Photo Credit: Harper Collins
In October, Stanford University and the University of Chicago set out to test the effectiveness of family-based treatment (FBT), an intensive outpatient program for adolescents suffering from anorexia nervosa. The treatment, also known as the Maudsley Approach, discourages hospitalization of the child and puts much of the recovery responsibility on the parents, who must not only be present every time the child eats, but also ensure that she does -- something, one can imagine, that makes for some very tense meal times.
Harriet Brown knows this well. She chose to pursue FBT when her oldest daughter battled anorexia in 2005 at the age of 12. In her book, Brave Girl Eating, she offers an intimate account of her experience with the treatment, then -- and perhaps still -- a little known and not-often prescribed form of therapy for anorexics. (Despite the study's successful results -- doctors found 50 percent of its FBT patients in full remission a year after treatment compared to 23 percent of patients receiving more traditional individual therapy -- critics question whether parents are properly equipped to get an anorexic to eat, let alone fully recover.)
Brown recently spoke with iVillage about the book and the dynamics of FBT, and provided insight for parents on the early warning signs of anorexia.
Did you talk with your daughter before setting out to write the book?
We had already come at it because I did a piece that was in The New York Times Magazine a couple years ago. We talked about the pros and cons. She talked about her feelings -- I'm sure she didn't share them all with me -- but she said, "I don’t want to always be that girl. I don't want to be Googled and be that girl." [Brown does not use her daughter's real name in the book and they do not share the same last name.] And I didn't want that for her either, but at the same time she felt like it really had a potential to help a lot of people, partly because a lot of people in this country don't know about family-based treatment, though I feel like that's beginning to change.
In reading the book, FBT doesn't come across as an easy road.
It is the easy road in the long term. It's not in the short term. It is in the long term because it shortens everything. I know families who send their kids to residential care and that feels easier because your child is away and someone else is dealing with it, but eventually they have to come home, and it's the norm after that kind of care to relapse. I think of [FBT] as short-term pain for long-term gain. For me, it was easier to be doing something even though it was very hard. There is something very disempowering about watching this happen to your child, so the feeling that you can get in there and do something, no matter how hard it is, for me that was far preferable.
Are there any characteristics a family needs to succeed with FBT?
You don't really need to be a special kind of family to do this. One thing the [Stanford/University of Chicago] study showed was that there were all kinds of families randomly assigned to do this, it wasn't like these were self-selected families. There were divorced families, single parent families, rich families poor families -- lots of different kinds of families can make this work. So don't be intimidated. The other thing is that you're often told by treatment people that this is a lifelong disease, but it doesn’t have to be, especially if you catch it early.
In the book, you mention how your daughter came home and announced she was cutting out desserts after learning about calories and nutrition, being weighed, and having her BMI calculated and fat measured in sixth-grade health class. Could our nation's current focus on ending childhood obesity take things in the wrong direction?
I would love to see school programs that focus on health instead of weight. If we were talking about being healthy and our idea of healthy didn't automatically translate to being thin, we'd be having much more fruitful conversations. We would be talking about the need to exercise, the need to eat well -- we wouldn't be demonizing certain foods. No one would be coming home from school and saying "fat and sugar are always bad for you." We need fat in our diet. Most of us get plenty, but if you demonize certain foods kids who are vulnerable are going to be pushed in a certain direction.
Parents get worried because they hear all this obesity stuff and they go to the doctor and they make a big deal about. So one piece of advice I would give is that kids grow at different rates, so you really can't know when a kid is 10, 12, 14 -- 16 even -- what their body is going to be like and I think the best thing you can do is leave them alone.
How was your self-esteem during this whole experience?
I write and research about body image and food and weight -- I have done that for years -- and I have worked pretty hard to develop positive body image and it really took a beating through this whole thing. It's impossible for it not to.
I'm the kind of person who is extremely calm in times of crisis and I didn't even really feel stressed for a lot of it. For me, it all fell apart after. I had to do a lot of conscious self-care. For me that's a lot of walking in nature, so I did a lot of hiking in the woods and had some hot baths.
We all know not to say things like "I look fat" in front of our children, but it can be hard to do. Any advice?
We need a paradigm shift. Not just "we shouldn't say these things in front of our kids," because kids know anyway, you can't really hide big feelings from them. I feel like what we need to do is an internal paradigm shift. "Can I look in the mirror and find three things I like about my body?" That could be a really hard thing to do for most of us.
It was interesting to me that the things that came out of my daughter's mouth while she was very anorexic were not that different in a way than the little voice that we all have in the back of our head. It just got louder and more overwhelming for her, but I think a lot of us have that voice.
What advice do you have for parents with anorexic children?
I've talked to many families at this point and I would say most of the time families know something is wrong pretty early. You don't know what it is maybe, but you know something is up, so my first piece of advice would be to trust your gut. Eating disorders are much easier to treat if you catch them early, so if you notice your child is looking thinner -- kids should never be able to lose weight -- that's a danger sign. If you notice a lot of excuses about not eating, a lot of anxiety, if you notice withdrawing from friends, these are things that could define a lot of things, but I would say jump on it right away. Get your child to a pediatrician and bring it up as a possibility. And if you still think something is up and the doctor doesn't, go for a second opinion. I'd rather make myself a pain in the butt than be falsely reassured, which I've done plenty of.
Would you try family-based treatment with your child? Chime in below.