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 ona. Improving family dynamicsb. Recovery of the patient’s healthc. Finding the cause of the ANd. Better communication

2. A University of Pittsburgh study shows that AN is caused by an excess of this chemical in the brain?

a. Serotoninb. Epinephrinec. Dopamined. Histamine

3. Family-based treatment for AN does all of the following except:

a. Empowers parents to feed the childb. Tells family members to support the patientc. Tells family members to be angry at the disease, not the patient.d. Places the blame for the disease on the parents.

MULTIPLE CHOICE QUESTIONS4. Which is not a goal of family-based treatment?

a. To place the patient in an inpatient facilityb. To strengthen family bonds and relationshipsc. To remove anger and guilt about the diseased. 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 _____.

REFERENCESAnorexia 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/brain-and-behavior/articles/2010/10/04/family-based-therapy-an-eating-disorder-treatment-that-works_print.htmlFindlay, 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.shtmlSmith, 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