Family Systems Therapy Versus the Maudsley Approach for Treating Anorexia in Adolescents

A new study will compare the effectiveness of Family Systems Therapy versus Behavioral Family Therapy (also known as the Maudsley Approach) for treating anorexia nervosa in adolescents aged 12-18 years old.

Individuals with anorexia nervosa have an intense fear of gaining weight, even though they are underweight, refuse to maintain weight that is 85% of their expected weight given their height and age, have a distorted body image, and miss three consecutive menstrual cycles in a row (for females). Anorexia is a life-threatening illness and has a high morbidity rate.

Both of the therapies that will be examined in the study involve the use of the family in treatment. In the Maudsley Approach, the individual suffering with anorexia attends therapy sessions with his or her parents and siblings. Parents work with the therapist in order to figure out what types of foods and how much of these foods must be consumed in order for the affected individual to gain a healthy amount of weight back. Parents must supervise every meal and work at ensuring that each meal is completed. Siblings are encouraged to act as a support system to the affected individual. Once the affected individual has regained a healthy amount of weight, he or she is gradually granted increasing responsibility for choosing his or her own meals again. Additionally, once a healthy weight has been reached, family and developmental issues are addressed in therapy.

In Family Systems Therapy, family members can address any family stressors or problematic communication patterns during therapy sessions.

Two-hundred and forty adolescents aged 12-18 years old are being recruited to participate in this study. All participants must be between 75-87% of their healthy body weight, and medically stable. All families will be randomly assigned to participate in the Maudsley Approach or Family Systems Therapy for nine months. Each family will attend weekly therapy sessions for the first 7-8 weeks of the study, followed by six bi-weekly sessions, and finally monthly therapy sessions for the remainder of the study.

The study will be taking place at six different locations: New York Presbyterian/Westchester, Sheppard Pratt in Baltimore, University of Toronto, Stanford University in Palo Alto, Washington University in St. Louis, and University of California in San Diego.

If you are interested in participating in this study, you can e-mail the study's coordinator, Samantha Berthod at: sab2024@med.cornell.edu.

"Enhanced" Cognitive-Behavioral Therapy for Individuals with Eating Disorders

A new study in the United Kingdom shows a new variation on Cognitive-Behavioral Therapy may be effective in treating a majority of individuals with eating disorders.

Eating disorders in the UK are classified somewhat differently than they are in the United States. Mainly, they classify eating disorders as Anorexia Nervosa, Bulimia Nervosa, and "atypical" eating disorders, which is the United States' equivalent to Eating Disorder Not Otherwise Specified. "Atypical" eating disorders in the UK are defined as having both features of anorexia and bulimia, such as self-starvation, binge-eating, making oneself throw up purposefully, taking laxatives, and exercising excessively.

The new "enhanced" Cognitive-Behavioral Therapy was developed from the previous form of cognitive-behavioral therapy, which was specifically designed for individuals suffering from bulimia nervosa by Professor Christopher Fairburn, who is a Wellcome Trust Principal Research Fellow at the University of Oxford. He also developed the new "enhanced" Cognitive-Behavioral Therapy, intended to help even more individuals suffering from eating disorders.

Fairburn and his colleagues conducted a study with 154 individuals suffering from eating disorders. Two types of enhanced Cognitive-Behavioral Therapy (CBT-E) were developed, a simple version and a more complex version. The simple version focused on the primary issue of the eating disorder while the more complex version of CBT-E focused on the eating disorder as well as other features that are commonly associated with eating disorders, such as depression, self-esteem, and perfectionism.

Each individual participating in the study received 20 50-minute sessions of simple or complex CBT-E over the span of 20 weeks.

The researchers discovered that participants responded well to both types of CBT-E and that these improvements held over a one-year period, the time in which relapse into an eating disorder is most common. More specifically, of the participants who completed treatment, two-thirds made a full recovery from their eating disorders. Although one-third of participants relapsed into their eating disorders, they maintained significant improvement.

This study seems to indicate that CBT-E is an effective treatment for a majority of individuals who are suffering from eating disorders. Fairburn and his colleagues are also conducting a large study in order to measure the effectiveness of CBT-E on individuals suffering from anorexia, specifically.

Source:
Psych Central: Behavioral Therapy for Eating Disorders

The Most Common Eating Disorder in America

While Anorexia and Bulimia are given most of the media and clinical research attention, it is actually Binge Eating Disorder that is the most common eating disorder in America today, according to a recently published survey.

Researchers at the Harvard University Medical School along with those at McLean Psychiatric Hospital interviewed 9,000 individuals between the years of 2001-2003 about their psychological histories and their eating habits. They interviewed individuals from all across the nation in order to collect more generalizeable data.

The researchers diagnosed less than 1% of women and 0.3% of men with anorexia, in which the main proponent of the disorder is self-starvation. Additionally, 0.5% of men and 1.5% of women were found to have bulimia, an eating disorder constituted by the binge-eating-purging cycle.

Finally, the researchers determined 2% of men and 3.5% of women suffered from binge eating disorder, significantly more individuals than those who suffered from either anorexia or bulimia. Binge eating disorder was defined as out-of-control eating, even after one felt full - at least twice a week.

