Treatment for anorexia and other eating disorders: the essentials for parents

The essentials for a parent who wants immediate answers: what are the main principles of the treatments covered in this book, and how long before you can expect some relief?

This is the whole of Chapter 4 of ‘Anorexia and other eating disorders – how to help your child eat well and be well’. I hope it sets you off on a productive path right away.

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The road ahead

Here’s an outline of the main elements of treatment for complete recovery:

• Set up specialist treatment – online if necessary. This means regular sessions with a professional qualified in a family-based approach, and depending on requirements, a psychiatrist, a dietitian, or a psychologist – each specialised in eating disorders. Given the dearth of good providers, some parents manage with self-help and a family doctor (more in Chapter 12).
• In a first phase (see the graphic above), we parents take responsibility for meals: this is ‘refeeding’ or ‘nutritional rehabilitation’. We get skilled at kind and effective support so that our children manage despite their distress. We don’t wait for them to be motivated to ‘beat’ the eating disorder. Their brain is currently sending them highly distorted messages about what feels ‘right’. The general rule is 3 meals and 3 snacks a day. We must provide calories and prevent big gaps between meals.

“I have been made team leader of food”

• While the body perceives a weight deficit, the mental state will stay poor. Your first priority is rapid weight gain. You may wonder how your child can gain a lot of weight when they fear it so much. On the whole (there will be fluctuations), that fear reduces as weight increases, paradoxically.
• In addition to weight and nutrition, early priorities are to protect your child from compulsive or excessive exercise (a gentle stroll with you might be fine), and from the use of laxatives, diuretics or vomiting.
• Most parents find that these tasks only succeed when they take a strong lead, with skill and compassion. Usually, that means the young person, however bright and independent-minded, has little or no involvement in food decisions, shopping, cooking or portioning. This tends to relieve them of the guilt and confusion they feel when they eat or rest. For a while, meal support and supervision interfere with both your life and your child’s (they’ll need help with meals in school, for instance). Yet for almost all families, progress only happens when parents take on this work. I help you with all this in Chapter 6, where I also discuss the more unusual cases where the opposite is true: where a young person makes better progress with collaboration.
• Your next priority is exposure work to free your child of fears, rigid rules, rituals and distorted beliefs. You’ll bring back the foods and behaviours that you consider ‘normal’ (Chapter 9). Start on exposure as soon as you can, but not if it gets in the way of your first priorities (weight gain, regular meals and interrupting exercise and purging). Don’t miss this work, as weight gain alone rarely fixes behaviours and thoughts.
• Throughout, you make your child’s life as rich and happy as possible and treat them with compassion. Accept, though, that they will need to go through some distress – avoidance will only prolong the misery of the illness.
• Gradually you will be on the lookout for what your child is able to do for themselves. Can they manage school, with or without meal supervision? Can they return to moderate physical activity? Can you coach them to choose between two snacks? To serve themselves a suitable portion of peas? Of lasagne? The aim is for you to safely step back, with your child managing age-appropriate autonomy and taking pride in their progress. To succeed, they might need coaching and supervision. If it turns out that a challenge was too much, too soon, you will treat that as a useful experiment, provide more coaching in easier steps, or go back to the last thing that worked. Some call this ‘Phase 2’ and it’s the topic of chapter 10.
• Psychological support may come in useful around this time – usually not any sooner – if your child needs help to resume normal life and relationships. Individual, confidential psychotherapy may be useful at this stage if they have co-existing mental health challenges.
• With time, your child is well – they just need time to consolidate. There’s education on relapse prevention, and discharge from treatment. Parents also start enjoying themselves, while exerting some light vigilance, because slip-ups are to be expected.
• And then one day, youngsters and parents realise that time, repetition and the pull of life have done the rest of the healing,[i] because the eating disorder thoughts and compulsions have gone, and a beautiful young soul has recovered.

I haven’t mentioned hospitals. If your child is medically at risk then a short stay in a paediatric ward can help reset things so that you can resume treatment at home. With some youngsters the illness is just too powerful, or the parents are not getting sufficient support, so a longer spell in an eating disorder treatment centre is needed. This does not provide a complete cure, but good units make parents part of the team and skill them up to take over as soon as possible.

