What is the Maudsley approach to treating anorexia?

Anorexia nervosa was initially recognized more than 125 years ago and today has one of the highest mortality rates among all the mental health disorders.  Advancements have been made to help treat this disease, but it continues to be on the rise.

Elizabeth Hunkins is a therapist with Aurora Behavioral Health Services.

Family based treatment (FBT) for anorexia nervosa (AN) is an outpatient treatment option that strives for weight restoration and addresses the adolescent’s development after weight has been restored.

This treatment model has been shown to demonstrate efficacy in numerous research studies, and consequently been a highly successful treatment alternative to higher levels of care.

One 2010 study, published in the Archives of General Psychiatry, showed 49 percent of those who had been in family therapy were in full remission, more than double the 23 percent of those who had been in individual therapy. And among patients who were in remission at the end of the treatment itself, only 10 percent of the family-therapy group had relapsed a year later, compared with 40 percent of those who had individual therapy.

In the Maudsley method of treatment, parents play an active role in the recovery process.  Parents are a key resource and essential for successful treatment for AN.  Maudsley does not believe there should be any “blame” on the family due to this illness or any hostility or criticism towards the adolescent.

Phase 1: Weight restoration:  The therapist’s focus with the family is about the dangers AN and severe malnutrition play, and assisting parents in re-feeding their child. The re-feeding stage is one of the most stressful points for the patient and also for the parents.  Therapists need to be mindful how this affects the entire family.  Helping the parents stay focused on the re-feeding and not get into power struggles with the illness is key.

The therapist helps the family understand the difference between their child and the illness, and continues to help towards the goal of weight restoration.  Usually during the beginning phase of treatment the therapist observes a family meal to provide an opportunity to assess the family’s interaction around food and then to assist/encourage parents in ways to help their child “eat a little more” as food is medicine.  Parents may need coaching that it is important to take time for themselves, as this can be stressful on a marriage.

Phase 2: Returning control over eating to the adolescent: The patient’s acceptance of the parents’ role in re-feeding, weight gain, and taking more control over the eating disorder behaviors are all positive signs that the family is entering phase 2 of treatment.  This phase encourages parents to help their child take more control over their eating and parents continue to maintain and watch over the adolescent’s physical health.  This phase will also begin to start discussing other family relationship issues that had to be postponed during the re-feeding phase.

Phase 3: Establishing health adolescent identity: This phase begins when the adolescent is able to maintain above 95% of ideal weight on his/her own.  Treatment shifts to the impact of AN and addressing other important treatment issues; identity issues, boundaries, personal autonomy, etc.

This treatment has shown great promise with those adolescents who have had AN if the family is willing to play an active role in treatment. Parents need to be aware of the time commitment this treatment will take prior to starting this treatment-as this treatment is not for every family.  The Maudsley therapist also believes in a treatment team approach, working with other medical professionals for the best successful outcome.

More information about the Maudsley approach can be found online at Maudsley Parents.

If you or someone you know may be struggling with an eating disorder, please contact Aurora Behavioral Health Services at 877-666-7223 or visit our web site at Aurora Behavioral Health Services.

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One thought on “What is the Maudsley approach to treating anorexia?

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