Anorexia, Asperger’s and the Maudsley Approach

17th August 2007

Anorexia, Asperger’s and the Maudsley Approach

posted in Eating Disorders, Family Issues, Feminist Topics, Health/Nutrition, Pop Culture |

From the British Times Online comes a rather interesting interview with Professor Janet Treasure, director of the Eating Disorder Unit at the South London Maudsley Hospital NHS Trust.

In the interview, Treasure asks the provocative question, “Is anorexia the female Asperger’s?”

To define: Asperger’s is a milder variant of Autism, differing in that non-social aspects of intellectual development generally proceed at a normal or accelerated rate, unlike Autism. Asperger’s is characterized by social isolation and eccentric behavior, and may include repetitive behavior patterns and impairment in social interaction. A good film to watch to see Asperger’s in action is Mozart and the Whale.

Treasure cites a study conducted a few year ago which found the same kind of weak central coherence in people with anorexia as those with Autism and Asperger’s. More than 20 percent of the anorexic group could be described as having a disorder from within the autism spectrum, said Treasure.

Treasure is a big advocate of the Maudsley model as an effective approach in treatment. The family therapy-based approach is geared towards adolescents ages 18 and under who are living with their families and is designed to intervene aggressively in the first stages of illness.

The approach is generally short-term, as short as 20 sessions or six months in duration. Proponents of the therapy – like Harriet and Laura Collins - say that if used early, anorexia doesn’t have to become a chronic illness or a death sentence.

But Treasure doesn’t discount the great influence societal cues wield in the development of the disease, either, which is important to note. It’s precisely this point that I differ from advocates of the Maudsley approach.

While I do believe eating disorders to be organic in nature, there is no gene which pre-determines that one will develop an eating disorder. Genetics may predispose one to the patterns and behaviors, as is seen in eating disordered people, but eating disorder behaviors often mimic other addictions, including alcohol and drugs.

Author Marya Hornbacher asks this very question in her book, Wasted, which is considered to be one of the most brutally honest eating disorder memoirs to date. To paraphrase, Hornbacher wonders why the personality traits so typical of anorectics didn’t instead lead her positive obsessions instead of anorexia and bulimia. There has to be some sort of environmental trigger which steers one to use food as their vice of choice.

The genetic-based Maudsley approach denies families as being pathological in the etiology of an eating disorder. Parents are, in essence, exonerated from blame. But numerous studies show families, especially a child’s relationship with each of their parents, are often central to the development or maintenance of an eating disorder. While parents are encouraged to take a pro-active, advisory role in the treatment of a child with an eating disorder, family dynamics which might have contributed to the disorder can be overlooked.

And other environmental factors are key too, in the development of eating disorders. In her book A Hunger So Wide and So Deep, Becky Thompson explores the links between sexual and physical trauma and their relationships to eating disorders. Poverty and racial, sexual, religious and other forms of discrimination are also contributing factors.

Maudsley approach aside, Treasure’s research into the ways in which the brain functions and its relationship to anorexia is crucial to the understanding of the disease. On a side note, she’s seeking participants for research projects in all aspects of eating disorders, the article notes. I’m not sure if this is restricted to Brits, but here’s the contact info:

Frankie Bishopp, 020-7188 0186 or e-mail bishopp@iop.kcl.ac.uk. Further information from the KCL website: www.eatingresearch.com.

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1 On August 17th, 2007, Laura Collins

said:

Oh, dear! There are some misunderstandings out there that need clarification.

Treasure works AT the Maudsley, but she is not talking about the “Maudsley Approach” or “Family-based therapy” that is described by me in my book and by Lock and le Grange in theirs. Treasure talks about the “New Maudsley Approach” but the two have little to do with each other.

The FBT/Maudsley approach has no position on the genetic issue or the biology of eating disorders. In fact the concept is explicitly “agnostic” on the cause of eating disorders.

The confusion, perhaps, comes from the fact that most modern researchers and theorists on EDs do recognize that EDs are 50-80% heritable and that there is no evidence of any other cause.

