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DEAR MAYO CLINIC: My godchild has been "captured" by anorexia nervosa -- held hostage by invisible forces that we cannot understand fully, if at all. It is just tragic. This talented, intelligent, loving and caring person has been in and out of treatment centers and hospitals, unable to start an independent life or take on college or work. Have we overlooked any resources that might help her overcome this terrible affliction? -- Stamford, Conn.
A: Many people with anorexia nervosa undergo multiple hospitalizations, and even long-term inpatient treatment, because it is a serious condition requiring professional care. But treatment's success might be enhanced by a new approach called family-based therapy, especially if it is employed early in the disease history, before a legacy of perceived treatment failures has been built up. While studies evaluating family-based therapy are few, the emerging body of evidence is encouraging.
How it works
Here's a general overview of how family-based therapy works:
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From the beginning of treatment, which is individualized for each family, the patient's parents are enlisted as an integral part of the team. For example, in weekly sessions at the clinic, the therapist provides guidance to the family about how best to structure meals and encourage eating and weight gain. An in-session meal -- to which the family brings a picnic lunch -- allows for some practice.
Parents are instructed to take charge of the patient's eating -- essentially, to refeed the patient -- until their son or daughter is able to eat healthfully and in sufficient quantity on his or her own. Over time, the patient gradually assumes responsibility for beneficial eating.
The reason why family-based therapy assigns the management of feeding to the parents -- this is actually one of its major innovations -- is that patients are not well enough to do it themselves. One serious limitation of traditional therapies is the assumption that anorexic patients are sufficiently motivated to change. To the contrary, they tend to be in denial regarding the seriousness of their eating disorder, and this prevents them from taking the necessary steps for recovery.
Integrated approach
Another limitation of traditional approaches is that a patient is often under the care of several professionals -- typically, a psychologist, psychiatrist, family therapist and dietitian -- who are not necessarily allied with one another or coordinated in their approaches.
Because there is no single, coherent plan of action, the effectiveness of treatment by even the best practitioners in these fields can be blunted. With family-based therapy, however, there can be a more integrated effort, with these specialties united and orchestrated right from the start.
Finally, a crucial part of recovering from anorexia nervosa is for the patient to assume the developmentally appropriate task of the teenage years and early adulthood -- becoming an autonomous individual. To do this, the patient must learn to connect with a healthy peer group. Family-based therapy helps provide the foundation for undertaking this vital step toward adulthood. -- Leslie Sim, Ph.D., Psychiatry and Psychology, Mayo Clinic, Rochester.
To e-mail a question, go to www.mayoclinic.org, or write: Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite 114, Buffalo, N.Y., 14207.
