Parents part of the solution, not part of the problem in teen bulimia treatment

April 5, 2007

Common practice in the treatment of adolescent eating disorder patients has been to exclude the parents. Many experts consider parents part of the problem and thus keep them away during therapy.

Two U.S.-based clinicians disagree and have written a "how to" book published in February that includes family in the treatment of these patients. They say parents are well poised to help their children overcome bulimia nervosa, a disorder characterized by binging and purging.

The book, designed for clinicians who deal with adolescent bulimia nervosa patients, will no doubt be discovered and used by desperate parents, too, the authors speculate.

Treating Bulimia in Adolescents is the third in a trilogy of books written by Daniel le Grange, PhD, associate professor of psychiatry and director of the eating disorders program at the University of Chicago, and James Lock, MD, PhD, professor of child psychiatry and pediatrics at Stanford University.

The duo wrote the parents guide Help Your Teenager Beat an Eating Disorder in 2005 and collaborated with two colleagues to write Treatment Manual for Anorexia Nervosa, a clinical guide for clinicians, published in 2001.

"We found many parents using the Treatment Manual for Anorexia Nervosa, even though it was designed for clinicians, simply because it gave them step-by-step advice on what should be done. We think we'll find the same thing with the bulimia book," Le Grange said. "And because bulimia affects more adolescents than does anorexia nervosa, there might be greater demand for it."

"We don't see parents as the culprit," he added. "We see them as a valuable resource in the treatment of these adolescents. Our goal is to empower parents to feed their kids. Feeding kids is something they do well."

Le Grange learned this approach at the Maudsley Hospital in London, known for its family-based approach. It has proven effective in treatment of anorexic adolescents and is being studied for efficacy with bulimic adolescents. But to date, nobody has written a manual for practitioners.

"Something else quite different about this approach is that it takes place in an outpatient setting, in 15 to 20 50-minute visits," Le Grange said. "Other methods to treat bulimia entail hospitalization or day-long visits. The Maudsley approach is truly a minimalist approach."

The Maudsley approach has parents supervising the adolescent's every meal, making sure an appropriate amount of food is consumed and remaining with the child for a while after the meal to prevent purging. This requires parents to be home for every meal, at least at the outset of treatment, and that the adolescent understand there is relatively little room for negotiation.

"Adolescents with bulimia are ill," Le Grange said. "If a child required chemotherapy or dialysis or was in a horrendous car accident, the parents would take whatever time off from work was necessary to deal with this emergency. Dealing with an adolescent who has bulimia can be just as critical."

The authors also discuss the necessity of parents being unified on their approach in dealing with a child's bulimia. They say both individuals must equally support the same strategies and restrictions for the treatment plan to be successful.

Additionally, they say parents typically have tried many things to help their sons or daughters change the self-destructive eating patterns of bulimia; however, usually, they haven't tried any of them consistently, confidently and with clear commitment from both parents.

Treatment plans for bulimia that neglect making use of the family unit miss a golden opportunity for reinforcement and are at risk for recidivism, according to the authors. They hope to see an increase in family-based treatment both in the United States and elsewhere, with this manual being the first step in that direction.

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