I am an advocate of FBT/Maudsley treatment, and I firmly believe eating disorders are a brain disorder triggered by malnutrition - but the two are unrelated and I am an individual, not a representative of Maudsley.

posted on August 17th, 2007 at 12:20 pm

2 On August 17th, 2007, B

I think it is an interesting question as to if malnutrition causes a brain disorder or if the brain disorder is existing and causes the eating disorder which leads to malnutrition. I have not studied eating disorders specifically, but I have read many books on nueroscience and brain function. One book that I have read called “The Brain, The mind” by M. Schwartz and Sharon Begley among other things describes in some detail what is beleived to be the cause of O.C.D.. O.C.D. is beleived to be caused by a disruption in the neural pathways. My best way of describing it would be the part of your brain that says your hands are dirty, wash them for the 32nd time can’t communicate with the part of the brain which says your hands are fine you don’t need to wash them. Seems to me the same neural disruptions could be the cause of many eating disorders.

posted on August 17th, 2007 at 1:02 pm

3 On August 17th, 2007, Rachel

Thanks for the clarification Laura. It is very confusing when the two share the same name!

posted on August 17th, 2007 at 2:59 pm

4 On August 17th, 2007, ngjn

I believe that MamaV is right, that there are two different anorexias: the mental disorder, and the social anorexia. While the mental disorder could definitely stem from a brain disorder, I highly doubt the social anorexia does. And if she includes social anorexia in this study, then almost 3/4 runway models have brain disorders. Which I highly doubt.

My 2 cents

posted on August 17th, 2007 at 4:32 pm

5 On August 17th, 2007, oakeshott

Rachel,
You write

“But numerous studies show families, especially a child’s relationship with each of their parents, are often central to the development or maintenance of an eating disorder.”

This has become one of those myths that gets repeated until people no longer question whether it’s true or not. Could you please list the “numerous studies” that prove parents are “central” to the development of an eating disorder?

I have yet to see a study conducted according to accepted standards of the scientific method that demonstrates a key role for parents in the origin of EDs. Please post the links so we can see what you’re referring to.

thanks.

posted on August 17th, 2007 at 9:06 pm

6 On August 17th, 2007, twilightriver

“Is anorexia the female Asperger’s?” Asperger’s is not exclusive to men. All I know about it is what I know from the two people I know who actually have it. Both of them are women.

Also, anorexia is not exclusive to women. There are by far more women who are anorexic than there are men, but there ARE men who are aneroxic.

Whoever wrote the headline really didn’t think about the implications. The interview and your response were both interesting, but I was so distracted by that headline, I have no other response.

posted on August 17th, 2007 at 9:16 pm

7 On August 17th, 2007, Harriet

I agree with Laura here. Treasure is not speaking of the Maudsley approach we have used and aedvocate.

As for the role of the family, I’m guessing if you polled 100 teenage girls (for the moment we’ll stick with girls), you’d find 10 who had significant issues with their parents. And 2 of those would also have anorexia (that’s the incidence rate, 1 to 2 %). Does that mean family issues caused or triggered the eating disorder? I don’t see how you would know whether they did or didn’t. That’s why FBT takes no position on causality–there are too many factors and it’s timpossible to tease apart.

And to be honest, I don’t think it matters. What we do know is that the quicker someone is weight restored and restored to normal life, the better the long-term outcome. All the fussing over who’s to blame often serves to distract from the essential issue, which is get the weight back on fast. Traditional therapy lets the sufferer down, way way down, by expecting her to “take charge” of her own recovery. Well, I’ve seen someone I love in the throes of anorexia, and she would have died had others not stepped in to coordinate her feeding. Traditional therapy is cruel, needlessly so.

And when you blame parents, you effectively incapacitate them. I’ve had those looks directed at me, the looks from pediatric residents and interns and, yes, doctors, the burning shaming looks that say “This is all your fault, you horrible mother!” And if I had let them get too far under my skin I wouldn’t have been able to help my daughter. Even if it’s true, it’s not helpful to the person with anorexia to go there.

