There is a process of discovering what, exactly, a child needs when they present with some concerning behaviours such as (but certainly not limited to): skipping meals, calorie-counting, obsessive exercise, and other ritualistic behaviours at meal time like cutting up foods into tiny pieces or refusing to eat from certain food groups with no indication that those particular foods are truly, medically problematic for the child (e.g., cutting out gluten in the absence of a diagnosis for Celiac Disease). Anorexia can take off very quickly and wreak havoc with the lives of the sufferer and loved ones. I strongly encourage parents to have their child evaluated by their family doctor for weight, heart rate, blood work and perhaps see a pediatrician and child psychiatrist given the serious nature of this illness. It is extremely important to not delay with intervening. I would always err on the side of caution whenever any anorexic or bulimic behaviours are suspected.
Each case is individual; however, I will present here a basic outline of what FAMILY BASED THERAPY entails when working with me:
FAMILY-BASED (MAUDSLEY-type) THERAPY (FBT)
THIS FORM OF THERAPY IS DESIGNED FOR PATIENTS (TYPICALLY UNDER THE AGE OF 18) WHO NEED WEIGHT RESTORATION. It can and may need to continue after weight restoration to maintain weight. Until the patient can successfully manage intuitive eating, parents will need to play a significant role. Intuitive eating is worked on once weight is restored. In brief, intuitive eating is learning body cues related to eating and honouring those cues of hunger and satiety – eat when hungry, stop eating when full, pay attention to the body’s needs for nutrition and fuel throughout the day on a consistent basis.
With FBT, THE PARENTS ARE RESPONSIBLE FOR RESTORING THEIR CHILD’S WEIGHT and view the food plan as medicine.
Ideally, treatment is conducted with a TEAM with eating disorder specialisations, including a:
The OBJECTIVES are to increase parental empowerment while disempowering the illness (anorexia), to restore the child’s weight, and to disrupt behaviours related to anorexia.
**The clinicians involved support the parents in disrupting the behaviour.
The ED therapist:
This can be done in one of several ways:
a)with the family coming together at the therapist’s office and eating a meal together;
b)at the family’s home during meal preparation and eating with the therapist present; or,
c)the parents can keep track of the child’s eating behaviours throughout the week and bring their observations and concerns to the therapist for support, suggestions, and insights into progress and how/if AN is still “ruling the roost”.
Seeing the child one-on-one for counselling regarding social, emotional, and attachment issues is typically ineffective until weight is restored as they are so compromised by the ramifications of the illness. However, each case is unique and it always depends on the child, the family, and the circumstances.