The above outline, like much of this book, is in line with a family-based approach. Professional institutions worldwide recommend this as the top child and adolescent treatment. However, if you are absolutely certain it’s not for you, don’t give up! Jump over to Chapter 12 where I introduce you to other valid treatments.

Food for weight restoration and stability

Food is an essential medicine in the first stage of treatment. If your child lost weight or failed to grow, they need to catch up. People who binge or purge need regular meals to gain stability and escape a vicious cycle of obsessive restriction, terrible hunger, eating with guilt or bingeing, followed by another attempt at restriction.

For people who are vulnerable to an eating disorder, ‘weight suppression’ is very likely to trigger an onset or relapse. That means youngsters must not lose weight and must keep gaining weight for growth. Your priority is now rapid weight recovery. If you’re wondering how much to aim for and what to do if your child previously had a high BMI, I go into detail in Chapter 6.

As a medicine for an eating disorder, food really sucks. It’s a distressing pill for people to swallow not once, but five or six times a day. Sadly, medical science hasn’t yet come up with anything easier. Take heart: meals get easier as weight goes up. The brain is particularly calorie-hungry, and you should see mood improve with nutrition. If you’re wondering how you can possibly get your child to eat, read on. In Chapter 7, I list general principles and offer some dos and don’ts. Then in Chapter 8, you can be a fly on the wall and witness an entire mealtime session. And in Chapters 13 to 15 I give you emotional tools to help you support your child meal after meal.

Train the brain: practice ‘normal with exposure work

Food is fuel, and there is an additional reason why it is medicine: the brain needs to relearn what is ‘normal’. For instance, when we repeatedly serve a fear food it starts to feel ordinary and safe again. Our children often lose the sense of what a normal portion is, what their body is supposed to look like, and what it feels like when they have enough body fat. Sometimes they need to remember what it’s like to be happy and carefree. They shed eating-disordered habits by engaging in new behaviours. Their brains need nutrition, exposure, and time, to heal and form new, healthy pathways.[ii] Our youngsters need help with this, and that’s why weight-restoration should never signal the end of treatment.

Unconditional love

Every step of this treatment call upon the ability of parents to give unconditional love and support. This is not empty sentimentality; the evidence is that criticism and hostility from parents impedes progress.[iii] We parents hold essential keys to the treatment, because families are all about love.

Your love helps your child to trust you so that together, you can tackle seemingly impossible challenges. Suffering is a lot more bearable when we are feeling loved and understood. And for those of you who worry that your child isn’t yet getting psychotherapy, note that your compassion provides emotional healing. You’re also modelling emotional skills which your child will one day use for themselves. If you yourself are presently suffering, you may already have felt how healing and empowering it is when someone hears you, understands you, and accepts you. Love is hard to put into practice in the middle of our daily storms. This is why I offer emotional tools as well as practical ones. Jump to Chapter 13 if you feel this is what you need the most right now..

When does psychotherapy have a role?

In a family-based approach, the young person normally does not get individual psychotherapy. Parents worry about this. When we’re new, we assume that there are psychological fixes that will make our children come to their senses and motivate them to eat again. We hope that with therapy for the bullying, the parents’ divorce, or the bereavement, the ability to eat will return. But this is putting the cart before the horse. Mental changes come because of physical recovery and behavioural work, not the other way around. Even if your child has moments of insight, they will likely lose all willpower at the next mealtime. The work is done bite by bite.

“Knowing that he didn’t need to have insight at the beginning or want to get better was a huge relief to me. It helped lift the sense of despair early on.”

If your child did not have any psychological issues before the eating disorder, they may not need any psychotherapy. The issues that currently make your youngster so unhappy – depression, anxiety, rigidity, delusional and obsessive thinking, compulsions – diminish with nourishment. They recede some more with behavioural work to make ‘normal’ feel normal again. And then time and a good life provide the final magic. When a health service doesn’t yet provide psychotherapy, it’s not to save money; it’s good scientific practice.

Having said that, clinicians are becoming more flexible in assessing each child’s needs. I say more in Chapter 12 to help you decide whether your child would benefit from one-on-one therapy sessions now or later. What is sure is that the feeding work has to go on just the same.