So I don’t really give a rip about what caused my daughter’s anorexia. I only care that she’s back to being a healthy teenager, not clawing at the sheets and shrieking in an Exorcist-type voice as she was when she was so deeply ill.

posted on August 17th, 2007 at 11:35 pm

8 On August 19th, 2007, Laura Collins

The name thing really is exasperating! “Maudsley Hospital” and “Maudsley Approach” and “the New Maudsley Approach” - it really is confusing.

The Maudsley Approach that everyone talks about is a manualized family-based approach where parents take the role that inpatient treatment would provide: nutrition first. That approach originated with clinicians working at the Maudsley Hospital in London. Treasure, who works at that hospital, subtitled her book “the new Maudsley Approach” but does not address the same issues.

posted on August 19th, 2007 at 10:59 am

9 On August 20th, 2007, Rachel

Oakeshott: Here are a few studies/reads to check out, all of which address the issue of family dynamics and the development of an eating disorder, specifically anorexia:

Humphrey LL (1989), Observed family interactions among subtypes of eating disorders using structural analysis of social behavior. J Consult Clin Psychol 57(2):206-214.

Lilenfeld LR, Kaye WH, Greeno CG et al. (1998), A controlled family study of anorexia nervosa and bulimia nervosa: psychiatric disorders in first-degree relatives and effects of proband comorbidity. Arch Gen Psychiatry 55(7):603-610.

Minuchin S, Baker L, Rosman BL et al. (1975), A conceptual model of psychosomatic illness in children, family organization and family therapy. Arch Gen Psychiatry 32(8):1031-1038.

Hall, L., & Cohn, L. (1992). Bulimia, A Guide To Recovory Gurze Books: CA.

Blinder, B.J., Chaitin, B.F., & Goldstein, R.S. (1988) The Eating Disorders. PMA Publishing: New York.

Field, Alison. Pediatrics, Vol. 107 No. 1 January 2001, pp. 54-60

Lott, Deborah A. “Eating Disorders and the Family: Controversies and Questions.” Psychiatric Times. September 1998, Vol. XV, Issue 9

And from ANRED:

A report published in the April 1999 issue of the International Journal of Eating Disorders, concludes that mothers who have anorexia, bulimia, or binge eating disorder handle food issues and weight concerns differently than mothers who have never had eating disorders.

Research at Oregon Health and Science University in Portland has produced strong evidence that exposure to stress (abuse, neglect, loss of a parent) in childhood increases the risk of behavioral and emotional problems (anxiety, depression, suicidality, drug abuse — phenomena frequently associated with eating disorders) in teenagers and young adults. http://www.ohsu.edu/ohsuedu/newspub/releases/111605stress.cfm

A recent study (American Journal of Clinical Nutrition. 2003;78:215) indicates that when parents restrict eating, children are more likely to eat when they are not hungry. The more severe the restriction, the stronger the desire to eat prohibited foods. These behaviors may set the stage for a full blown eating disorder in the future.

posted on August 20th, 2007 at 1:03 pm

10 On August 20th, 2007, Rachel

Harriet - I do see the merits in treating the physical symptoms first and foremost. Getting a patient back to a healthy weight range should be paramount. But I’m afraid that by ignoring the family dynamics at play, a patient runs the risk of a relapse or future reocurrence of the disease. Anorexia is not the most fatal of all psychiatric disorders because its victims starve to death - although many are irreparably harmed physically by the disease and some die as a result of physical maladies - but because most of its victims commit suicide.

I don’t think treatment ought to be a blame game - guilting someone isn’t effective in the slightest. But I do think the family dynamics ought to be examined. Anorexia is a mental illness and as such, treatment shouldn’t end with a patient reaching an ideal weight range. The psychiatric nature of the illness can’t be ignored.

posted on August 20th, 2007 at 1:10 pm

11 On August 20th, 2007, Harriet

Hi Rachel,
I think what happens with eating disorders (and with other conditions that come on in adolescence especially) is that because we are human beings, we want to impose meaning on them. And we do this–after the fact. It’s like saying the gods must be angry because it’s thundering. A very understandable human impulse, to make meaning out of chaos and non meaning. But that comes later.

