by Belinda Dalton
Special to F.E.A.S.T.
Anorexia nervosa (AN) is the third most common illness in adolescents, following obesity and asthma. It is a condition that is potentially chronic and extremely complex to treat as both psychological and physical consequences can, in worst cases, be fatal. One aspect of the illness is a distortion in the beliefs of the sufferer that lead them to deny that they are unwell and need treatment. Many sufferers describe feeling fat, despite being extremely underweight. They are unable to see the severity of their condition as a result of malnourishment. This ambivalence often delays the early identification and acceptance of their illness and commencement of treatment, that can be life saving.
Research supports early identification and intervention in resulting in better outcomes of recovery in shorter time frames. It can be difficult to identify AN in the very early stages as many of the symptoms can mimic typical adolescent behaviour. And as the level of concern about childhood obesity is prevalent in many health messages, parents and health professionals alike can fall into the trap of thinking the adolescents’ latest health kick is a responsible approach to this ever-increasing problem.
Warning signs of AN include:
Withdrawal from social activities especially those involving food,
Mood swings, irritability, anxiety around food, difficulty concentrating
Over-concern about body size, shape or particular body parts (such as stomach and legs), fear of becoming fat
Increased exercise, often solitary
Dieting, restrictive eating, skipping meals, becoming vegetarian
Pre-occupation with label reading, cooking for others, being ‘health’ conscious
Dramatic weight loss
Dizziness, fainting, low blood pressure (with postural drop), low heart rate, sensitivity to the cold
Gastro-intestinal complaints such as bloating, nausea and constipation
Amenorrhea (cessation of menstrual cycles)
If parents are concerned their child may be developing an eating disorder, often their parental instincts are correct and specialist treatment is required, urgently. Left untreated, AN, as do other eating disorders, becomes a serious, chronic, life-threatening illness that impacts on the physical and emotional development of the young person affecting all aspects of life.
There are essentially two treatment options available in Australia for adolescents with AN. The first approach involves individual therapy with the adolescent with AN, and may consist of a combination of individual psychotherapy, nutritional counselling, medical management and psychiatric intervention. This approach requires the adolescent to recognise there is a problem and willing to engage in therapy and make the necessary changes to bring about recovery. Typically, this approach has little family involvement, depending on the practitioners’ style of therapy. Many parents report they simply taxi their child from appointment to appointment, excluded from any information about ways they can support the recovery process in their child.
In direct contrast, family-based treatment (FBT), known also as the Maudsley Model, involves and empowers the parents to make the necessary changes to bring about recovery from AN. It is not necessary, or expected, for the young person to be desirous of getting well to use this approach, in fact the young people are usually very resistant to the idea. All members of the family living at home with the young person with AN, attends treatment. The parents form an essential part of the treatment team, determining food challenges and behavioural changes that brings about weight and health restoration and the siblings provide support to their sister or brother. The solution-focussed treatment is founded on principles of respect for the family and taking a non-blaming, non-judgemental approach. The focus of therapy is unity against AN, rather than seeing the young person as the problem and therefore needing to change. Assessment and ongoing medical management by a medical doctor, paediatrician and psychiatrist for the medical complications and need for medications that may assist with reducing OCD, anxiety or depression in the young person is supported. As the treatment is intense and can create significant levels of distress in the young person (as would a hospital admission for nutritional resuscitation), medication can aid the young person in managing their distress.
Satisfactory progress in weight/health restoration to 95% IBW (ideal body weight) in phase one, gradual handing back control to the adolescent (age appropriately) in phase two, readies the young person for subsequent work on relevant issues providing them with the ego strength required to cope with the exposure and consequences of therapy and to manage normal adolescent life.
The outcomes of FBT are considered best practice in the world. International research shows 75-80% recover in about 12 months duration of FBT. This is in stark contrast to the mainstream medical model using individual therapy, which shows 40% recovery rates in 4-7.5 years once treatment is commenced. FBT actively works against AN becoming a chronic, life-threatening condition. FBT provides an effective form of therapy that enables treatment to commence once AN has been diagnosed, irrespective of the readiness for change of the young person with the eating disorder.
Belinda Dalton, one of F.E.A.S.T.'s Advisory Panel, is the Director of the Oak House, in Melbourne, Australia, a private facility that offers recovery programs for all ages of people whose lives are affected by eating disorders. The Oak House is a leader in delivering this family based treatment in Victoria. At the Oak House, they also use family based treatment for adolescents with bulimia nervosa and those over their most healthy weight. For more information see www.theoakhouse.com.au
Le Grange, D. (2004). Family-based treatment for adolescent anorexia nervosa: A promising approach? Clinical Psychiatry.
Le Grange, D., Binford, R., & Loeb, K. (2005). Manualized Family-based treatment for anorexia nervosa: A case series. Journal of the American Academy of Child & Adolescent Psychiatry.
Rhodes, P. (2003) The Maudsley Model of family therapy for children and adolescents with Anorexia Nervosa: theory, clinical practice, and empirical support. Australian New Zealand Journal of Family Therapy.