Eating disorders in adolescence: the maudsley treatment model

Eating disorders are serious disorders that affect adolescents with increasing frequency. Two major subgroups of the disorders are recognized; anorexia nervosa, and bulimia nervosa. They can be associated with significant morbidity and mortality. Anorexia Nervosa (AN) in eating disorders is one of the most serious disorders that seriously threaten life. The incidence of female adolescents is 0.3–0.7%. Mortality rate is reported as 7–18%. In anorexia nervosa, children or adolescents restrict food intake and this restriction causes a significant reduction in body weight. The patient is very scared of gaining weight or getting fat; behaves in a way that makes weight gain difficult, even though he is significantly low in body weight. These behaviors may be self-vomiting, laxative use or excessive exercise. There is a problem with how the patient perceives the body weight or shape. Bulimia Nervosa (BN) is a disorder with recurrent binge eating episodes. Many people can eat more food than they can eat. The control over eating is abolished. They do inappropriate behaviors like vomiting, laxative using, exercising to avoid gaining weight after eating. Bulimia patients may not be aware of their condition, because they may be normal weight or overweight, as opposed to anorexic patients. Family-Based Treatment (FBT) is a new treatment modality for eating disorders that was created by combining appropriate methods of family therapy approaches. FBT or Maudsley approach that was developed in England for anorexia nervosa (AN). Eventually spread all over the world. FBT is considered to be the first choice of adolescent AN treatment as evidence-based, although few studies showed that adapted FBT for adolescent bulimia nervosa is an acceptable treatment modality. Treatment success rates of FBT are around 70%. Adolescent is a part of the family in FBT; for this reason interest of parents is very important for treatment success. Parents should respect their children during the treatment, they should be able to look from adolescent’s perspective. All problems and disputes in the family should be postponed. The treatment should be the main objective of the family. Parents are temporarily authorized on adolescent to reduce severity of the disease. Once success is achieved, parents may become able to control adolescent’s eating behavior. FBT consists of three phases. At phase 1, therapist just focuses on eating and gaining weight of patient. Parents are given responsibility of adolescent eating. When the patient reaches 90 % of calculated target weight, treatment is passed to phase 2. Previously postponed problems begin to be raised at this phase. Control over eating passes from parents to adolescent with supervision of parents, slowly. At phase 3, adolescent should increase personal autonomy and set appropriate family boundaries. Although FBT is first- line modality for adolescent AN, only a few therapists apply this therapy in our country. In this workshop, family-based treatment applications for eating disorders in adolescence will be taught.