If you read the Minnesota Starvation Study, you will see classic anorexic-style thinking, behaviors, obsessions, etc. The starvation comes first. In the case of anorexia, kids fall into it by accident: either they go on a diet and go too far, or they start training for a sport too hard and lose weight, or they get sick, or they start “eating healthy” because a school health class scares the crap out of them, or whatever. And for those who are susceptible, that starts the ball rolling.

If you look at family dynamics of 100 teenagers, you’re going to find messed-up stuff happening in a lot of those families. But only 1 or 2 will have anorexia. Correlation is not causality.

But I can understand why people want to believe tha family dynamics are responsible. We want to attribute fault (if not blame) because it makes us feel more in control. We seem to prefer that to simply acknowledging that bad things happen sometimes and there’s nothing we can do about it. Though in the case of anorexia, I think if teenagers did not diet, that right there might prevent a lot of cases.

Anorexia is a brain disease, yes. It affects the brain because the brain is part of the body. If you give a diabetic too much insulin, or not enough, she will have psychotic-type responses. But that doesn’t make diabetes a mental illness.

And I don’t think anorexia is a mental illness either.

posted on August 20th, 2007 at 4:23 pm

12 On August 20th, 2007, Stephanie Long

I think this is a fascinating thread. But as a survivor, I question how can you NOT consider family influences even when there is a strong indication of genetic component? In my case, my family would no more sit at a table and eat with me than they would admit that my mother had debilitating depression. The two go hand in hand sometimes, and to investigate one is to illumate the other.

posted on August 20th, 2007 at 4:52 pm

13 On August 21st, 2007, Laura Collins

Rachel,

I really appreciate your willingness to engage and thoughtful examination of these issues. Most of the time those on all sides of these issues simply say our beliefs and there is little useful conversation or exchange.

I wish we could sit down (around a good dinner?) and thrash these things out. I would love to take all the citations you list and explain how they are superceded by later research, speculatory, derivative, anecdotal, and circular. But in this forum I’ll settle for this one point that sums it up:

Correlation is not causation. Of course families with eating disordered members have other family members with disordered eating: it is a genetically transmitted set of traits! The same is true of many illnesses, where clinical and subclinical strains of the illness will show up in family members. There are plenty of mothers with eating disorders whose behavior increases the chances of an eating disorder in the children: because they share genes and ED behaviors are self-perpetuating once commenced.

Bad parenting, abuse, neglect, chaotic family relationships: these are of course common phenomena. But there is no credible evidence that kids with EDs have worse parents than the general population.

In fact, most people with EDs have perfectly normal families and quite functional and loving parents. It is that benefit of the doubt that I and others ask in the treatment of our eating disordered kids. I was assumed, by the clinicians who treated my child, to be pathological. That assumption derailed my efforts to help, undermined my relationship to my daughter, and was emotionally crushing at a very tough time. Most families, I’ve found, are treated that way. This is the tragedy of the antiquated and anti-scientific legacy of ED treatment. It is changing, but slowly. It is very, very sad.

posted on August 21st, 2007 at 9:02 am

14 On August 21st, 2007, Rachel

Harriet:

I’m very familiar with the Minnesota Starvation Study – in fact I wrote a paper on it for a history class. Your theory does have its merits – the effects of starvation on the body and mind can’t be dismissed.

Where we differ though is on the point whether anorexia is a mental illness, which I believe it is and in fact, has been classified as such in the DSM-IV.

Correlation is not causation, but nor can you dismiss the vast archive of studies which show a direct link between environmental factors and the development of eating disorders. Speaking from personal experience, my family played a central role in the development of my eating disorder. You mention a study of 100 teens - do you have any studies you can cite which evidence this theory?

In your view, you equate anorexia on par with that of a disease like cancer or lymphoma – entirely organic in nature and completely separated from an illness of a psychiatric nature. I can understand why people would like to believe this is the case – because then anorexia can be portrayed as a disease with a ready and sure remedy and it also absolves family members of any responsibility whatsoever in the development of the disease.

I think the success of the Maudsley treatment you advocate is that the disorder is nipped in the bud before it has time to fester. The longer abnormal eating behaviors persist, the more difficult they are to overcome.

While not every anorectic’s case can be attributed to issues like family dynamics, a great deal can be. Anorexia afflicts both mind and body and you do a grave disservice to the anorectic if you simply ignore the mind and focus instead on the physical nature of the illness.

