Maudsley for young adults

We need better eating disorder treatment for young adults. What fascinates me about the reflexive critique of Family-Based Maudsley is that the same people who resist using evidence-based treatment like to cite the very same study for why it is only for kids. But: they're reading the studies selectively and without comparison. There ARE no good studies on what works for young adults - not for Maudsley and not for anything else. The truth is there is just a lot we don't know.

So, to review:
  • Yes, Maudsley can work for young adults. This is happening all over the place, and often successfully and often after years of unsuccessful treatment.
  • The studies that showed better results for adolescents were talking about patients 18 and under, not under 16 as I keep reading out there.
  • The drop-out rates for adult treatment are so high there just aren't good data.
  • Longer illness lowers success rates. Period. So: older patients struggle more. This is not to say that older patients cannot recover but that they need MORE help from everyone, including family, not less.
We need more data. We need to know how to personalize and refine treatment for older patients, for bulimia, for BED, for patients without healthy families, for diabulimia, for everyone. The only way to do that is through well-designed research, and that is in its infancy.

Good news - some of the best out there ARE doing that research:
The University of Chicago Medical Center Family Based Treatment for Young Adults, recruiting NOW.


  1. Laura, I absolutely agree that there are no good studies of what works for young adults (or, for that matter, older-than-young adults...) with AN.

    If a young anorexic adult is still living at home, or is able to move back home then I personally (and theoretically) see no reason why Maudsley wouldn't work as well for a young adult as it might work for an adolescent. In actuality, a young adult who has been anorexic for a number of years is often emotionally and physically immature because of the effects that their AN has had on social and physical development.

    Everybody needs support - from family and/or friends during recovery from AN, and to help them stay recovered. And, it's important that the family/friends don't collude with the anorexic mindset, or become very hostile to the ill person. Once an anorexic adult passes their 20s it is much harder to recover, in part because the individual may have subjected themself to years of social isolation. They may be re-fed in an EDU - to return home to an empty house, with few friends, an absent family and perhaps no motivation to maintain their weight.

    Nevertheless, what I do feel is significant, and what has been highlighted by some clinicians, is that patients who don't respond to traditional Maudsley FBT (or other treatments that are effective for some other patients) don't respond because of strong personality or autistic characteristics which make FBT and understanding others more difficult.

    For example, autistic characteristics may run within families and can make understanding anothers' point of view and others' emotions very difficult. If there are two very rigid people who both have different ideas and poor ToM, then unless FBT is adapted to account for these characteristics then FBT is unlikely to be effective.

  2. Absolutely. ALL treatment needs to be personalized to the particular patient, co-morbidities, and assets.

  3. success= support,support, support
    a support system who understands the fierceness of this illness.

  4. Cathy,

    Just wanted to say you sound like such as smart young woman. I like to read your comments.

  5. Anne, above, I am flattered by your comment... thanks. I often worry that I'm something of an obsessive-compulsive debator (as well as an obsessive-compulsive-everything-else!).

  6. I am pleased to see that other centers are focusing on family based treatment of young adults. As you know, we have always done FBT for young adults at the Kartini Clinic.

    When we considered how to treat young adults for the first time about 5 years ago, I briefly posed "non-family based" treatment as an option, but we discovered we wouldn't even know how to do it, since family-based treatment is all we have ever done.

    Unfortunately, when an ED strikes an older adolescent or young adult, it strikes at one of the developmentally most challenging times, a time when the young adult is trying to differentiate from their parents. GIven the nature of the illness, a large feature of family "support" is, of necessity, parents or other family members being in charge of food for a while. Just like for younger kids, only harder to accept.

    We have had amazing young adults in our program, most of whom have gone on to do very well. And no way could it have been done without their families.

  7. Exactly: "Just like for younger kids, only harder to accept."

    Just as it is with any illness striking a young adult, and of course complicated by the reality that the patient is less likely to understand the necessity of being dependent a bit longer in this regard.


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