One of the authors of the study pointed out those who struggle with binge eating are at risk for obesity, diabetes, certain types of cancer, heart disease, and stroke. In addition, the lead author of the study asserts binge eating disorder should be given more attention, given its high prevalence.

The study noted those between the ages of 18-29 are most likely to have an eating disorder, and individuals with eating disorders often struggle with depression and/or anxiety as well.

Personally, I am glad to see more research being done on binge eating disorder. When I was writing my thesis in college on personality traits and behavioral characteristics common among those with eating disorder, I found very few studies to cite in my paper. I am glad binge eating disorder is beginning to receive the attention it deserves, and I hope more individuals who struggle with binge eating disorder will be able to get help for their struggles more easily.

Source:

Fox News: Survey: Binging Most Common Eating Disorder in America:
http://www.foxnews.com/story/0,2933,249481,00.html?sPage=fnc/health/mentalhealth

Eating Disorder Warning Signs and Information

In light of today's Dr. Phil show on eating disorders, I'm sure there will be some friends and relatives searching for information about eating disorders. I hope the information I provide here can help you help someone you love.

I wrote some posts about Anorexia and Bulimia last year, which I thought may be helpful for people looking for information about the disorders:
What is Anorexia Nervosa?

What is Bulimia Nervosa?

Some warning signs that your loved one may be suffering with an eating disorder include:
-Making excuses to avoid meals or eating, such as, "I already ate," "I'm not hungry," or, "I'm going to eat later with so-and-so."
-Measuring portion sizes or weighing food
-Cutting food into tiny pieces before eating it
-Using diet pills
-Skipping meals
-Wearing layers of clothes or wearing baggy clothes to cover weight loss
-Complaints of being cold all the time
-Weight fluctuations
-Rapid weight loss or gain
-Large amounts of food missing from cabinets or the fridge could be signs of binging behavior
-Noticing several wrappers and food containers in piles could also be a sign of binging
-Taking frequent trips to the restroom after meals could be a sign that your loved one is purging
-Complaints from your loved one about how he or she is fat, disgusting, and/or ugly
-An obsession with food, weight, food, and/or body image

If you believe someone you love is suffering from an eating disorder, please encourage him or her to seek professional help. If not treated properly early on, eating disorders can, and do, become fatal conditions.

Dr. Phil Schedule Feb. 25-29, 2008

This week's Dr. Phil's shows are as follows:

Monday: Deadly Thin - Dr. Phil talks with a woman who is struggling with Anorexia and Bulimia. Aimee is only 60 pounds, but she still believes she's fat. Dr. Phil also talks with a former guest who has an inspiring story of recovery.

Tuesday: Alter Egos - Dr. Phil talks to guests who lead double lives.

Wednesday: Internet Cheats - Tameka wants her fiance to take down his MySpace profiles because he has already cheated on her twice with them. Her fiance says he needs the profiles to promote his business. Find out what happens when Dr. Phil asks the fiance to take a lie detector test.

Thursday: Still Choosing the Crown - The guests on this show are wives and mothers, but still want to compete in pageants. Dr. Phil has some words of advice for a woman who is pregnant with her seventh child and still competing in pageants.

Friday: Follow-ups - Dr. Phil brings back some of his most popular guests for follow-ups.

Brain abnormalities in recovered anorexic individuals

A colleague of mine wrote this article on a recent study of individuals who had recovered from Anorexia Nervosa:
http://www.associatedcontent.com/article/465252/anorexia_nervosa_patients_have_different.html

Eating Disorder Not Otherwise Specified IS Real

Eating Disorder Not Otherwise Specified (ED NOS) is as real as Anorexia Nervosa or Bulimia Nervosa.

ED NOS is diagnosed when an individual does not quite meet the criteria for Anorexia or Bulimia Nervosa, yet has disordered eating behavior. For instance, ED NOS might be diagnosed if a teen girl is significantly underweight, but has not stopped having menstruation. Or a young woman might be diagnosed with ED NOS if she has been engaging in binge-eating and purging behaviors for more than three months, but she only does it on average once a week.

Individuals who compulsively overeat are also diagnosed with ED NOS.

Despite the lack of attention the media and even many mental health professionals give individuals with ED NOS, it is a real issue. It's likely that more individuals suffer from ED NOS than from Anorexia Nervosa and/or Bulimia Nervosa.

What lies at the core of disordered eating is often similar whether the individual starves herself, binge-eats and purges, or overeats.

In the end it doesn't really matter WHAT diagnosis the individual with disordered eating has. It matters more that the individual needs help and that she is hurting.

If you know someone with ED NOS, please take their issues and concerns as seriously as you would with an individual that has Anorexia or Bulimia Nervosa.

Books

If you have a loved one who suffers from an eating disorder, you may not understand his or her mindset.

There are some really good fiction books written about eating disorders that can help a loved one of a family member or friend better understand the condition.