Laura:

I do appreciate the exchange and dialogue on the disease. I think all of us here are all working towards the same end-goal: how to best effectively treat and reduce the cases of anorexia.

It’s not that I suggest “kids with EDs have worse parents than the general population.” This is, I think, what lies at the heart of those who refuse to cede the merits of studies which show the link between family dynamics and eating disorders – no one wants to feel like they’re at fault. And a parent does not have to be a “bad parent” in order to engage in behaviors which may lead a kid to choose an eating disorder.

I’m also not saying all cases of ED’s can be attributed to family dynamics either. While the behaviors of many ED sufferers are similar, there is no textbook reason on how an ED develops. But completely discounting the role of family dynamics, as well as other factors including poverty, abuse amongst other environmental factors is shooting ourselves in the foot.

And as well, both of you speak as if it is only children who develop anorexia. The rising numbers of adult-onset anorexia reveal otherwise.

posted on August 21st, 2007 at 12:01 pm

15 On August 21st, 2007, Laura Collins

My interest in spreading the word about the biological nature of eating disorders is not to absolve anyone of guilt, nor is it to downplay the role of emotional and psychological support and guidance. It is to dispel the myth of family pathology in eating disorders so that families CAN do the WORK needed to support their kids so that the KIDS can do the WORK of recovery.

It is a lot of work, and along with the full nutrition there is much to do. There’s nothing easy, or simple, or lazy about it.

I’d love it if I could look to family dynamics in causing my child’s illness. Are you kidding? Do you think I would not sacrifice my ego for my child’s life? I wish to goodness that I could find fault, and change myself to help save my child. But that doesn’t work, and it doesn’t work because it ISN’T the cause of eating disorders. It is a distraction and a sad one. Parents are easy targets, just as they were with schizophrenia and autism and even asthma for goodness sake.

Traditional treatments didn’t work, and don’t work, because they blame the sufferer and their loved ones. Some of the newer treatments work better because they concentrate on changing thoughts and behaviors (CBT) and surround the ill person with the supports they need to get full nutrition long enough for the brain to recover (FBT/Maudsley).

People don’t “choose” eating disorders. Family dynamics don’t cause eating disorders. Period. But family support can be the best - and longest term - tool for recovery. Sometimes we have to change the way the family does things, absolutely, but that isn’t because they caused the illness. But we can’t do that work when we are hampered by the antiquated and specious “link between family dynamics and eating disorders.” That idea has been abandoned and repudiated by the leading researchers, the head of the NIMH, NEDA, AED - the experts. There are professionals who still peddle this stuff but they are slowly moving away from it. Thank goodness.

posted on August 21st, 2007 at 12:41 pm

16 On August 22nd, 2007, Rachel

Hi Laura-

It isn’t that I believe environmental factors CAUSE eating disorders, but that they certainly influence one who is already genetically predisposed to addictions to choose FOOD and WEIGHT as the vice of choice. There is no proven gene which will specifically lead someone to develop an eating disorder. Behaviors for many addictions are very similar, and I think we have to examine why it is so many women, and increasingly men, look to food as the means by which to manifest these symptoms.

You’re right - eating disorder treatment must change. The CBT therapy you mention sounds an awful lot like cognitive therapy which has steadily made grounds in the past decade. Concentrating on blame won’t do anyone any good, but ignoring the environmental influences is like treating a child for lice and then sending them right back into a school infested with it.

posted on August 22nd, 2007 at 1:41 pm

17 On August 22nd, 2007, Laura Collins

An eating disorder is not a choice, nor is it a vice.

And I don’t have lice.

Seriously, it doesn’t seem that we have that much common ground to work with, but there is a little. You recognize a genetic component, and I fully endorse the idea that environment matters.

I happen to think the environment that needs to change is the acceptance and promotion of dieting (restricting one’s diet to change one’s appearance), the belief that all exercise is inherently good for you, and a medical world that doesn’t recognize malnutrition when confronted with it. That environment needs to change.