Medication

There are no drugs to cure eating disorders. But some youngsters greatly benefit from medication to assist with anxiety, depression, delusional thoughts, or self-harm – especially at the beginning of treatment, when eating causes such high levels of distress.[iv] It’s the role of psychiatrists to assess and keep reviewing.

Your child's increasing wellbeing: a visual guide

You’ll be wondering how and when your child’s mental state will get fixed. Here’s the big picture. The first major improvements in mood come with weight gain. Also with regular meals and interrupting harmful behaviours (over-exercise and purging). As we introduce other work (exposure, coaching for independence, and perhaps psychotherapy), progress continues: we generally see improvements in mood (depression, anxiety, self-loathing), fears, the use of rituals (body-checking, measuring portions) and the attachment to eating disorder behaviours (over-exercise, purging, restricting). Thoughts and beliefs also improve: you’ll see less of (‘carbs are bad’) and obsessive thinking (‘Am I fat? Did I eat too much?’). It’s quite a transformational journey, and many of us have seen our children end up wiser, more insightful and better resourced than their peers.

While the graphic above offers the big picture, progress is rarely linear, and every child has their ups and downs in different domains. This week’s weighing freaked them out and meals are hard again. At the same time, they’re more like their old self, engaging with you, with friends. Their body image is often the last thing to return to ‘normal’: indeed time is one of the healing factors.

If you are seeing zero progress, that’s a sign you need more help from your professionals.

What is this method called?

There are variants of this method, and they’re so similar that we parents don’t need to worry about which we’re getting. For an umbrella term I’ll use the words ‘family therapy’ or a ‘family-based approach’.

Occasionally I use names referring to specific manuals[v] or publications, such as ‘family-based treatment’ (FBT) or ‘family therapy for eating disorders’ or ‘anorexia/bulimia-focused family therapy (FT-AN or FT-BN)’. I won’t use the word ‘Maudsley’ as it gets confused with the very different ‘New Maudsley’ (more in Chapter 12).

You’ll need to know that what I write is in line with approved methods, so jump back to the first few pages or to my website to see how experts in these methods recommend my resources.

Choose a family-based approach first

If your child or adolescent has anorexia or bulimia (or a so-called ‘atypical’ version of those), any therapist following the science should support you with a family-based approach before considering any other method. This is recommended by professional organisations worldwide.[vii]

“The evidence to date indicates that Family-Based Treatment (FBT) is the most effective treatment for children and teenagers with anorexia. A key component of the FBT model is that the parents are given the responsibility to return their child to physical health and ensure full weight restoration.”[viii]

Canadian Paediatric Society

Further down the line, other methods can be useful as adjuncts. Nowadays most treatment providers claim to deliver ‘evidence-based’ treatment and ‘family therapy’. But are they? Check that any reference to ‘family therapy’ is not about ‘fixing’ the family – quite the opposite, it’s about making good use of wonderful parents:

“Treatment with the family as opposed to treatment of the family”

Maudsley Service manual

In Chapter 12 I offer a checklist to help you choose good treatment. Briefly, for now, the following indicates that a method is not family-based:

• It’s mostly one-on-one sessions between your child and the therapist
• The focus right from the start is on getting the patient motivated and taking responsibility for their recovery
• There’s an emphasis on looking for some ‘underlying causes’
• Parents are to stand back or just make gentle suggestions
• Parents are seen less as a precious resource and more as a problem
• There is no ambition to achieve full recovery, let alone full weight-restoration

A family-based approach may not work for you, and there are individual therapies that have a relatively good evidence base, but only as a second choice (more in Chapter 12). For now, to put it simply, your child needs your help.

One size fits all?

Should we follow a treatment approach to the letter? Treatment methods fail a number of patients, and we don’t know why. Research has highlighted some essential ingredients[ix] but we are left guessing which elements might be optional or even detrimental.

And while knowing what works for most people is useful, we don’t always know it will work for your child. I hope your treatment team makes these conversations easy for you.

