False choices, and older patients

Family-based Maudsley therapy works best for adolescents living at home when they've been ill less than three years.

It doesn't work as well for independent adults who have been ill longer.

This is not hard to understand. No treatment works very well for independent adults. And the longer you are symptomatic, the worse your prognosis.

Attacking Family-Based Maudsley treatment because it doesn't work as well for older patients is like saying we shouldn't operate on small tumors because surgery doesn't work as well when the tumor has spread.

Let's not consign another generation of patients to disability or death.

Comments

  1. I agree it's totally wrong to attack any intervention that does work on the basis of the cases when it doesn't. FBT has a relatively good (from the small number of clinical trials that are available) record of success and I applaud that whole heartedly. On the other hand I do think that it is important to recognise that NO treatment works for everyone and to try and find other options for those of us who are maudsley failures.

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  2. The real question is not whether Maudsley works as well for older patients as for younger ones, but whether Maudsley works better for older patients than OTHER METHODS OF TREATMENT available for older patients. Let's hope there'll be some clinical trials to answer that question.

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  3. I think there are also different hurdles when the sufferer is an adult. . .

    There (usually) has been more independance established between the parent/"child". Some adults are living away from home, working full-time or raising families of their own. You would not think to see this in people with ED's, but it is true. . .

    I think the relationship with your parents CHANGES as you get older --so there is a problem with enforcing Maudsley -- both practical (distance,time, etc) and psychological (independance, etc).

    Maudsley might work with an adult (as we have seen on the Maudsley Forum) if they are willing or still very dependant on their families for financial support. Otherwise the approach may be impractical. The idea of loving parental "control" over food becomes intrusive.

    From personal testimony, I know Maudsley did not work with me and more traditional treatment did.

    It's important (whether you are a Maudsley activist or an advocate for traditional treatment) to see both sides of the equation. There is no cookie cutter approach to treatment.

    ED treatments are still very new, as is the research done in Maudsley. As you all have stated, there are not great treatment comparisons and in fact, there is not even a clear definition on what recovery looks like from study to study.

    VERY few specialists (I think our psychiatrist in the program gave us one example) have done long term studies lasting 10+ years on outcomes.

    A:)

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  4. It may not be the answer to treatment with independent adults but the information provided / approaches / steps etc are still invaluable. We really should stop looking for that one approach fits all model and stop discarding models with parts we don't like. If we could be open minded enough to be flexible and use aspects of each treatment type that do make a positive contribution to recovery then maybe the success rate in adults will markedly improve.

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  5. Roll on the research and clinical trials. For some of us who have xplored other options Maudsley has been a godsend. Every therapy has it's place. Making Maudlsey workable for older patients could herald a turning point in recovery options.

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  6. Average age for AN diagnosis is 14, for BN: 17. These are young minors. Most of these families are not offered or told about FBT/M - and what I hear from people is that the approach "doesn't work for everyone" as if that justifies it.

    FBT/M should be tried first for most of these families.

    For older patients, it looks like CBT should be the first option.

    But my point is that so many of those older patients might not still be ill if they'd been offered FBT in the first place!

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  7. Laura,

    What treatment works for adults and what works for adolescents is really the same: full nutrition for as long as it takes, maintaining a healthy body weight that is determined by growth charts and other history (as opposed to a random formula or groping at chicken guts in a bizarre ceremony), and full-time support to gain the skills to support not only recovery from ED but also to deal with the issues that may make relapse more likely.

    It's like cancer: the key to recovery is to get rid of the tumor. Whether you use radiation or chemo or surgery isn't necessarily the issue.

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  8. Carrie - spot on! Eating and weight restoration need to happen, and the question is what method works for THAT patient best. Worry about the other stuff after you've got the systems working again!

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  9. Yes, I really do believe that Carrie has the answer - ever thought of running for President Carrie, or Pope or Chief Rabbi depending on your preferences?

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  10. No, if I was in charge, it *wouldn't* be a democracy... Hee hee.

    No treatment will work for everyone. It doesn't for cancer, or diabetes, or heart disease, and it doesn't for eating disorders. But that doesn't mean to throw quality and research out the window the second Opition A doesn't work. I've had friends recover with very unconventional means, and I love that they're doing well. And all of those unconventional means have still involved eating properly, being at a healthy weight, enjoying food and movement, and not purging.

    But Pope Carrie...I'm really liking the sounds of that, Marcella.

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