I think any family that is dysfunctional or abusive needs help, not because of an eating disorder under the same roof, but for its own sake. I think toxic relationships and our sexist culture and the equating of beauty with virtue need to change BECAUSE THEY ARE BAD FOR ALL OF US.

Recovery from an eating disorder is heroic work in a healthy, loving, functional environment. It is epic in a dysfunctional one. But assuming that one’s environment was toxic just because you have an eating disorder is cruel, and unhelpful.

posted on August 22nd, 2007 at 3:50 pm

18 On August 22nd, 2007, Rachel

And ignoring such a toxic environment does a grave disservice to one with an eating disorder.

I never said eating disorders are a choice. I don’t think anyone would actively choose the hell that is an eating disorder. And yes, much like drugs and alcohol, food and weight is a vice in the sense that they are the manifestations of a larger, more complex psychiatric issue. Perhaps you are misreading my interpretation of the word vice, as you did in another issue where I used the phrase “vain attempt” to mean vanity.

You speak to me as if I have no clue or inkling of the nature of eating disorders. And yet I lived this life every day for years and continue to struggle with disordered behavior. You look at disorders from the outside in, but I have the benefit of first-hand knowledge of the complexities of the disease. Compound this with the years I’ve spent researching food-related disorders from both a psychological and academic standpoint. Yet you continue to discount and invalidate my very real experiences and findings with more second-hand “research.”

Quite frankly, it’s a little offensive.

My experiences aren’t everyones, but nor am I alone.

But, to conclude this conversation I think we will all have to agree to disagree. I don’t think any further debate on the subject will change each of our minds.

posted on August 22nd, 2007 at 4:55 pm

19 On August 22nd, 2007, Harriet

Rachel,

I’m sure I speak for Laura when I say that no offense was intended from either of us.

Sometimes, though, it’s easier to see the truth from the outside looking in.

With all due respect, I don’t necessarily think those who suffer from a particular condition have the most insight. In fact anorexia is one of those conditions that is anosognosic, meaning that sufferers often have little insight or may not even recognize that they have it.

Obviously I’m not saying this is true for you; please don’t read it that way. All I’m saying is that an outside perspective is often clearer.

We certainly disagree on this. I’m certain that time will prove me right on this. And I hope you know that I wish you, and everyone who struggles with an eating disorder, nothing but the best.

posted on August 22nd, 2007 at 5:29 pm

20 On October 16th, 2007, Rebekah Hennes RD

I had anorexia 17 years ago. I have a sister who had bulimia. I have worked in the eating disorder field for 10 years in private practice, inpatient treatment programs, and day-patient treatment programs.
My family had no diet or food issues which they taught to me. However, my family was not perfect and family therapy can be helpful.

It is interesting that there is such a heated discussion over parent’s roles (if any) in the development and treatment of eating disorders. Of course, some parents have some odd ways of relating to food and their bodies. They can be very restrictive and diet-based parent’s who teach, by example, this behavior to children who are quite young. There are also many parents who have no issues with food and weight and their child may still develop an eating disorder.

It is very individualized and one family’s experience is not anothers. Treatment is also very individualized. The maudsley method cannot be done in some households.

What I am very pleased to see is the focus on aspergers. Through my career, there have been some client’s who cannot eat without constant and direct supervision. And they really appear to have a desire to recover. Adolescents who may have a form of aspergers may do very well with a family who can do the maudsley method. But the adult female with aspergers and anorexia is my concern.

Usually the adult client will do very well in an inpatient setting, relatively well in a day-patient setting, and fall hard and quick in an out-patient setting. I have usually had to find a group home (eating disorder based) and keep them there for a time. If a client can afford it…she never leaves.

Has anyone had better success with an adult female asperger-type anorexic?

posted on October 16th, 2007 at 11:53 pm

21 On October 16th, 2007, Rebekah Hennes RD

?

posted on October 16th, 2007 at 11:56 pm

22 On October 17th, 2007, Harriet

“The maudsley method cannot be done in some households.”

Rebekah, I’m going to challenge you on this one. Not because I think it’s necessarily untrue, but because of the way you’re putting it out there–as a statement of fact, of course we all know this method is suitable only for certain households, maybe very special households where there are no issues around food or parenting or anything . . . in short, no households.

