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ANOREXIA TREATMENT

Extreme Measures

When Kids' Size Is a Problem, Parents Seek New Solutions

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By Carrie Arnold
Special to The Washington Post
Tuesday, February 24, 2009

After 15-year-old Christina received a diagnosis of anorexia nervosa in 2006, her parents were told there was only one thing to do: Send her to a residential treatment center. "The nutritionist, the family physician, the therapist: They all said she's got to go," her mother, Anna Grieco, remembers.

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The Griecos had learned of Christina's illness just months earlier, although she had been struggling with the eating disorder for three years. They found outpatient therapy for her right away, but it didn't stop her from slashing her calories to starvation levels.

Feeling helpless and guilty, as if they were somehow to blame, the Griecos, who live in Chantilly, arranged for Christina to spend two months in an eating disorders clinic in Arizona, at a cost of more than $100,000.

In their haste, they forgot about a note that one therapist had scribbled on a scrap of paper: "Maudsley approach," it read. "Very effective for adolescents."

Looking back, the Griecos wish they had focused on it sooner.

Unlike traditional eating disorder treatment programs, which tend to equate parental involvement with parental interference, the Maudsley approach treats the family as an integral part of the healing process.

Named for the London hospital where it was developed in the 1980s, the Maudsley approach views food as medicine and parents as the optimal people to help their child return to health. Unlike traditional psychotherapy, this family-based treatment views the ill teenager as unable to start eating, rather than as choosing not to eat.

"Contrary to the general belief that kids with anorexia nervosa have an iron will, it's the exact opposite," said Tomas Silber, an adolescent medicine specialist and head of the Don Delaney Eating Disorders Program at Children's National Medical Center. "They literally cannot stop [starving]."

Therapist as Coach

Treatment with the Maudsley approach consists of three phases. During Phase I, the family focuses on working together to help the adolescent return to a healthy weight, with the therapist typically acting as a coach. As weight is restored and disordered thoughts start to retreat, Phase II hands control of food and eating back to the teenager. During Phase III, a therapist works with the adolescent to deal with any issues that might stand in the way of a healthy launch into adulthood. "Parents have to learn to step up to protect the child," Silber said, "and in the process of therapy you also let go of the older adolescent or young adult that emerges out of the disease."

A combination of promising research studies and the development of training programs for therapists has increased the popularity of this approach in the United States. The National Institutes of Health is funding research on the Maudsley approach at five universities across the country, and parent-advocates have stepped forward to demand further research.

As Daniel Le Grange, director of the Eating Disorders Clinic at the University of Chicago and one of the original developers of the Maudsley approach, said, "Parents are so helpful in taking care of children in any other sphere of life, why do we not include them when it comes to the treatment for anorexia?"

The exclusion of parents remains common in much anorexia treatment. Some therapists fear that parental involvement will interrupt the normal processes of growing up; others fear taking away the adolescent's control of something as fundamental as what they eat.


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