Family-based Treatment of Adolescent Anorexia Nervosa:
The Maudsley Approach printable view
Daniel Le Grange, PhD and James Lock, MD, PhD
Even though anorexia nervosa (AN) was first recognized more than 125 years ago, this disorder still bewilders patients and their families and perplexes clinicians and researchers. Our understanding of the medical features of AN has advanced, increasing our success at weight restoration in specialist inpatient settings. Inpatient and day hospital treatments are generally effective in weight restoration, however, they are disruptive to the adolescent’s family, social and educational life, and relapse is common. Moreover, weight restoration alone is not sufficient for recovery. The Maudsley family-based outpatient treatment for AN is a promising alternative model to costly inpatient or day hospital programs. This model, which strives to bring about weight restoration and restore the adolescent’s developmental trajectory, is explored in this article.
Research into treatment of anorexia in adolescents
Few controlled clinical trials have been conducted to explore efficacious outpatient treatments for adolescents with anorexia (1). While research has not been extensive, recent published reports of the treatment for adolescent AN have been more encouraging.
This handful of treatment trials (2) all investigated a particular type of family-based treatment which is designed to:
Prevent hospitalization of the adolescent by assisting the parents in their efforts to help their adolescent in his/her recovery from AN, and; to return him/her to normal adolescent development unencumbered by the eating disorder. This treatment was conceived by a team of child and adolescent psychiatrists and psychologists at the Maudsley Hospital in London and has come to be known as the Maudsley Approach or Family-based Treatment (FBT) for AN.
These studies have all demonstrated the efficacy of this treatment – that is, approximately two thirds of adolescent AN patients are recovered at the end of FBT while 75 - 90% are fully weight recovered at five-year follow-up(3). Similar improvements in terms of psychological factors were also noted for these patients. Clinical and research endeavors by The University of Chicago and Stanford University have shown promising results in their FBT studies, which are comparable to the positive outcomes that were initially established in the Maudsley studies. These researchers have shown that most young patients with AN require on average no more than 20 treatment sessions over the course of 6-12 months, and that about 80% of patients are weight restored with a start or resumption of menses at the conclusion of treatment(4).
The Maudsley Approach
The Maudsley approach can mostly be construed as an intensive outpatient treatment where parents play an active and positive role in order to: Help restore their child’s weight to normal levels expected given their adolescent’s age and height; hand the control over eating back to the adolescent, and; encourage normal adolescent development through an in-depth discussion of these crucial developmental issues as they pertain to their child.