I realize you didn’t say that, but that’s the implicit meaning behind your words, at least as I’m reading them on the internet with no verbal cues from you. And since this is a common misperception I would like to address it.

You don’t have to be perfect family to “do Maudsley.” You don’t have to have no food or diet or body image issues. “Doing Maudsley” is simply a method of parents supporting children and adolescents through the hell of anorexia. It’s appropriate for every family. This is not to say it will be successful for every family; there are families and situations where it won’t work, or where it won’t work at a given point in a child’s illness/recovery. But short of an abusive situation, I can’t think of a situation where it’s inappropriate for a familiy to support a child.

And just to clear up another misconception while I’m at it–there are three phases of Maudsley therapy. It is NOT a “feed-em-and-forget-em” therapy. Phase 1 is weight restoration. Phase 2 is gradual transfer of responsibility for eating back to the adolescent. Phase 3 is supporting the adolescent through normal teen growth and development–issues of autonomy, sexual development, and so on.

posted on October 17th, 2007 at 10:27 am

23 On October 17th, 2007, Rebekah Hennes RD

Harriet,
I did mean…an abusive situation and/or where the parents are not interested and are way too busy in their own lives that they would rather dump their child at a treatment center. I am a mother and have been surprised that some parents out there are like that…but they do exist. Please don’t assume I am attacking the Maudsley method. I understand that the topic is controversial…but not everyone has issue with it.

We have families who do Maudsley and they have their own issues around food. I am not debating the value of Maudsley. We did something unconventional and very similar to the 3 Phases of Maudsley (even though we had not heard of Maudsley) in our inpatient setting. I know Maudsely insn’t inpatient). We took total food and menu control away from the client during Level 1. During Level 2 the client learns to recognize her somatic cues and learns to cope with her emotions and stress differently. On Level 3 full responsibility is given back to the client while she is able to practice Intuitive Eating.

During the first phase of recovery, a client cannot make choices independent of her ED. This idea is also controversial…but our results have been highly superior when compared to the conventional way of treating eating disorders.

It seems that many clinicians/individuals who have had an ED and get caught up in their emotional reaction of how they would feel in Level 1 or Phase 1. But level 1/phase 1 works very well and the client is quickly removed from ED and can then get on with her life instead of frequenting treatment centers.

posted on October 17th, 2007 at 11:51 am

24 On October 17th, 2007, Rachel

Rebekah - So you work at an inpatient ED facility? I’m interested in what the costs are for inpatient treatment for say, the average length of stay for your patients. Does your center offer assistance to those without health insurance coverage or whose coverage may not cover your facility’s services?

posted on October 17th, 2007 at 12:21 pm

25 On October 17th, 2007, Rebekah Hennes RD

Approximately:
inpatient treatment costs $1200+/day
daypatient 500+/day

When I had anorexia I was in a psych ward for 1 month and then my insurance ran out and I was discharged.

The recommended length of stay for treatment is at least 2-3 months.

There are many foundations that raise money to “scholarship” individual’s treatment and some will decrease the cost depending on need. It depends on who owns the facility.

Most treatment centers still teach clients to eat based on a meal plan or exchange system which handicaps them for eating in the real world. Five or six years ago, I worked in an inpatient treatment center which was one of the first (if not the first and only) inpatient treatment centers to teach intuitive eating. The day patient treatment center that I work at, in Los Angeles, also teaches Intuitive Eating.

Myself and some other dietitians have a new book coming out that teaches treatment centers how to teach intuitive eating to ED clients.

The profit from that book will go into a foundation to scholarship women who cannot pay for treatment.

posted on October 17th, 2007 at 3:12 pm

26 On October 17th, 2007, Rachel

Thanks for the info Rebekah. Wow, $1,200 a day. Kind of mind-boggling, actually. Do you have any statistics on your center’s long-term effectiveness? What kind of demographic most frequented your center? I mean, did you get a range of economic classes, or were most of the patients’ families financially able to pick up where insurance left off?