Your clinicians’ level of expertise matters. What’s their training in the family-based method? Do they have experience with a wide variety of patients, including those with co-occurring disorders or autism? Are they willing to problem-solve with you, or do they stick to rigid protocols? Are the opposite protocols in place elsewhere, and if so, who’s right? Within my country’s national health service, I see major differences in goal weights, whether to weigh open or blind, whether to give a meal plan, and so on.

A rule of thumb is that the less experienced the clinician, the more they should consult the treatment manual (just like someone who’s not an experienced cook would be wise to stick to recipes). Basically, we ‘don’t know what we don’t know’, especially when we don’t keep abreast of the field. Some of the truths we are so dogmatic about today will be overturned by a piece of research tomorrow. From the authors of the Maudsley service manual:

“The differences between the manuals […] act as a further reminder, that our knowledge of how treatments work is still very limited and that in applying manuals to practice, therapists need to understand the concepts that underpin the interventions. They also highlight, that families vary and that what may suit one family well may be a poorer fit for another family and that clinical flexibility and respect for the families’ own view must not be lost when treatment is informed by a therapy manual.”[x]

Daniel Le Grange, co-author of the FBT manual, worries when we ‘see the manual and its guidance with a bit too much rigidity’ and wants us to retain ‘an appropriate sense of fluidity’:

“I believe rules are made so that you know when to set them aside […] We should never be rigid, it should never be. ‘Oh everyone has to go this way. Probably most people will go this way […] but there are always exceptions”[xi]

In this book, I aim to highlight what usually works best as well as variations that might be great for some – and terrible for others. I find the adaptations made by parents of autistic youngsters particularly instructive[xii] – if only because they highlight how one person’s solution is someone else’s flop.

“Our 11-year old son seemed different –actively suicidal, with school a huge contributor to massive anxiety. I felt a great deal of anxiety and despair as we tried to implement the tools of family-based therapy but saw complete failure repeatedly. The phrases you suggest for mealtimes just made him madder, sarcastic. What helped was to be kind, calm and confident, remove stressors, and to involve him in some of the meal preparation.”

There are many everyday questions which have no scientific answers. How long to persist with this difficult meal? How much rudeness to tolerate? Will rewards help or hinder? To cope with uncertainty, set up experiments and draw your own conclusions.

When to treat co-occuring disorders

Eating disorders are often accompanied by what’s called ‘comorbid’ or ‘co-occurring’ conditions and share genes with them. The most common are anxiety disorders (including OCD), neurodivergence such as autism, attention deficit hyperactivity disorder (ADHD) and depression.[xiii] Some youngsters may later be diagnosed with depression, borderline personality disorder (BPD), or bipolar disorder (manic depression). Some comorbids were present a long time before the eating disorder and they get worse with undernutrition. But it’s also common for co-occurring conditions to appear only as temporary effects of starvation[xiv]: hunger and malnourishment are conducive to aggression, volatility, depression, suicidality, anxiety or rigidity.

Unless there is a risk of suicide or serious self-harm, and unless the co-occurring condition makes eating disorder treatment impossible, the general rule is to treat the eating disorder as a priority because:

• it presents the greatest risk to health.
• as the eating disorder recedes, many of the other problems usually do so as well.
• psychological treatment for a co-occurring condition may be a waste of time while your child is malnourished.

There are plenty of exceptions to the general rule, so do seek out specialists who can advise you.

Adapting for autism spectrum disorder (ASD)

Many youngsters with an eating disorder are also autistic (this now includes the old diagnosis of Asperger’s). Whereas ASD is part of the child’s makeup, the eating disorder can be treated. Some parents wish that autism had been diagnosed early because they’d have adapted the treatment. But it’s tricky to diagnose autism while malnutrition causes anxiety, rigidity, and rituals. Conversely, ASD is sometimes revealed precisely because malnutrition tends to intensify autistic characteristics.

Some parents report that their child’s love of rules makes refeeding and rapid weight gain easier. Others say their child can only eat if given some autonomy over meals. Still, the parents must be able to steer choices so that portions are large enough. Progress may be slower, but some report that this approach has eventually freed their child of the illness. Autism presents in such varied forms that there is no unique, correct way of modifying the eating disorder treatment. You and your clinical team will need to assess, experiment and adapt. You are not alone though: others have been contributing their know-how – see my website for more.

