Saturday, June 30, 2007

One more reason why I'm a fan of family-based treatment

There are very few follow-up studies (or heck, any studies at all) of anorexia treatment, so I was glad to see this one, done in Norway a couple of years ago. I wasn't so glad of its outcomes.

The study was a one-year followup of adult anorexics who'd been treated on an inpatient unit. Of the 24 patients they followed up with, 10 (42%) had improved one year later, while 14 (58%) had "poor outcomes."

I'm grateful that they did the study, frankly, because most of the numbers on inpatient anorexia treatment come straight from the clinics and units, which often stand to make a tidy sum on treatment. Their followups are usually done at discharge, so they don't take into account what almost always happens after that: relapse and rehospitalization.

So bravo to the researchers in Vikersund. And chalk up another reason why family-based (Maudsley) treatment is an excellent option for anorexia.

6 comments:

Jane said...

I think there's a big distinction to be drawn between information from researchers/clincians and information from the residential treatment industry. AED and Pubmed are more reliable resources than residential facility websites.
Here's a link to the most comprehensive wrap up on EDs I know about
http://www.ahrq.gov/downloads/pub/evidence/pdf/eatingdisorders/eatdis.pdf

Harriet Brown said...

Wow, thanks, Jane. That's a great resource, all 1239 pages of it. :-) And I couldn't agree more about the quality of data and who's reporting it.

carrie said...

As most of you know, I am recovering in part through family-based therapy and a VERY modified version of the Maudsley Method.

What I think the ED world needs is a similar-type treatment for adults who may not be able to rely on parental or home support to help with refeeding. It's true that most EDs start in adolescence. However, they may not be diagnosed until later, or even develop until later. That's where I want to see research. Full nutrition and a healthy weight *for your DNA* is the first step. But a way to maintain it long term...that's the kicker.

Harriet Brown said...

Hi Carrie,

I love the idea of extending Maudsley in this way. In the U.K. this treatment has been done on IP wards for 20+ years. Here, alas, most are released from IP wards long before true health is restored. And then their efforts to stay healthy are undermined by so many things, as you have discovered yourself--everything from dieting co-workers to doctors who don't see the dangers of being thin for some people. I haven't gotten my mind around how exactly this might be done yet, but I know it's a great idea.

Anonymous said...

As I teen I was in the (now defunct) Center for Affective Disorders at UW Hospital in Madison. The depressed patients like me would eat with the patients who were there for anorexia or bulimia treatment. I remember one meal time vividly - there was a long discussion about what to do to appear to have gained weight each morning, how to sneak purgatives into the hospital after visits home. During outside time too, I heard a lot of encouragement between the girls (and women) to continue those behaviors.

In comparison to that atmosphere, the Maudsley approach seems really amazing. In the U.S. in many ways it seems very daring to get that involved with one's own kids! I just read your Nov 06 article and I was very moved.

As a person who has struggled with depression/bi-polar disorder, I see a lot of parallels between what happens to a person with those illnesses and a person with anorexia (not to mention their families). With these problems it seems as though there is a lot of blaming to do, and not enough empathy from society, clinicians, etc.

Anyhow, I wanted to thank you for your eloquence and energy.

Jen

Harriet Brown said...

Hi Jen,

Thanks for sharing that. When my daughter was first diagnosed with anorexia, her dr told me about that place and lamented its passing. From what you're telling me, we were lucky it was gone. :-)

I think you're dead right about the parallels with depression, bipolar, and a host of other brain/mental illnesses. All affect an entire family; all are illnesses where a lot of blame is portioned out.

I'm glad you're healthy and so eloquent yourself!