USING FAMILY-BASED INTERVENTIONS
TO FIGHT ANOREXIA NERVOSA
By Molly Howard
Objectives:
• To understand what a family-based intervention is
• To learn how family-based interventions treat patients with Anorexia
Nervosa (AN)
• To become acquainted with the Maudsley Method (MM)
WHAT IS A FAMILY-BASED
INTERVENTION?
• Treatment involving all
family members
together
• Treatment that seeks
improvements in –
– Family Dynamics
– Communication
– Specific Problems
• Short term treatment
DESCRIPTION OF ANOREXIA NERVOSA
(AN)
• Eating disorder
characterized by a fear
of weight gain and food
• Mental illness, not a
diet
• Patient has distorted
image of self
• Highest mortality rate
of any mental illness
STATISTICS ASSOCIATED WITH AN
• Ten million females and 1
million males suffer in the
US (NEDA).
• Leading cause of death
among females between
the ages of 15-24
(Anorexia Nervosa)
• Of those who survive – 47% recover fully
– 33% improve somewhat
– 20% remain chronically ill
(Smith)
HISTORY OF USING FAMILY-BASED
TREATMENT (FBT) ON PATIENTS WITH
AN
• 1978
• Dr. Salvador Minuchin
in Philadelphia
• Concentrated on
“psychosomatic
families” (Smith)
• 86% success rate
FBT = THE MAUDSLEY METHOD
• 1987
• Named after the
Maudsley Hospital in
London
• Replaces parental blame
with empowerment
• 3 phase outpatient
treatment
• Focuses on weight gain
and not the cause of AN
GOALS OF FBT
• Family goals
– Strengthen bonds
between all members
– Understand the disease
affects all members
– Remove anger and guilt
– Encourage all members
to support each other
GOALS OF FBT
• Individual goals
– Phase 1 – Adequate
weight gain to restore
patient to normal level
– Phase 2 - Control over
food and mealtimes
– Phase 3 - Return to
normal growth and
development
WHO BENEFITS?
•
•
•
•
Patients
Parents
Families
Local resources
PHASE ONE
• Family sessions with
certified MM therapist
– Parents given control
– Therapist watches one
meal
• Parents feed 3 meals and
3 snacks per day.
• Siblings provide support.
• Average duration is 10
weeks (Smith).
• Must achieve 90% Ideal
Body Weight (IBW)
PHASE TWO
• Patient gets control of
own eating.
• Must continue to gain
weight
• No signs of rebellion
• Must conquer social
settings without
restriction
PHASE THREE
• Counseling begins to
understand root cause
• Establish boundaries
within family
• Address developmental
issues
MAIN POINTS OF FBT
• Family members can be
angry at the disease, not
at the patient.
• AN will not go away
unless there is treatment.
• No one caused AN, and
no one is to be blamed.
• Parents are in control of
the child’s eating habits
until weight is returned to
normal.
SUCCESS OF FBT
• Only 10% relapse rate
after 1 year
– Compared to 40% for
those who did individual
therapy
• Only 10% relapse rate
after 5 years
– Compared to 36% for
those who did individual
therapy
CRITICISM OF FBT IN TREATING AN
• Erosion of trust
between parent and
child
• Introduces too much
conflict within family
• No individual therapy
MULTIPLE CHOICE QUESTIONS:
1. In the Maudsley Method, the primary focus is on
a. Improving family dynamics
b. Recovery of the patient’s health
c. Finding the cause of the AN
d. Better communication
2. A University of Pittsburgh study shows that AN is caused by an excess of this chemical in the brain?
a. Serotonin
b. Epinephrine
c. Dopamine
d. Histamine
3. Family-based treatment for AN does all of the following except:
a. Empowers parents to feed the child
b. Tells family members to support the patient
c. Tells family members to be angry at the disease, not the patient.
d. Places the blame for the disease on the parents.
MULTIPLE CHOICE QUESTIONS
4. Which is not a goal of family-based treatment?
a. To place the patient in an inpatient facility
b. To strengthen family bonds and relationships
c. To remove anger and guilt about the disease
d. To help the patient gain weight and recover from AN
5. Which statement is a criticism of family-based treatment?
a. FBT causes families to spend too much time apart.
b. FBT causes too much conflict inside the family.
c. FBT is too expensive because of the high cost of
inpatient care.
d. FBT blames the parents for causing AN.
SHORT ANSWER QUESTIONS:
1. Using the Maudsley Method, ___________
are put in charge of feeding the patient with
AN.
2. The Maudsley Method got its name from a
____________.
3. The Maudsley Method is a form of _______
________ treatment.
SHORT ANSWER QUESTIONS
4. The goal of Phase 1 is the restoration of the
patient’s _________.
5. Returning control of feeding herself to the
patient is the goal of Phase _____.
REFERENCES
Anorexia Nervosa (n.d.). In National Alliance on Mental Illness. Retrieved November 5, 2011,
from http://www.nami.org/
Dubansky, H. (2010). Family-based therapy: An eating-disorder treatment that works. US News
and World Report. Retrieved from http://health.usnews.com/health-news/family-health/brainand-behavior/articles/2010/10/04/family-based-therapy-an-eating-disorder-treatment-thatworks_print.html
Findlay, S., Pinzon, J., Taddeo, D., & Katzman, D. (2010). Family-based treatment of children
and adolescents with anorexia nervosa: Guidelines for the community physician.
Paediatrics and Child Health, 15(1), 31-35. Retrieved from
http://www.ncbi.nlm.nih.gov.ezaccess.libraries.psu.edu/pmc/articles/PMC2827322/
(n.d.). In Anorexia Nervosa and Associated Disorders (ANAD). Retrieved November 7,
2011, from http://www.anad.org/news/the-hidden-health-crisis-on-campus-eating-disorders/
(n.d.). In National Eating Disorders Association. Retrieved November 6, 2011, from
http://www.nationaleatingdisorders.org/
(n.d.). In National Institute of Mental Health. Retrieved November 7, 2011, from
http://www.nimh.nih.gov/index.shtml
Smith, A., & Cook-Cottone, C. (2011). A Review of Family Therapy as an Effective Intervention
for Anorexia Nervosa in Adolescents. Journal of Clinical Psychology in Medical
Settings, doi:10.1007/s10880-011-9262-3