15-year-old daughter has recently developed anorexia. She has been
limiting herself to 500 calories a day. She has seen our family
practitioner and we have an appointment with a therapist scheduled.
been reading about the Maudsley approach, and I have one question.
Since my daughter has expressed that she is sometimes tempted to make
herself vomit when she feels she has eaten too much, how is that dealt
with during the refeeding stage in the Maudsley approach? What happens
if she panics when she sees the scale going up not down? Right now,
she says the only thing stopping her from vomiting is the fear that
she'll erode her esophagus.
Kara Fitzpatrick, PhD responds:
As parents it can feel very disempowering to think that we might ask our child to trade one set of symptoms (restriction) for another (purging). Within the Maudsley model, parents are in charge of re-nourishment efforts, including assisting their child in controlling purging or other “compensatory” behaviors, such as over-exercise. Just as with all re-nourishment efforts, parents can intervene when the eating disorder takes hold through various strategies, such as monitoring after meals and providing distractions that are incompatible with purging behaviors. Siblings can also help play a role in soothing your child after a meal.
Confronting the fear that comes with increased intake is a vital part of helping your child overcome this illness and parents are in an excellent position to provide this support and modeling. Therapists can help the family realize important skills and strategies that play the family’s strengths. One thing that is important to recognize is that panic is often something the anorexia will do when it loses control. Staying calm and consistent will help. That is one critical reason that parents are such strong “change agents” in therapy: they are not frightened or panicked by the anorexia and can provide an environment that helps confront the illness when their child cannot do so on her own.
Kara Fitzpatrick, PhD
Dr. Fitzpatrick is a psychologist working with Eating Disorders at Stanford University/Lucile Packard Children's Hospital and serves as clinical advisor to Maudsley Parents. She is widely trained in a variety of models for treatment and performs research in applied clinical treatments for adolescents and neuropsychological factors associated with eating disorders.