"Center Stage"

You know what? I think I may soon be able to retire and go back to my formerly scheduled life!

With Maudsley Method, Bringing In Family to Fight Anorexia

With articles like this, the life of families facing this illness just got a whole lot easier, the job of the family just got a lot clearer, and the credibility of families needing this kind of support just got a lot stronger.

Dr. Strober, we've discussed this. If parents were getting this kind of support from the beginning they wouldn't be in the drastic situation you describe. Hospitalization and inpatient don't solve the problem, anyway: the real work goes on at home. Parents need this kind of support early, middle, and long-term. Time to stop blaming and marginalizing. Time to put parents "center stage" to do the difficult but necessary work we need to do.


  1. Retirement didn't seem to be on the mind of Walter Kaye as a result of the study, far from it, and would you really want to retire from a world in which there is Walter Kaye?

  2. It's complicated.... There is absolutely no doubt that statistically, parental control of feeding using the Maudsley approach IS the most effective means of helping sick adolescents with AN. At least, this is what group data show. For that reason it makes sense that all parents be made aware of the Maudsley approach(es) and maybe it should be a first line of treatment for adolescents.

    However, Michael Strober does have a point. For some adolescents Maudsley doesn't seem to work, however dedicated parents are to help their child. The data from the recent study that support the efficacy of Maudsley in statistical terms also support the fact that some adolescents don't respond to this treatment approach. These non-responders may do better with residential, inpatient care, or intensive one-to-one therapy from outside of the family (?). As yet we don't know what works for these people.

    Maudsley wouldn't have worked for me. As a teen my family didn't do Maudsley 'by the book' (and the book hadn' been written...), but they did something similar. At least, my mother tried to. The reason why this home-based approach (led primarily by my dedicated mother) didn't work was not, as Strober states: "some families are so mired in conflict that they cannot work together as required by the family-based treatment". The problem was with the way that my
    AN presented and my ASD characteristics.

    I developed very rigid, inflexible, repetitive behaviours around eating (restricting) and over-exercising - in part due to bullying at school and an inability to cope with adolescence. When someone with ASD develops a behaviour pattern that feels 'right' and relieves anxiety it is VERY difficult for them to break this pattern.

    The problem for me wasn't conflict at the outset with my family (although my behaviours did cause conflict) but my obsessionality, anxiety and rigidity. Perhaps I needed to be removed from the environment in which I practiced all my food and exercise rituals, and also the school where I was bullied?

    It's hard to say what would have worked for me in my teens, but eventually what did work for me as an adult was a real desire to change on my part (I re-fed myself) and intensive one-to-one therapy with a specialist psychiatrist. Support from family and friends has also helped enormously.

  3. I'm joking about retirement, FBT is only one small part of what needs to be done to help parents support their loved ones.

    Cathy, I know it may seem like it, but no one is saying that Maudsley is the only option. All I want is for it to BE an option. Bringing up Maudsley shouldn't have to be followed by a list of reasons why not. A new antibiotic is just a new antibiotic. A new therapy isn't an attack on all other therapies.

  4. Don't quit your day job just yet, Laura! ;)

  5. I don't think Strober was saying that Maudsley isn't an option.

    I think he agreed it was an option though for a certain subset of individual (low weight, long period of illness, complicating family factors, combidities, etc.), a higher level of care may be required. . .

    However, I don't agree with him that long term residential care is in any way shape or form effective at treating AN past basic starvation.


  6. I am celebrating right along with you, Laura! This is a therapy that works for a goodly percentage of adolescents, and that is reason for much happiness! As the word gets out about this, there will be more demand and more people will be saved from the hell-fire that is an eating disorder. The "some people" who can't get helped this way for whatever reason will receive another kind of treatment. May they all recover to live fulfilled lives!

  7. Hi Laura, I don't think that I've heard anyone suggest that Maudsley is the only way. What the research data around Maudsley suggest is that it is the most promising treatment for adolescents with AN during the earlier stages of the illness.

    I guess the way my mind works is that I see statistical data based upon probability and (often) normally distributed findings within a population. But a normal distribution contains outliers - i.e. people with characteristics, responses to intervention (etc.) that are unexpected/atypical and don't lie with 2 or even 3 SDs of the mean. So the intriguing question is: why do these outliers have unusual characteristics/responses?


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