When Your Child is Anorexic
How active you are may be the key to effective treatment.
Dispelling the Toxic Family
"The older point of view was that families of anorexic girls were in
some way toxic," says Robin. It's true that family problems often
contribute to anorexia, Robin says, but it's also true that parents can become
a therapist's best allies. Indeed, Ivan Eisler, PhD, a London University
psychologist who is leading the training workshop in New York this week, says
girls whose parents are directly involved in therapy "in many cases may
require no more than a few sessions to achieve good results."
One reason parents can become so effective is that they're with their
daughter for hours each day. When properly trained, they can monitor and guide
the eating process, says Amy Baker Dennis, PhD, an assistant professor at Wayne
State University Medical School, and director of training and education for the
Academy for Eating Disorders. Also, parents intimately know their daughter and
her social life. When a truce is called in the battle for control, they can
help her solve problems and surmount the hurdles she faces. Moreover, the new
style of treatment doesn't prevent a family from using therapy to work on
issues that may have contributed to the eating disorder.
Dennis cautions that this approach won't work for all families. Girls whose
parents have serious problems of their own -- substance abuse or mental illness
-- are still best treated individually, she says.
Dinner Wins a Trip to the Mall
When Megan's family walked through the doors of Children's Hospital, Megan
was a high-school senior who had lost 50 pounds in six months. Siegel first
reassured the girl's parents that they were not to blame for her illness.
"This approach neutralizes the parents' sense of guilt and engages
them," she says.
Then Siegel placed Claire and Bob in charge of preparing meals planned by a
dietitian. They never forced Megan to eat. "That was Megan's one
responsibility," Siegel says. Instead, Siegel trained the Donovans in how
to use behavioral incentives to subtly encourage Megan to eat. For instance,
when Megan refused food, her parents required her to rest quietly to conserve
her energy. When she ate, they gave her both small and large rewards. Eating a
healthy dinner could earn her a trip to the mall with her friends. And when the
scale showed Megan weighed 100 pounds -- a difficult mark for her to achieve --
they took her to Chicago to shop for a prom dress.
The first several months of treatment were not easy. Megan, who said she
looked and felt great at 85 pounds, was often hostile and deceptive. She would
hide food in a napkin to avoid eating, or put coins in her panties before she
was weighed. Siegel coached the Donovans on how to hang tough. "The
therapist needs to convey to the parents that he or she will see them through
this and keep them in control of their daughter," Siegel says.