Intervention program designed for families of anorexic patients offers promising treatment of a disease that currently results in death in approximately ten percent of all cases. These include an intensive outpatient program for teens and adults with anorexia or bulimia nervosa and a new intervention treatment designed for families of anorexic patients, known as the “Maudsley” approach.

 

Anorexia is characterized by reduced food intake, the relentless pursuit of weight loss and body image distortion. Bulimia nervosa, which is a related disorder and often has similar symptoms, is also associated with recurrent binge eating, followed by purging.

“We often hear that societal pressures to be thin cause many young women and men to develop an eating disorder. Many individuals in our culture, for a number of reasons, are concerned with their weight and diet. Yet less than half of one percent of all women develop anorexia nervosa, which indicates to us that societal pressure alone isn’t enough to cause someone to develop this disease,” said Walter H. Kaye, M.D., professor of psychiatry at the University of California, San Diego (UCSD) School of Medicine, who heads UCSD’s Eating Disorders Program..

Kaye’s research has found that genes play a substantial role in determining who is vulnerable to developing an eating disorder. Genes contribute to why people develop obsessions or exhibit certain personality traits, such as perfectionism and anxiety. Such traits are usually present in childhood before an eating disorder develops and seem to put people at risk of developing the disorder.

“Societal pressure isn’t irrelevant; it may be the environmental trigger that releases a person’s genetic risk,” Kaye added.

UCSD’s eating disorder program offers the latest advances in therapy, based on sound scientific principals and evidence, according to Kaye. One example is use of the Maudsley therapy. Rather than blaming parents, Maudsley teaches parents the skills necessary to be able to manage and support a child with anorexia nervosa at home.

“The family needs to understand that they are not the cause of anorexia, but they are definitely part of the solution,” said Kaye. “Parents learn new limit-setting and negotiation skills.”

The intensive outpatient program provides individual, group and family therapy scheduled to fit the patients’ needs. However, many families of anorexic patients live in areas where there are few professionals who have expertise in treatment of the disease, and may live too far from San Diego to attend outpatient therapy.

In order to provide treatment at a reasonable cost to these out-of-town families, the UCSD Eating Disorders program has developed a unique, five-day, intensive family treatment program that is the first of its kind in the country. During the program, the parents and the adolescent with anorexia nervosa are able to stay in a nearby residential hotel.

The patient is given a comprehensive medical and psychological evaluation, and all family members partake in “anorexia nervosa 101.” This is an education course, based on the latest scientific studies, that helps help families understand the purpose of symptoms in people with anorexia. An important component of the program is an intensive introduction to the Maudsley family therapy which can continue after the families return home.

The UCSD team of two psychiatrists, a psychologist, therapists and a dietician meets with the parents and the child, to help facilitate a supportive approach to fight the eating disorder. The parents are coached on how to take a central role in the child’s recovery. Together, the family learns to fight the illness, not the patient.

Kaye’s studies using brain imaging have shown that alterations of brain chemistry may be the root cause of anorexia. For example, such images have shown disturbances in neurotransmitters including dopamine, which is associated with responses to reinforcement and reward, and influences eating behavior, anxiety and over-exercise. Kaye and his colleagues at UCSD are conducting new brain imaging studies to study risk factors for anorexia and bulimia nervosa. 

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