• On my website: Eating disorder treatment for your autistic child or teen[xv]

Expect full recovery

Our family therapist said she expected ‘nothing less than full recovery’. You need to know that this illness is treatable. Your child only sees a dark tunnel of low mood and isolation, and you’re the one holding the candle of hope. My daughter only gave me one piece of advice as I wrote this book: ‘Make sure they know they will recover.’

You may have found depressing statistics on recovery: they will reflect old treatments and will not apply to you. A family-based approach is very different and more effective (more on that in Chapter 12).

People recover at any age, even after decades of sub-standard treatment. Don’t allow anyone to tell your child they will have to forever live with their eating disorder. I have followed families where the illness was very severe and complicated, with several years of tube feeding in eating disorder units, and the young person is now recovered and thriving. Your child is not a statistic. You will use all the tools at your disposal, and take the time it takes, to accompany them all the way to complete freedom. In the process, you will all grow closer, stronger and wiser. Sure, some things are not in our control. So we focus on the things we have the power to do. We cannot control how many apples a tree will produce, but we can provide the conditions for it to flourish.

* Expect full recovery (not just ‘remission’) from an eating disorder *

How long before my child is well again?

The illness hits our children in different ways, so some recovery journeys are relatively straightforward, while for others it takes time. Most parents report that treatment took longer than they’d expected, and want you to know, ‘This is a marathon, not a sprint’. But with time, things become easier – routine almost. If you’ve recently started tackling the eating disorder, you might be going through the worst of it right now.

“Just 4 weeks ago I would scarcely have believed that we would be where we are now. It’s amazing how quickly he improved once we worked out how to help him. That included reducing this anxiety (by taking him out of school), simplifying his life and giving love and support all the time, whilst controlling our own behaviours. His psychological symptoms are abating (apart from the OCD) just as you said they would as his weight goes back up.”

Some youngsters progress fast after a difficult start. If you can’t get your child to eat, or if after 2 or 3 weeks you have little hope of driving weight gain, insist on more help. You might be offered meal support at home, a week in a paediatric unit, access to day treatment or a lengthier stay in an eating disorder unit.

Let me give you some indicators so you can form realistic expectations – this is for anorexia. The period of weight gain needs your intense support. Your child will have to catch up on the weight they should never have lost if they’d stayed on their growth curve, plus possibly more. With the recommended weight gain of 0.5 to 1 kg per week, you can do the maths. With every meal eaten and every kilo gained, our children tend to get better physically and mentally. They manage to eat without too much cajoling… and you, too, gain confidence. The crisis is over. Increasingly, there will be delightful moments when you feel, ‘My kid is back!’

“Last night, when I picked up my girl, I had forgotten to bring the snack for the ride home. She said, ‘But Dad, I'm hungry.’ Just matter-of-fact. So matter-of-fact that I didn't realize she had said them until a few minutes ago, nearly 12 hours later.
I have waited for those two words, ‘I'm hungry.’ I have not heard them since I don't know when.
ED took another hit last night. And my girl took another step. I am joyful.”

There can be day-to-day or week-to-week fluctuations, so if you have bad times, gain some perspective by zooming out on the bigger picture.

Eventually your child will reach the weight their body needs, and many (but not all) of us see a big improvement (but not complete recovery) in their mood and thinking.

As I explained at the start of this chapter, the next tasks you’ll have to help your child with are behavioural changes (extinguishing fears), followed by coaching for independence (Phase 2). How long this takes is highly variable – I tend to think around six months, with decreasing intensity. There may be areas you’ll continue to support or supervise because your child isn’t yet able to handle them wisely. Gradually, though, they’ll ease into normal life, and you’ll allow yourself more freedom too.

Another way of looking at the timescale of the illness is that life will seem more normal when visits to therapists end. This typically happens 6 to 12 months after the start of family therapy, the recommended treatment for adolescents. Studies indicate that fewer than half of patients have fully recovered by then, so expect your role to continue quite a bit longer. Therapist Sarah Ravin reports that of the anorexia patients who completed treatment with her, it took between 2 and 48 months for them to achieve full recovery.[xvi]

A year or two after treatment started, for most of us life feels increasingly normal, though I consider it wise to maintain some level of vigilance until our children are in their mid-twenties and their brains have fully matured.

