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Family Based Treatment for Anorexia Nervosa

An Overview of the Maudsley Method

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Updated June 13, 2014

What Is Family-Based Treatment for Anorexia Nervosa?

Family-Based Treatment (FBT) is a three-phase treatment approach for anorexia nervosa in adolescents, initially developed at the Maudsley hospital in London and is often referred to as the "Maudsley Method." It has since been researched extensively in the United States.

The philosophy of FBT differs from other treatment models in several ways. In FBT, an adolescent suffering from anorexia nervosa is not seen as in control of his/her behaviors. Instead, the eating disorder is seen as controlling the adolescent. Neither the adolescent nor the family is seen as the "cause'" of the eating disorder. Parents are seen as a vital tool in recovery. As such, FBT encourages parents to take control of the adolescent's eating until weight is restored and control can be handed back to the adolescent. The role of siblings is also important in FBT as they are able to play an important supportive role.

FBT typically advances through three specific phases, each with its own goals:

  • Phase I focuses on re-feeding and empowering the parents. During this phase, weight restoration is the primary concern. Other emotional or relationship issues are set aside at this time. The parents are considered in-charge of choosing and making appropriate meals for the adolescent, plating meals, and providing support for the adolescent to eat an appropriate amount.
  • Phase II focuses on returning age-appropriate control to the adolescent. This includes things such as the adolescent being able to serve himself/herself and choose how much food to put on their plate or choosing what foods to order at a restaurant.
  • Phase III focuses on general adolescent and family issues. It may include adjusting family boundaries, as they may have been somewhat blurred during the weight restoration process.
  • If the adolescent is also suffering from other diagnoses such as depression or anxiety, these issues are treated after phase III has been completed. The rationale behind this is that the adolescent is not considered fully equipped to deal with these issues when they are malnourished.

Does Family-Based Treatment Work?

There have been multiple research studies which show that Family-Based Treatment is effective with adolescents who have been diagnosed with anorexia nervosa. Although there are not as many studies with adolescents who have been diagnosed with bulimia nervosa, the results of the existing studies have been positive.

Who Makes a Good Candidate for Family-Based Treatment?

  • Adolescents (under age 18) diagnosed with anorexia nervosa or those who are experiencing subclinical symptoms and are diagnosed with eating disorder, not otherwise specified.
  • The adolescent is medically stable. One goal of FBT is to avoid hospitalization. However, this is not always possible. It is, however, possible to use FBT once an adolescent has been medically stabilized at the inpatient level and has been discharged.
  • Families who have a high level of commitment to the treatment process. FBT can take up a significant amount of time and energy on the part of all family members, but especially on the part of the parents. Parents must be available to support their child's meals throughout the day and have the emotional energy to help their child battle the eating disorder on a daily basis.

Who Is Not a Good Candidate for FBT?

  • Families in which a parent suffers from a severe mental illness, including (but not limited to) an eating disorder. These parents are often ill-equipped to meet the demands of FBT.
  • Families where there is severe discord in the relationship between the parents. Families of all types, including divorced and two-household families have been successful at FBT. However, even if the parents are divorced, the parents must be able to be in agreement and work together against the eating disorder.
  • Malnourished adolescents who do not have anorexia nervosa.
  • Older people suffering from anorexia nervosa or those who do not live at home with their families. However, there are research studies being done to assess whether FBT is effective or can be adapted to treat young adults.
  • Families in which there is a great deal of parental criticism of the adolescent may be a poor match for FBT. However, research shows that doing FBT in separate adolescent and parent sessions (rather than in traditional, conjoint sessions) can be effective.

Sources:

Le Grange, D., Crosby, R.D., Rathouz, P.J., Leventhal, B.L. (2007). A randomized controlled comparison of family-based treatment and supportive psychotherapy for adolescent bulimia nervosa. Archives of General Psychiatry, 64(9), 1049-1056.

Lock, J., Le Grange, D., & Agras, W.S., Dare, C. (2001). Treatment manual for anorexia nervosa: A family-based approach. New York, NY: Guilford Press.

Lock, J., Le Grange, D., Agras, W.S., Moye, A., Bryson, S.W., Jo, B., (2010). Randomized clinical trial comparing family-based treatment to adolescent focused individual therapy for adolescents with anorexia nervosa. Archives of General Psychiatry, 67(10), 1025-1032.

Loeb, K.L., & Le Grange, D. (2009). Family-based treatment for adolescent eating disorders: Current status, new applications and future directions. International Journal of Child and Adolescent Health, 2(2), 243- 254.

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