Anonymous: You are correct that nothing on SDN should be construed as medical advice. It would be unethical to give medical advice. Anyone seeking medical advice should go see the appropriate health care professional in person for evaluation and treatment.


-t

Thank you for the welcome.As an interested bystander I'm finding many of the threads on this site very interesting, although in the interests of my sanity and my ability to hold on to my job (in medical administration) I'd better not spend toooooo much time here as well as on the other (eating disorders) sites I frequent. 🙂

I am really glad that there can be debate and sharing of information and ideas. As someone whose particular fascination is the economic history of medicine what do you here think of the economics of the treatment of eating disorders? Should more resources go into relatively cheap (for the state or insurance company) outpatient programmes using evidence based FBT, CBT or IPT, or should centres of excellence with full medical and psychological staff and IP, OP, PHP options be the norm. If individuals choose something different to that provided in their locality, who should pay for it? Any suggestions?

I read this today. It's from another Internet forum and therefore no more (or less) scientifically based or reference than anything on this forum. I find it absolutely fascinating though.

The simple truth is that until eating disorders become profitable illnesses
to treat, those who suffer will continue to receive inconsistent and
sub-standard care.

When the 30-day insurance max is reached in any mental illness (UNLESS it is
judged biologically based) well or not, you are given the boot - unless of
course, you can self-pay. Not with cancer though, because it is a PROFITABLE
illness. Hospitals are actively looking for the cancer dollar. Insurance
covers! And what it doesn't cover, often times a community will rally behind
the sufferer and their family with bakes sales, car washes, walks, and all
sorts of events to supplement uncovered expenses. Sorry Carla, there will be
no fund raisers for you.

And until "big pharma" sees profit in treating eating disorders with the
next great "purple pill", again, treatment will be sketchy.

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That blog was an interesting read- marcella, thanks for sharing it.

In an effort to clarify a few things I saw on there, let me make a few points. First, to my knowledge, none of the posters in this thread are medical students. There was some discussion of whether ED issues are discussed in medical school, and that is moot for this particular group of respondents. Second, I was mentioned as "the moderator"; although it is true that I am a Senior Mod on SDN, Psychology is not my assigned forum- that honor lies with Therapist4Change. I post a fair amount here as I am a clinical social worker with almost-but-not-quite 10 years of post-grad clinical experience.

In my initial post, I spoke of refeeding, and I think I may have been using a much narrower definition in my mind than what many on your board are using. Below 75% of optimal body weight, the body is prone to going through "refeeding syndrome" and needs close medical monitoring- hence the AAP guideline. Since I work in a medical facility, and ALL of the patients on my service are <75%, my mental definition was of the acute stages. I wholeheartedly agree that refeeding is a PROCESS, much of which occurs as an outpatient with the parents and caregivers being responsible for meals under the guidance of the ED team. We get our patients to about 78-80% and the rest is done outpatient and/or in a treatment program.

I re-read Harriet's article this morning, and I do stand by my opinion above- that a lot of the support that her family likely received goes largely unmentioned. My critique is not of Maudsley, nor of the family, but of the slant of the article itself. I think she relayed the frustration of the treatment process very well, and raised some excellent points regarding barriers to treatment: prohibitive costs, proximity to appropriate treatment providers, having no idea where to start looking or what you're even looking for.

For me to want to share the article with the families I work with, I'd like to see more emphasis on the fact that Maudsley utilizes a team approach. The most frequent argument I hear from parents is the lack of necessity of a dietitian. Again- we all know how important this person can be to the family. So if Harriet ever writes another article, I'd want her to talk about things like: What role did the dietitian play? No doubt, the meal plan was adjusted ad nauseum to accomodate for Kitty's preferences, growth, and level of activity.. And the pediatrician? What kind of monitoring was done- weights, heights, lab work, vitals? How often? What about the therapist? How often? Family sessions only or did Kitty have individual time? Which team members are/were available for after-hours issues- because Lord knows that crises do not schedule themselves between 8-5 M-F. I cannot relay via internet how much I would LOVE to have such a peer-written resource to provide to parents so that it's not just coming from "us" to "them".

Engaging parents to take an active role can be difficult, often due to ignorance or stigma about EDs, limitations in resources (both family and geographical), and unfortunately in a few cases I've worked with, seeming apathy. The family themselves have to be willing to invest the time, energy, and money. Of my families who are willing and able to do that, we have some great outcomes! It's wonderful to see the fervor with which the parents on the blog have fought to get and keep their children healthy. I truly wish I could say that was my experience with every family who walked through our doors. Truly.

