Dr. Robin says family therapy is important for girls with anorexia nervosa.

Parental involvement is a critical component of therapy for young girls with anorexia nervosa, says Arthur Robin, PhD, professor of psychiatry and behavioral neurosciences. They must be supportive as a mother and father, but they must also function as the “family pharmacist” of sorts, distributing doses of food as if it were medicine to help their daughters cope with severe eating disorders.

According to a study that Dr. Robin published in the December 1999 issue of the Journal of the American Academy of Child and Adolescent Psychiatry, girls with anorexia nervosa have a faster, more effective return to healthy eating habits when their parents take charge of their diets and meals. This is a radical concept for most therapists who formerly believed that family conflict and lack of independence would hinder effective treatment for the adolescent. Not only did this report make national headlines, it also won a Scientific Achievement Award from the academy as the best paper published on eating disorders last year.

The old school of thought regarding treatment for anorexia concentrated on individualized therapy which included changing the girls’ abnormal perceptions of body image, weight, food and starvation. In the 1970s, family therapy became more popular and its benefits are now being scientifically documented by researchers like Dr. Robin and his colleague, Dr. Patricia Siegel.

“One form of therapy is to directly counsel girls with anorexia nervosa to change their attitudes toward body image and eating,” said Dr. Robin. “But, by the time these girls get to us for treatment, they tend to be out of control. At age 12 or 13, their thinking is so rigid and distorted, it is often hard to help them adjust their attitudes based on reason, insight and understanding. So, at this point, we put parents in control of the illness. They are charged with administering medication to help their daughters get better. Only in this case, the medication is food.”

In Dr. Robin’s study, two types of therapy were compared: individual treatment, where the adolescent was in charge of her eating routines, and family therapy, where the parents were in charge. While both therapies worked well, the girls who used family therapy gained more weight and gained it faster. Furthermore, more of those girls had reached healthy target weights one year later.

The patient, parents, dietitian and therapist work together to set target weight goals. Parents are trained to prepare and monitor their daughters’ meals, regulate exercise and establish clear consequences and rewards for consuming all of the required daily calories. For example, one teen-age girl, who had starved herself to 85 pounds, was allowed to take an out-of-town trip to shop for a prom dress once she reached 100 pounds. The ultimate reward came at 115 pounds, when she was allowed to regain control over her own eating habits.

Dr. Siegel, who helped develop this anorexia nervosa treatment based on her background in family therapy, said she hopes to establish guidelines for all therapists to use this method as a standard treatment. A group of British researchers recently demonstrated the effectiveness of a similar family therapy, providing even more evidence of its success.