Your book project sounds compelling. When will it be available?

posted on October 17th, 2007 at 3:42 pm

27 On November 21st, 2007, alicia

As a professional in the psychiatric community it concerns me that anything is being 80% attributed to genetics of a psychological nature. Never has any psychological disorder including bi-polar disorder or schizophrenia (which have the most valid reseach of biologial behind then) been proven to be 80% genetic. Please explain how the starving brain causes the illness that began the symptoms. If anorexics have anorexia because they don’t eat why did they not eating to develope anorexia.

posted on November 21st, 2007 at 4:11 pm

28 On November 21st, 2007, Rachel

I don’t understand the last part of your question fully, Alicia. But I do think that many eating disorders are genetic in nature. This is not to say that a person carries a genetic gene that will cause them to develop anorexia or bulimia specifically, but people are born with certain genetic propensities that, in the right environment, can lead to an eating disorder. This is evident in that many anorexics are similar in nature, perfectionist… bulimics are often people-pleasers, et all.

These same genetic tendencies can manifest themselves in other addiction-related disorders, like alcoholism and drug use.

posted on November 21st, 2007 at 4:25 pm

29 On November 21st, 2007, Laura Collins

That anorexia is 50-80% heritable is well-established. And this is more than schizophrenia and bipolar.

For references: http://eatingdisorders.ucsd.edu/WhyDoTheyKeepDoingIt_Kaye_6_23_07.pdf and go to page 7 for a chart and citations.

And one thing that people often forget is that “environment” means things like prenatal nutrition, viruses, extreme athletics, and the diets that have become almost a rite of passage in our society.

In other words, EDs used to be assumed to be choices. They aren’t. They are real brain illnesses. Patients need extensive supports - both physical and psychological - to recover and avoid relapse. They don’t need blame or shame or to be asked to fight it by force of will.

Name an eating disorder that didn’t start with restrictive eating, an illness that limited nutrition, or overexercise. That is the common factor. Too little nutrition for the energy needs of that individual. We can all argue about what made someone decide to diet, or run track, but if you have the genes for it those activities will lead to eating disordered thoughts and behaviors.

posted on November 21st, 2007 at 7:00 pm

30 On November 21st, 2007, Meowser

I never saw this post before, wow.

As a female who is coming to realize that she does indeed have Asperger traits — in her 40s — I have to say, anyone who would ask if anorexia is the “female Asperger’s” has a really poor understanding of both.

Asperger’s will make you socially awkward because your brain wiring is different and it can cause problems in both sending and deciphering social signals. It is not life-threatening. Not unless it is severe enough that it also renders you homeless because you can’t make a living, but that’s a social problem, not a physical problem.

And it’s not as if all anorexics are female or all Aspies are male. I can tell you that probably fewer women are diagnosed with AS, and more women learn how to “mask” their AS traits because they are less socially acceptable than they are in men. Hence the very late diagnosis for me. But nobody can go 40-plus years as a full-on anorexic, completely undiagnosed and untreated, and not only survive it but have it go completely unnoticed by everyone except a trained professional who you just happen to see for an unrelated reason!

posted on November 21st, 2007 at 7:03 pm

31 On November 21st, 2007, Harriet

Alicia,
I’m frankly floored that you “work in the psychiatric community” and yet seem to have no understanding of how eating disorders develop. I hope this discussion is helpful in developing the understanding any clinician needs to work with e.d. patients and families.

Laura is absolutely correct in pointing out that anorexia starts with restrictive eating. About 80 percent of middle-school-age girls are on a diet at any given time, and dieting is one of the biggest triggers for an eating disorder. I’ve never had anorexia but I have noticed throughout my life that whenever I’ve gone on a diet, I tap into feelings of moral superiority that lead to further restricting. I’m guessing I don’t have the genetic susceptibility toward anorexia. For someone who does, that can be the beginning, and it can take place long before full-blown anorexia develops. My daughter, for instance, took the concept of “healthy eating” very seriously in 6th grade and began restricting her food intake then. It was subtle at first–fewer desserts, less fatty foods. It took two years to develop into full-fledged anorexia. That’s an excellent example of how genetic susceptibility + triggers (environment) can contribute to an e.d.

posted on November 21st, 2007 at 7:12 pm