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Medical Edge Newspaper Column from Mayo Clinic
FAMILY PLAYS MAJOR ROLE IN ANOREXIC PATIENT’S RECOVERY
DEAR MAYO CLINIC: My godchild has been “captured” by anorexia
nervosa — held hostage by invisible forces that we cannot understand fully,
if at all. It is just tragic. This talented, intelligent, loving and caring
person has been in and out of treatment centers and hospitals, unable
to start an independent life or take on college or work. Have we overlooked
any resources that might help her overcome this terrible affliction? —
Stamford, Conn.
ANSWER: Many people with anorexia nervosa undergo multiple hospitalizations,
and even long-term inpatient treatment, because it is a serious condition
requiring professional care. But treatment’s success may be enhanced by
a new approach called family-based therapy, especially if it is employed
early in the disease history, before a legacy of perceived treatment failures
has been built up. While studies evaluating family-based therapy are few,
the emerging body of evidence is encouraging.
Here’s a general overview of how family-based therapy works:
From the beginning of treatment, which is individualized for each family,
the patient’s parents are enlisted as an integral part of the team. For
example, in weekly sessions at the clinic, the therapist provides guidance
to the family about how best to structure meals and encourage eating and
weight gain. An in-session meal — to which the family brings a picnic
lunch — allows for some practice.
Parents are instructed to take charge of the patient’s eating — essentially,
to refeed the patient — until their son or daughter is able to eat healthfully
and in sufficient quantity on his or her own. Over time, the patient gradually
assumes responsibility for beneficial eating.
The reason why family-based therapy assigns the management of feeding
to the parents — this is actually one of its major innovations — is that
patients are not well enough to do it themselves. One serious limitation
of traditional therapies is the assumption that anorexic patients are
sufficiently motivated to change. To the contrary, they tend to be in
denial regarding the seriousness of their eating disorder, and this prevents
them from taking the necessary steps for recovery.
Another limitation of traditional approaches is that a patient is often
under the care of several professionals — typically, a psychologist, psychiatrist,
family therapist and dietitian — who are not necessarily allied with one
another or coordinated in their approaches.
Because there is no single, coherent plan of action, the effectiveness
of treatment by even the best practitioners in these fields can be blunted.
With family-based therapy, however, there can be a more integrated effort,
with these specialties united and orchestrated right from the start.
Finally, a crucial part of recovering from anorexia nervosa is for the
patient to assume the developmentally appropriate task of the teenage
years and early adulthood — becoming an autonomous individual. To do this,
the patient must learn to connect with a healthy peer group. Family-based
therapy helps provide the foundation for undertaking this vital step toward
adulthood.
— Leslie Sim, Ph.D., Psychiatry and Psychology, Mayo Clinic, Rochester,
Minn.
Additional Resources:
Treatment
of Anorexia Nervosa
Appointment
Information
More
Information on Anorexia Nervosa
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Medical Edge from Mayo Clinic is an educational resource and doesn’t
replace regular medical care. To e-mail a question, go to www.mayoclinic.org,
or write: Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite
114, Buffalo, N.Y., 14207. For health information, visit www.mayoclinic.com.
© 2004 TRIBUNE MEDIA SERVICES, INC.
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