Treatment for eating disorders is hard. For one, it's difficult to get sufferers to recognize that their disorder is a problem. Eating disorders are largely ego-syntonic, which means the patients aren't typically distressed by ED symptoms. Even if they do agree to be assessed and treated, it's also difficult to keep an eating disordered person regularly attending treatment.
Relinquishing eating disorder behaviors provokes tremendous amounts of anxiety, fear, and frustration. People may have panic attacks, lose their ability to concentrate, begin abusing alcohol or drugs, or even become suicidal. If these emotions become too difficult to tolerate, the patient often leaves treatment prematurely, known in the research literature as "treatment drop-out." High rates of drop out, especially for anorexia nervosa--a study in the Archives of General Psychiatry from 2008 found that treatment drop out rates for anorexia patients were as high as 46%--have left the treatment of this disorder in a "dismal state of affairs," according to a review in the American Journal of Psychiatry.
Yet hope remains. For adolescents with eating disorders, family-based treatment (FBT, aka the Maudsley Approach) has been shown to be superior to other forms of treatment. Adults with eating disorders also have options--cognitive behavioral therapy, dialectical behavioral therapy, and interpersonal psychotherapy have all been shown to be effective for bulimia nervosa and binge eating disorder. But the high drop out rates have prevented researchers from identifying empirically sound treatments for adults with anorexia.
I was at the International Conference on Eating Disorders last week in Miami, and researcher Cindy Bulik, director of the Eating Disorders Program at the University of North Caroline, Chapel Hill, shared data about an innovative new treatment for adults with anorexia called UCAN (Uniting Couples Against Anorexia Nervosa). This treatment engages the patient and her partner--all study participants thus far have been heterosexual females, although there's no reason to think this wouldn't work with males with anorexia and in couples of different sexual orientation--in improving not just the anorexia but also the couple's overall relationship.
Traditionally, eating disorders treatment has focused on the individual changing his or her own behaviors. Although family may be involved when adolescents are treated, this is generally not considered as important for adult patients. Parents have the legal authority to require their adolescent remain in treatment, whereas adults more frequently drop out. The result is that much more evidence exists about effective treatments for adolescents with anorexia than for adults.
Like FBT, UCAN considers loved ones an integral part of treatment. Also like FBT, UCAN has significantly lower drop out rates than other studies. A one-year trial of FBT had a drop out rate of 14%. In UCAN, Dr. Bulik reported that the drop out rate was only 5%. It would have been zero if not for a husband's untimely work transfer, she said.
Even if you don't measure the treatment's ultimate efficacy, these studies are a breakthrough in that they're some of the first studies with a very low drop out rate. Although no one was formally studied the reason why, it's not hard to identify the common thread to both of these treatments: the involvement of family.
Far from being universally pathological, families can help anorexia patients recover. In FBT, parents play an active role in returning their teens to health by overseeing food and weight gain. More than that, parents show their caring and involvement simply by just being there. By simply expecting that the adolescent will attend weekly therapy sessions, eat all meals, and one day have a life beyond their eating disorder, parents can send a powerful message.
Although partners doing UCAN don't dictate food intake as in FBT, they are aware of what their wife or girlfriend is expected to be eating. They can encourage and support because everything is aboveboard. And partners have a safe space in which to express how anorexia is affecting their relationship and work on healing hurts and moving forward.
The message is that, for eating disorders, love helps heal. Patients often feel unloved and unworthy, and constant expressions and actions of caring drive home the reality that they are worth recovery. They deserve wellness and health and happiness. Sure, you can attack this cognitions in therapy, but it remains that love is powerful. And an increasing number of studies are showing that love may be more powerful than anorexia if families can learn how to use it as a tool.
Not that type of therapy and nutritional restoration isnt important, but it seems that the common thread to some of the most successful treatments for anorexia involve loved ones to provide much needed support.