Sliced bread

I can certainly be trusted to bring up Family-Based Maudsley therapy whenever possible, this is true. But I really do believe in the necessity of other adjuncts and alternatives in creating a plan for treatment or changing course in treatment. The point is for parents to know the alternatives and have access to them.

Among the tools that parents need to know about are Dialectical Behavioral Therapy - alongside or instead of FBT/Maudsley for patients with co-morbid personality disorders or other emotional regulation issues. For bulimia, SSRIs and Cognitive Behavioral Therapy are an alternative. For adult patients whose parents are involved many families find the "New Maudsley Method" (nothing to do with FBT/Maudsley except the hospital they originate from) extremely helpful. If home-based re-feeding isn't possible, I believe re-feeding still has to be immediate, non-negotiable, and permanent at whatever setting is available. For situations complicated by co-morbid conditions there need to be creative combinations of options.

I'll keep bringing up FBT/Maudsley until it is routine for it to be offered to families, trust me, but that doesn't make it the last word in treatment.

How about you? What other adjuncts and alternatives do you think parents need to know?


  1. Thank you, Laura! This post is exactly what I've been hoping to find!

  2. Brilliant - SO succinct.
    What do I think parents need to know? That there are various options as to treatment, but that clinicians using ANY of them should treat the whole family with dignity and be open to the idea of family involvement where appropriate.

  3. I think parents should be aware of, and at least consider, Mandometer.
    (No, I don't have any relationship with the Mandometer organization.
    No conflict of interest here.)

  4. I've come back to sharpen up my own comment. I think parents need to know that there are various options as to treatment, but that clinicians using any of them should treat the whole family with dignity and always have family involvement unless there is a clear contra-indication to this.

  5. What do you think about adults with ED. I don't think the Maudsley approach is an option, or is it?

  6. Sally,

    The principles of the Maudsley approach apply to everyone, in my opinion:

    Full nourishment and weight normalization.
    No compensatory behaviors.
    Responsibility for the above is given to others, not left to the patient.
    Illness is not the patient's fault, and is seen as controlling the person and not the other way around.
    6-12 month process.
    Control of eating, behaviors returned to patient as they are able to manage healthfully.
    Support for normal development and individual psychological needs ongoing.

  7. Laura,

    I do like the idea of the Maudsley approach. I can see how it could apply to everyone.... but many adults don't have people in their lives to do all of that.

    It is a given that children have parents and the parents are responsible and this can and should be done.

    But what about the adults? I find that this (and from my own experience) that there is little help, little recognition and really hardly supported.

    I guess what I am getting at is that I wish there was more help for the adult patient. In theory this approach would work but in the real world I don't see that an option for most.

    I hope in time there is more awareness for adults with ED and someone as passionate as you to be a voice.

  8. Parents need to know, that anorexia is not always about being afraid of weight gain. That anorexia is far more complex, and that it is a food aversion which can be triggered by many different things, not always by fear of being fat. Some people just plain hate eating, are obsessed with food textures, want to die, etc. Some people are a mixture of all of the above and more. I would like parents to understand that anorexia is more than a disease about body dsymorphia.


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