Some of the good fiction books I've read about eating disorders include:

The Best Little Girl in the World by Steven Levenkron

Diary of an Anorecix Girl by Morgan Menzie

Stick Figure by Lori Gottieb

The Monster Within: Facing an Eating Disorder by Cynthia Rowland McClure

Living with Anorexia Nervosa

Reading the diagnostic criteria for Anorexia Nervosa from the Diagnostic and Statistical Manual of Mental Disorders is vastly different than hearing the stories of individuals who have suffered with the condition. In this post, I want to offer some insight into what it is like to live with Anorexia Nervosa.

I initially began starving myself at the age of 13 or 14 as a way to lose some weight, to look as thin as my friends looked. I wanted people to compliment my looks like they did with my friends.

Because I attended a residential school for most of my high school career, starving myself was easy. All I had to do was lie to my mother about what I had eaten that day. No one could force me to eat away from home.

When I transferred schools in the middle of my junior year, I was already obsessed with the amount of food I was eating. It became harder to hide my starving behaviors, though, so I gained a little weight during that time.

However, when I moved to college, I began starving myself with a new vigor I never knew I had. I was determined to be thin, beautiful, and perfect. During my college years I lost a significant amount of weight.

It was during this time, too, that I began to have insight into why I was so intent on starving myself. I learned that I used restricting behaviors to cope with feelings I couldn’t handle, especially “negative feelings”.

I began to explore my restricting behaviors in therapy and I learned that being with my family was especially triggering for my eating disorder. When I went home I felt as if I had no control over what happened to me, and I used restricting behavior in order to give myself control over something – my body and weight.

I hated my body so much. No matter how thin I got, it was never thin enough. I thought thoughts like, “I am so fat!” even when I was extremely underweight, “I am eating too much” when I was only consuming a mere 500 calories or less a day, and “I’m still not good enough”.

As I entered into my Master’s program, I continue to starve myself, at least for the first year of my program. When my boyfriend, Dave, moved in during my second year in the program, however, things changed. I actively sought more intensive therapy for my eating disorder and Dave and I worked on getting my weight to a healthy level.

Since then, I have spent a year in recovery from Anorexia Nervosa. I still have plenty of days where I feel I am too fat, not good enough, or as if I am eating too much. But now I know that when these thoughts occur, I need to pay attention to what is going on inside of me. I need to examine my feelings and I need to examine why I feel as if I have no control over my life.

Recovery is possible for you or a loved one who has Anorexia Nervosa. Recovery is a hard and trying journey, one that you or your loved one will be on for many years. But once you’ve achieved a level of recovery, you’ll never want to go back into your eating disorder.

Eating disorders don’t have to control you; you can beat it with professional help, time, and a strong support system.

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Anorexia

Eating disorders are serious issues in American society. One of the 3 eating disorders, Anorexia Nervosa affects approximately 0.5% of American women and 0.05% of American men, according to the American Psychological Association (2000). Not only do individuals with Anorexia Nervosa suffer physically, they also suffer mentally as well.

What is Anorexia Nervosa exactly?

The Diagnostic and Statistical Manual of Mental Disorders defines Anorexia Nervosa with these specific criteria:

1. Refusal to maintain a minimal body weight (less than 85% of weight expected for age and height).

2. An intense fear of becoming fat or gaining weight.

3. Denial of unhealthily low weight, basing one's self-evaluation on his/her weight, or a disturbance in the way in which one experiences his/her body shape or weight.

4. Amenorrhea, the absence of menstrual cycles for at least three consecutive months (in postmenarchael women) or the presence of menstruation only when on hormones such as estrogen.

Anorexia Nervosa has two subtypes:

Restricting type - during the current episode of Anorexia the individual has not engaged in any binge-esting or purging behaviors. Binge-eating is classified as consuming significantly more calories in one sitting than what is considered "typical" for that culture. Purging behaviors could include the misuse of laxatives, diuretics, or self-induced vomiting.

Binge-eating/purging type - During the current episode of Anorexia the individual has engaged in binge-eating and/or purging on a regular basis.

Example:
Nancy is a college freshman this year. She has difficult adapting to change and misses her friends and family very much. Nancy became concerned about her weight when her roommate said she could stand to lose a few pounds at the gym with her. It has been six months since Nancy's roommate expressed this judgement, but Nancy continues to worry about her weight. Nancy keeps a chart of the food and calories she consumes, eats very little, and exercises multiple hours a day. Yet she manages to keep good grades.

Friends and family have expressed concern for Nancy, telling her she has gotten too thin and that she needs to eat more. Nancy, however, sees herself as extremely fat and feels she needs to lose more weight.

At her last doctor's visit, Nancy admistted that she has not had her menstrual cycle for four months now, but refuses to go into treatment for her eating disorder, insisting that she doesn't have a problem.


Anorexia Nervosa is a serious condition, and those who suffer from it often face serious medical complications and sometimes even death as a resulf of the lack of nutrients being put into the body and dangerously low body weight.

This post is the first of a series of posts on eating disorders. Later this week, I will discuss how to recognize Anorexia Nervosa in family and friends, how to help those who suffer with the condition, and the medical consequences that result from Anorexia.