The guts to try

The sad truth: the Family-Based Maudsley approach doesn't work as often with older patients because nothing works as well with chronic sufferers.

And because we don't have the guts.

Yet a growing number of families are doing it sucessfully anyway and a growing number of clinicians are supporting them.

Let's ask ourselves: which parts of the Maudsley approach don't apply to all patients:
  • Food is medicine.
  • Parents don't cause it, patients don't choose it.
  • Patients need tremendous amounts of support.


  1. All parts of the Maudsley approach apply to all patients, regardless of age.

    Your point about having "the guts" is so true. Family members and clinicians alike are often afraid to trample on a young adult's autonomy, even at the expense of her life. "But she's an adult..." I hate it when clinicians and caregivers say that to justify backing off. In the end, it just allows ED to stay in control.

    Even when clinicians and loved ones do have "the guts," however, the problem I've seen in working with older patients (meaning those in their 20's) is that there is a tremendous amount of brain damage by that point which is not as easily reversible as it is in a young teen who has been ill only a matter of months. Not that it is ever "easy" for teens, either, but relatively speaking, they make better progress in less time.

    Fortunately, the human brain is resillient. If an older patient is provided with excellent treatment and tremendous amounts of support, he/she absolutely can recover. It just takes a lot longer.

  2. From the perspective of someone who is finally physically recovered at the age of 25 after 13 years of eating disorder, I totally agree. I always think people must think I'm really naive when I say this, but I really believe that everyone has the capacity for recovery - it's just so, so hard to keep on track when you're doing it on your own, which is often what it comes down to when you're an adult and the professionals have more or less given up. I did it, but that's largely because the idea of spending another 13 years with an eating disorder suddenly started to look like a far more frightening prospect than death. It's impossible to really believe that you can recover (or even want to) when you're ill, you either have to be helped part of the way to health, to a position where you are free enough from the eating disorder to be able to start fighting for yourself, or you have to be prepared to take an incredibly scary leap of faith, from the 'safety' and comfort of the eating disorder to the unknown of recovery and life. I am in awe that anyone ever manages it as an adult, I usually think I just got lucky! I feel like I've won the lottery or something :)

    Anyway, enthusiasm for the novelty of ED-free life aside, I agree with you and Dr Ravin. It's possible, it just takes a lot of time, effort and patience, and it would be so much easier if treatment providers realised this instead of telling patients that they are chronic and hopeless.

  3. At 25 years old I have now had my eating disorders for 13+ years. My parents have done so much for me...sending me to treatment kicking & screaming as a resistant teen, examining their own shortcomings & struggles, and ultimately remaining by my side & not giving up on me. However, despite knowing I have their support I often feel like I am trying to recover on my own. As the poster above, I am terried of this hellish excuse for a life to BE my life forever. But it is so hard...part of me wishes someone would step in and take the control from my hands (though I know the ED would HATE this & fight like hell). I guess sometimes I wish someone was brave enough to face off with my ED. But, in that sbsence, I myu trying to utilize the support I do have to help hold me up as I try to slay this beast.

  4. I would be one of those "older patients" (mid 20s). I have a freaking awesome therapist who uses maudsley for patients with local family. My family isn't local so FBT isn't exactly an option. However, my therapist has had my parents on the phone, she has talked to them without me and with me, she has taught them how to talk to me about food. It's not maudsley, but my therapist really involves my parents (I'm almost 25), and - while I majorly resisted at first - I am so grateful for it. It has changed the course of my whole recovery. Suddenly progress started being way easier when there was honesty, support, and understanding from every angle in my life . There was nowhere to hide, no secrets to keep.... and, the worst/best part is that my parents, having learned from my therapist, became really effective at talking with me about food and about ED stuff. Having my parents and local friends involved is like having a gigantic safety net. Sometimes I feel like I don't want the safety net becuase it keeps me healthy, but, ultimately, I ALWAYS am grateful for it.

    I guess the point of this post was that I agree that parents can be used at any age.

  5. " parents can be used at any age."

    Use us! Use us!

  6. Dr Ravin said:
    "Your point about having "the guts" is so true. Family members and clinicians alike are often afraid to trample on a young adult's autonomy, even at the expense of her life. "But she's an adult..." I hate it when clinicians and caregivers say that to justify backing off. In the end, it just allows ED to stay in control."

    I could not agree more.
    There can be no real automomy while an eating disorder in control.

  7. Use us, use us please do. But please support us too.

  8. I loved reading the "Use us" comments. It made me smile... reminding me that my parents like being included. Those were very sweet comments :)

  9. Having an eating disorder (in recovery currently), I have experience with the maudsley method. I was a sophmore/junior in highschool at the time... and let me tell you-- not good at all. Before everything, my parents and I were close and got along well. When they took on the role during the maudsley method, I saw them as the 'enemy' and began to avoid them, lie, and hide everything. I was very physically and emotionally sick, and that put me over the edge. I felt so out of control over everything in my life being taken away, I tried to commit suicide during it. I then went IP and healing began to happen in me. I know it's diff. for everyone though, but I've found working with my therapist best for me!

  10. I celebrate and applaud your recovery, Anonymous, no matter how it comes about!!


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