Abnormal Psychology

Eating Disorders 467

Although IPT for anorexia has not yet been well researched, IPT for bulimia has

been, and many studies have shown that it is an effective alternative to CBT for buli-

mia (Apple, 1999; Birchall, 1999; Fairburn, 1997, 2005). IPT may require more time

than CBT to reduce symptoms, but at 1-year follow-up, its results are comparable to

those with CBT (Fairburn et al., 1986, 1993; Wilfl ey et al., 1993). For example, Fair-

burn (1997) randomly assigned people with bulimia to one of three treatments: CBT,

IPT, or behavior therapy (BT). All three treatments decreased participants’ symptoms,

but CBT was slightly more effective. Over time, however, the benefi ts of BT declined,

while people in the CBT and IPT groups continued to improve. Other studies have

reported similar fi ndings (Agras, Walsh et al., 2000; Wilson et al., 2002).

Family Therapy

Prior to the 1970s, anorexia was treated psychodynamically, which was the type

of psychological treatment most widely available at that time. But in the 1970s,

psychiatrists Salvador Minuchin in the United States (Minuchin, Rosman, & Baker,

1978. and Mara Selvini Palazzoli in Italy (1974, 1988) began to treat girls and

young women with anorexia using family therapy, treating the family as a system.

As we saw in Chapter 4, systems therapy identifi es the problem as maladaptive fam-

ily interactional patterns and structures, and treatment is designed to change these

patterns and roles. As with IPT, treatment does not specifi cally address the patient’s

eating and food issues. Family therapy for anorexia nervosa has been found to be

most effective for young women and girls who live with their parents.

The most widely used family-oriented treatment for anorexia is called the

Maudsley approach (Dare & Eisler, 1997; le Grange & Eisler, 2009; Lock et al.,

2001), named after the hospital in which the treatment originated. This approach

does not view the family as responsible for causing problems and in fact makes

no assumptions about the causes of the disorder. Instead, the Maudsley approach

focuses on the future by: (1) helping parents view the patient as distinct from her ill-

ness, and (2) supporting the parents as they fi gure out how to lead their daughter to

eat so that she can proceed with her development to adulthood. The therapist asks

the parents to unite to feed their daughter, despite her anxiety and protests. Once

her weight is normal and she eats without a struggle, they gradually return control

to her, and other family issues—including general ones of adolescent development—

become the focus (Lock, 2004). The initial phase of treatment requires an enormous

commitment on the part of the family: A parent must be home continuously to

monitor the daughter’s eating. Clearly, the Maudsley approach is not feasible for all

families. But research results indicate that it is perhaps the most effective treatment

for adolescents and young adults with anorexia (Keel & Haedt, 2008).

Psychiatric Hospitalization

In contrast to medical hospitalizations, psychiatric hospitalizations for eating dis-

orders are often planned in advance, and they usually take place in units that

specialize in treating people with eating disorders. Psychiatric hospitalization is rec-

ommended when less intensive treatments have failed to change disordered eating

behaviors suffi ciently. The hospital environment is a 24-hour community in which pa-

tients attend many different types of group therapy, including groups focused on body

image, coping strategies, and relationships with food. These groups can decrease the iso-

lation and shame patients may feel and give patients an opportunity to try out new ways

of relating. Hospitalized patients also receive individual therapy and usually some type of

family therapy; medication may also be administered, if deemed appropriate.

The short-term goals of psychiatric hospitalization for anorexia and bulimia

include increasing the individual’s weight to the normal range, establishing a normal

eating pattern (three full meals and two snacks per day), curbing excessive exercise,

and beginning to change irrational, maladaptive thoughts about food, weight, and

body shape. For those who purge or otherwise try to compensate for their caloric

intake, an additional goal is to stop or at least reduce such compensatory behaviors.

One type of family therapy for people with

anorexia is the Maudsley approach. The fi rst step

of this family treatment is to empower the parents

to fi gure out how best to lead their daughter to

resume normal eating.

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P S

N

Maudsley approach

A family treatment for anorexia nervosa

that focuses on supporting parents as they

determine how to lead their daughter to eat

appropriately.