To attempt to educate and engage, we provide parents with FAQs about EDs, reading material suggestions (including Lock/LeGrange and Siegel in particular), and ongoing support both during and after hospitalization. We share with them that current research shows EDs to be about 50% genetic. My physician shares research about differences in PET scans of brains of anorexic vs non-anorexic teens which show that this is not a "behavioral" issue- it's truly a change in brain function. We tell them it's not their fault, but we need their help in getting their child well. We let them know that the average recovery time is 5-7 years, so they need to prepare themselves for the possibility of a long haul. It's a start. Several mothers, finding us after multiple attempts to find help, have talked to me about how they can do outreach to other parents as a preventive measure. Ideally, they'd be able to teach about early warning signs and be able to direct other families to us so that there is minimal time wasted on unproductive phone calls with underinformed or misinformed medical providers.

Ultimately, we're all on the same team- keeping kids healthy. (And adults, too. But I don't work with them so I'm just going to ignore them for the sake of this post. 😎 )

nice post.

👍

-t

Very good post Pingouin - do I have your permission to post it on the other site? I

Here is some research that talks about other treatment options for patients with anorexia:

Bruch, H. (2001). The Golden Cage: The Enigma of Anorexia Nervosa. Harvard University Press. Boston.

Garner, D.M., & Bemis, K.M. (1982). A cognitive-behavioral approach to anorexia nervosa. Cognitive Therapy and Research, 6, 123-150.

Garner, D. M. & Garfinkel, P. E. (1985). Handbook for psychotherapy for anorexia nervosa and bulimia. New York: Guilford Press.

Garner, D.M., Vitousek K.M., Pike, K.M. (1997). Cognitive-behavioral therapy for anorexia nervosa, in The Handbook of Treatment for Eating Disorders, 2nd edition.( 94-144). Edited by Garner DM, Garfinkel P.E. New York, Guilford.

Johnson, C. (1990). Psychodynamic Treatment of Anorexia Nervosa and Bulimia. Guildford Press. New York.

Pike, K.M., Walsh, B.T., Vitousek, K., Wilson, G.T., & Bauer, J. (2003). Cognitive behavioral therapy in the post-hospital treatment of anorexia nervosa. American Journal of Psychiatry.160 (11), 2046-2049.

-t

ps. Ignore any formatting/style errors. 😀

I'm now reminded of why I avoid blogs like the plague.

It is an important discussion to have though - delineating the role that therapists play in the recovery process compared to everyone else (health worker, family, individual, everyone really). I stay out of ED because its just not an area of major interest to me (even though it is very close to the "addictions" family), but that's just a matter of personal interest and its certainly an area very much in need of additional treatment/research.

Ollie123 said:

I'm now reminded of why I avoid blogs like the plague.

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Maybe playing in the deep end of treatment is making me over-estimate the depth of pathology for people in their first handful of years in their EDs, but I've worked with a good deal of adolescents and their pathology is typically quite ingrained and often times rooted in very significant things that family-based intervention can't begin to touch, but many times would cause further damage. I don't do out-patient work, so I know I tend to see patients at their most compromised. I guess as long as people can find recovery, that is what matters.

I decided to bow at on the blog, as the anonymity of the internet was too much for some and their vitriol and venom was becoming obnoxious, though I welcome further professional and cordial discussion here.

-t

It did seem like alot of the discussion boiled down to people just referring to completely different situations.

Based on my EXTREMELY rudimentary knowledge of this area (that is to say, don't take anything I'm about to say seriously), I think the benefits from a family based treatment come in the form of an improved social support network, which is really an important part of recovery from any psychological disorder. From what I know of ED though, like most disorders, we don't HAVE a good treatment right now (at least not anything that meets my standards of good), we are just stuck choosing from a list of things that don't work very well and its more a matter of what sucks the least. What can I say, I'm a cynic.

As for venom, this is why I stay away from blogs. Too political, too personal, etc. Not that I blame people for being very personally vested in something that deeply affects them and those they care about, but it seems like in most of the blogs I've stumbled across people are too emotional to actually engage in a reasonable discussion, and (in my eyes at least) they often end up hurting their own cause. Of course, there's always good ones as well, but the vocal minority just makes it not worth it to me. It reminded me of the feminist blog a few months back arguing that ECT is America's way of keeping women down, albeit much less extreme.
This is why I love academia. If people want to debate, they can do so empirically via peer-reviewed journals😉 (I wonder what that says about my own psyche....)

biogirl215 said:

As the OP, I'd just like to apologize if I opened up a can of worms, so the speak; I just think this was/is an interesting topic... Sorry (slinks back into underground layer....).

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No problemo!

It offered a lively discussion.

-t