Here are factors that usually support faster improvement and better outcomes in the case of anorexia:[xvii]

• Treatment follows a family-based approach (nutrition, no purging, compassionate family support, consolidating normal behaviours).
• Treatment starts as early as possible. Right away, your child gains weight at a fast rate.
• Recovery may proceed quicker if your child didn’t have other mental health disorders prior to the onset of the eating disorder.
• It may seem particularly tragic when the illness hits a very young child, but this makes treatment easier and increases the chances of a swift recovery.[xviii]
• If time is on your side (i.e. if there’s no pressure for your child to leave home), you have a better chance of future-proofing your child against relapses.

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* Next: Chapter 5 – What parents need to know about the causes of eating disorders *

* Go to Table of Contents *

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Endnotes [click]

[i] O’Toole, J., ‘Tincture of time’, http://www.kartiniclinic.com/blog/post/tincture-of-time/

[ii] For instance, Hildebrandt, T., Bacow, T., Markella, M. and Loeb, K.L., ‘Anxiety in anorexia nervosa and its management using family-based treatment’, Eur Eat Disord Rev. (January 2012) vol. 20, no. 1, pp. 1–16, http://www.ncbi.nlm.nih.gov/pubmed/22223393
For these concepts put in practice for adults, see Tabitha Farrar’s book ‘Rehabilitate, rewire, recover!’ https://amzn.to/2Gpxnrk

[iii] There’s a focus in the manuals on parents being supportive, not critical. One study indicates that the higher the ‘expressed emotion’ (hostility, criticisms) from fathers, the lower the chances of recovery: Daniel Le Grange, Elizabeth K. Hughes, Andrew Court, Michele Yeo, Ross D. Crosby, Susan M. Sawyer, ‘Randomized Clinical Trial of Parent-Focused Treatment and Family-Based Treatment for Adolescent Anorexia Nervosa’ in J Am Academy Child & Ado Psych (2016), vol. 55, no. 8, pp. 683–692, http://tinyurl.com/z7rwsgr

[iv] The AED Guidebook for Nutrition Treatment of eating disorders (2020) reviews medication www.aedweb.org Dr Julie O’Toole provides a good introduction to the role of medicines like Olanzapine, Prozac or Zoloft. ‘Directly observed therapy, baby bird style, swish and swallow twice’ (13 May 2011) on https://www.kartiniclinic.com/blog/post/directly-observed-therapy-baby-bird-style-swish-and-swallow-twice/ and on Let’s Feast Blog (23 May 2014): ‘Medication’ letsfeast.feast-ed.org/2014/05/guest-post-by-dr-julie-otoole.html and an entire chapter in Dr Julie O’Toole’s Give Food a Chance (https://amzn.to/2CivYS6).

[v] The FBT manual is by Lock and Le Grange in the US: amzn.to/3jZKpPW The Maudsley Service manual outlines treatment at the South London and Maudsley’s child and adolescent service, with Ivan Eisler, Mima Simic, Esther Blessit, Liz Dodge and team, who train many of the UK clinicians: mccaed.slam.nhs.uk/wp-content/uploads/2019/11/Maudsley-Service-Manual-for-Child-and-Adolescent-Eating-Disorders-July-2016.pdf

[vi] Maudsley Service manual: mccaed.slam.nhs.uk/wp-content/uploads/2019/11/Maudsley-Service-Manual-for-Child-and-Adolescent-Eating-Disorders-July-2016.pdf where you’ll find a nuanced discussion on externalising

[vii] UK:
Nice guidelines (May 2017): nice.org.uk/guidance/ng69 I explain them on anorexiafamily.com/nice-guidelines-adolescent-eating-disorder-ng69
Australia/New Zealand:
Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of eating disorders. https://www.ranzcp.org/Files/Resources/Publications/CPG/Clinician/Eating-Disorders-CPG.aspx
US:
The National Institute of Mental Health in nimh.nih.gov/health/topics/eating-disorders: ‘Family-based therapy, a type of psychotherapy where parents of adolescents with anorexia nervosa assume responsibility for feeding their child, appears to be very effective in helping people gain weight and improve eating habits and moods.’

