In my last post, I listed 5 warning signs that should alert parents to the possibility that their child may be developing an eating disorder. Recognizing that there may be a problem is a hugely important first step. But then what?
That's the position my husband and I found ourselves in five years ago, when our older daughter, Kitty, was diagnosed with anorexia. We'd known there was a problem for six weeks or so, and we'd been trying to get her to eat. But we felt helpless in the face of her resistance. She was tired, her stomach hurt, she wasn't hungry, she'd already eaten, she didn't like what we were having, she wasn't in the mood, it was too hot to eat, she didn't feel well—she had 50 different excuses for not eating. But they all boiled down to the same immutable fact: She wasn't eating enough to keep her alive. She was falling away before our eyes. And we felt powerless to stop that diminishing.
Getting the diagnosis was a relief on one level; now the word anorexia was out on the table. It could not be avoided. So now what? Our instructions were to try to find a therapist, and to try to get Kitty to eat.
Things didn't go well. We waited weeks to get in to see a therapist, only to come away sure that she wasn't going to be helpful. And we kept trying to get Kitty to eat, to no avail.
Luckily, after a week or two I stumbled on another kind of treatment, family-based treatment, known as FBT or the Maudsley approach. This is the approach my husband and I used to help Kitty recover. As I learned later, it's the only evidence-based treatment for teens with anorexia, and it gets far better results than other treatments. Between 80 and 90 percent of teens with anorexia treated with FBT recover, and are still recovered five years later; the most generous recovery estimates for traditional treatment hovers around 50 percent, and the length of illness is longer-five to seven years. Recovery with FBT typically takes six months to a year.
Family-Based Treatment: Phase 1
FBT has been successful for treating both anorexia and bulimia. I'm going to talk here about treatment for anorexia, since that's what we experienced.
Phase 1 in FBT is weight restoration: getting the child or teen back up to her target weight as quickly as possible. This ball falls mainly in the family's court. The therapist meets with the family weekly, providing medical supervision and supporting the family through the challenging work of weight gain. But it's the parents-and the sufferer-who must do that work. Each family has to figure out the best strategies for getting the calories in in a loving and supportive way.
In our case, the key was to make sure nothing else in the house happened until our daughter ate the meals I prepared and served. I dished out her food and put it in front of her, in a technique known as the magic plate. One of the hallmarks of anorexia is intense anxiety and negotiation around not just eating but also food preparation and serving. Magic plate sidesteps some of that by having parents decide what and how much to serve, prepping the plate, and putting it in front of the sufferer. Then the challenge is how to lovingly support the teen so she can eat the food she needs.
I found that persistence and consistency were the keys. Sometimes I felt like a politician on-message, repeating one or two simple truths in a calm way: I love you and I'm not going to let you starve. You need to eat all of this before you can go to school, take a shower, fill in the blank.
In the beginning, I didn't think it would work, frankly. We'd been trying to get our daughter to eat for months; wouldn't this be more of the same? My husband and I begging, cajoling, crying, and Kitty steadfastly not eating? But it wasn't the same at all, for one crucial reason: My husband and I now felt empowered to get Kitty to eat. It was our job now. Before, we'd been given conflicting messages: Try to get her to eat, but it's not about the food. Try to get her to eat, but she has to choose to eat on her own. We were desperate for her to eat, but at the same time we felt hopeless and helpless.
FBT reframes the feelings all parents have in that situation. We were no longer in an adversarial position with our daughter; we were supporting her health. Our encouragement to eat was loving but firm. And it worked. Not easily, not every single time, but from the moment we drew the line and started FBT, Kitty started eating.
Next post: Pitfalls and triumphs.
Harriet Brown's memoir, Brave Girl Eating: A Family's Struggle with Anorexia, was published this week by William Morrow.