Harriet Brown

Brave Girl Eating

Hope for Teens with Anorexia

Finally, a treatment that works for teens with anorexia.

Posted Oct 13, 2010

Five years ago, my husband and I sat in our pediatrician’s office and asked, “What’s next?” Our 14-year-old daughter had just been diagnosed with anorexia, and we were terrified.

We learned some difficult truths that day: There was no proven, effective treatment for anorexia. And the treatment and recovery statistics were beyond dismal: 20 percent of those with anorexia die—a higher mortality rate than any other psychiatric illness; another 45 percent stay sick for years, cycling in and out of hospitals and programs; and only about a third of those diagnosed recover, usually after five or six years of relapse and remission.

But starting this week, parents in that situation should hear a different story. The results of a year-long randomized controlled study, just published in the Archives of General Psychiatry, establish for the first time a best-practice treatment for adolescent anorexia: family-based treatment (FBT), also known as the Maudsley approach.

People with anorexia feel overwhelming guilt and terror when they eat. In FBT, a specially trained therapist helps parents stand up to the eating disorder, finding ways to lovingly encourage their teens to eat and supporting them through the backlash of fear and anxiety. Once a child is weight restored, parents back off and kids learn to take charge of their own eating again. At this point psychotherapy can help teens get back on track with normal emotional and social development.

It sounds simple, though it’s not; I wrote about our family’s experiences with FBT in a memoir called Brave Girl Eating. Then again, nothing about anorexia is simple. Families go through unimaginable anguish for years when a child or teenager develops the illness. And too many anorexic teens become chronically ill adults who lead diminished, fear-wracked lives.

Which is why this study is so important. Families were randomized to either FBT or individual therapy, at University of Chicago or Stanford. After a year of treatment, more than 50 percent of patients getting FBT were in full remission, compared with 23 percent of those getting individual therapy. Teens who recovered through individual therapy were four times more likely to relapse than those who recovered through FBT. “For an adolescent with anorexia nervosa who’s medically stable, family-based treatment should be the first line of treatment,” says Daniel le Grange, Ph.D., director of the University of Chicago’s Eating Disorders Clinic and one of the study’s co-authors.

Change comes slowly in the therapeutic field. In the years since our family used FBT to help our daughter recover from anorexia, I’ve heard plenty of criticisms of FBT, many from therapists: That it takes a “very special family” to make it work. That it takes a cooperative patient (there’s no such thing; anorexia is ego-syntonic, meaning that the person who has it doesn’t perceive it as a problem). That it violates the autonomy of the patient in a damaging way.

This study refutes these criticisms. There was no cherry-picking of “special families” or compliant teens. As for the autonomy issue, to my mind it’s comparable to taking charge of a child’s chemotherapy—a necessary, life-saving, time-limited act that helps a teen get on with her life.

FBT isn’t perfect, of course, and it’s not for every single family. A 50 percent recovery rate isn’t good enough; we need more research and more effective treatments. Still, this finding marks the first time in 130 years of tracking the illness that we can identify a first-line treatment for teens with anorexia. And for millions of American families, that’s the best news possible.

Harriet Brown is the author of Brave Girl Eating and an assistant professor of magazine journalism at the S.I. Newhouse School of Public Communications.

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