ANNAPOLIS, MD. – Two treatment strategies appear to be effective in the management of and recovery from eating disorders, according to one eating disorder expert speaking at the annual meeting of the Southern Psychiatric Association.
Dr. Harry A. Brandt said the treatments – family-based treatment (FBT) and Cognitive Remediation Therapy (CRT) – are "really exciting and are ... helping patients a lot."
FBT has been shown to be very effective for adolescents with anorexia and is appropriate for children and adolescents who are medically stable. "The current focus leads to a shift from viewing the family as a cause of an eating disorder to, instead, evaluating family dynamics that might develop in the context of an eating disorder – perhaps functioning in a maintenance or perpetuating way," said Dr. Brandt, director of the Center for Eating Disorders at Sheppard Pratt, Baltimore.
In family-based treatment, no assumptions are made about the origin of the disorder. Instead, the focus is on what can be done. "The parents are engaged as a resource. No blame is directed at the parents or the kids with the eating disorder." Siblings also are involved, play a supportive role, and are protected for the job assigned to the parents.
FBT, an outpatient intervention designed to restore weight, requires a team approach that includes a primary therapist, a pediatrician, and a psychiatrist. Brief hospitalization might be necessary to resolve medical concerns.
Also, parents are viewed as the most useful resource in their child’s treatment under FBT. In fact, the parents play an active role in the recovery process and in restoring their child’s weight, Dr. Brandt said. Therapy is aimed at assisting/supporting the parents in their efforts to help their child recover from anorexia, so that adolescent development can get back on track.
At the start of treatment, the adolescent patient is viewed as incapacitated in terms of eating behaviors with an inability to maintain an optimal weight for age and height.
The therapist’s role is to be a coach or consultant to the parents and to empower them to develop strategies aimed at managing the anorexia and finding ways to help feed the child until weight restoration is achieved. The therapist also encourages sibling support and understanding.
Lastly, the therapist teaches the family to externalize the illness, modeling a no-blame approach with recognition that the eating disorder behaviors are mostly outside the control of the adolescent. "Instead of getting angry at the kid, the therapist helps the parents to get angry at the illness. A parent’s not going to get angry at a kid who develops pneumonia but might get angry at the bacteria that caused it," he said.
FBT works through three phases: weight restoration, returning control of eating to the adolescent, and establishing a healthy adolescent identity. "These are fluid. If we move into phase two and the child stops eating, we might have to go back to phase one for a span of time."
Parents are supported in their efforts to restore their child’s weight and are encouraged to present a united front. Parents monitor meals and snacks, while restricting physical activity.
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