From the American Academy of Pediatrics:
Rosen, D. S. and the Committee on Adolescence, ‘Identification and Management of Eating Disorders in Children and Adolescents’, Pediatrics, Official Journal of the American Academy of Pediatrics (2010) vol. 126, p. 1240, http://pediatrics.aappublications.org/content/126/6/1240.full.pdf . They write: ‘Family-based interventions, nevertheless, remain an effective and evidence-based treatment strategy for adolescent AN in both open trials and randomized controlled studies … Unfortunately, family-based treatment by experienced providers is not available in all communities. Nevertheless, the essential principles of family-based treatment can still be encouraged by community providers in their work with patients and families.’

[viii] Canadian Paediatric Society. Position Statement. ‘Family-based treatment of children and adolescents with anorexia nervosa: Guidelines for the community physician’ (Posted 1 January 2010, reaffirmed 30 January 2013). Findlay, S., Pinzon, J., Taddeo, D., and Katzman, D. K. (Canadian Paediatric Society, Adolescent Health Committee), Paediatric Child Health (2010) vol. 15, no. 1, pp. 31–5, http://www.cps.ca/documents/position/anorexia-nervosa-family-based-treatment

[ix] For instance, Ellison, R., Rhodes, P., Madden, S., Miskovic, J., Wallis, A., Baillie, A., Kohn, M. and Touyz, S., ‘Do the components of manualized family-based treatment for anorexia nervosa predict weight gain?’ in Int. J. Eat. Disord. (May 2012), vol. 45, no. 4, pp. 609–14, http://www.ncbi.nlm.nih.gov/pubmed/22270977. This showed that parents taking responsibility, being united, not criticizing the patient and externalizing the illness predicted greater weight gain. Sibling support did not predict weight gain.

[x] Maudsley Service manual: mccaed.slam.nhs.uk/wp-content/uploads/2019/11/Maudsley-Service-Manual-for-Child-and-Adolescent-Eating-Disorders-July-2016.pdf

[xi] Daniel Le Grange, co-author of the FBT manual, talking about blind versus open weighing youtu.be/wAu3LEaj_eU?t=2697

[xii] https://anorexiafamily.com/autism-eating-disorder-tips

[xiii] A good starting point to learn more about comorbid conditions is Carrie Arnold’s book Decoding Anorexia.

[xiv] Dr Julie O’Toole explains this beautifully in ‘The many disguises of an eating disorder’, http://www.kartiniclinic.com/blog/post/the-many-disguises-of-an-eating-disorder/

[xv] https://anorexiafamily.com/autism-eating-disorder-tips

[xvi] Dr Sarah Ravin reports on end of treatment outcomes with her own eating-disorder patients: http://www.blog.drsarahravin.com/eating-disorders/end-of-treatment-outcomes-for-patients-with-anorexia-nervosa/

[xvii] For more on this, see Lock, J., ‘Evaluation of family treatment models for eating disorders’, Curr Opin Psychiatry (2011), vol. 24, no. 4, pp. 274–279. http://www.medscape.com/viewarticle/744675

[xviii] Ravin, S., ‘Defeating the Monster: Helping Little Girls Overcome Anorexia Nervosa’. http://www.blog.drsarahravin.com/eating-disorders/defeating-the-monster-helping-little-girls-overcome-anorexia-nervosa/

Evidence that being at the younger end of the 12 to 18 range is a predictor of successful weight gain: Agras, S. W., Lock, J., Brandt, H., Bryson, S. W., Dodge, E., Halmi, K.A., Jo, B., Johnson, C., Kaye, W., Wilfley, D., Woodside, B., ‘Comparison of 2 Family Therapies for Adolescent Anorexia Nervosa. A Randomized Parallel Trial.’ In JAMA Psychiatry (September 24, 2014) http://archpsyc.jamanetwork.com/article.aspx?articleID=1910336

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* Next: Chapter 5 – What parents need to know about the causes of eating disorders *

* Go to Table of Contents *