Attention: Not all treatment methods for anorexia nervosa (and other eating disorders) are the same.
There is a difference between the treatment of eating disorders in children and adolescents in German-speaking countries and in English-speaking countries. These advocate a proven, scientifically based approach based on the biological and behavioural aspects of eating disorders.
On the other hand, many German services continue an outdated traditional method. Here parents and children are often separated and parents are not involved in eating. Unfortunately, this leads to a higher relapse rate.
Let us not make it too easy: there are many clinics in Britain, the United States and elsewhere that also use methods from the 1970s, and conversely there are a small number of top German experts.
That is why I speak in general and can only offer you a guide so that you can check the type of care that is offered to your child.
Errors in the treatment of anorexia / unacceptable treatment of eating disorders:
It is considered superfluous, or worse, guilty or “toxic” to the patient.
There is a long wait between the first visit to the family doctor and the treatment.
Time is wasted; patients are expected to become dangerously underweight before being helped. No weight loss is normal in a young person. If the behavior is not normal, it is necessary to treat it.
The risk to the health of a person who was overweight and lost weight quickly is not known. A “normal” weight does not say anything. Even without clinical underweight, an eating disorder can be dangerous.
We bridle the horse from behind: We ask people to intellectually understand the damage they do to themselves, we expect them to be motivated to change, and we hope to heal them by revealing so-called “root causes”.
However, the malnourished brain does not function normally and the person cannot do what is expected of him. It is necessary to nourish the patients first and change negative habits – with a lot of support – before the state of mind can change.
The treatment focuses on psychotherapy. However, the best results come from family-based therapy (FBT) without individual psychotherapy.
Patients are hospitalized for months (sometimes we isolate the person and isolate them from the family) and parents feel redundant and defenseless. When the patients come home, no one knows how to support them, and the relapse is imminent.
Why such differences?
How do we explain such differences from one centre to another, from one country to another? It is probably historical. France and Germany in particular have a psychoanalytic tradition, a philosophy that, for example, has long blamed parents for autism and schizophrenia. This is long outdated scientifically.
The United Kingdom is used to behavioural therapies. In addition, the majority of research and information on the Internet is in English, and the origin of family-based therapy (FBT) for anorexia is in London and Stanford.
English-speaking parents talk to each other on the Internet, read English-speaking research and call for progress. For German-speaking parents, it is more difficult to obtain information about FBT or home care support.
The first choice: specialized family-based therapy
(not to be confused with family therapy, ask for FBT)
Scientific studies conducted since 1992 indicate that parents are an important resource in the treatment of children, adolescents (and possibly adults).
Family-based therapy is a very advanced treatment method that is very different from traditional family therapy in general. Parents who want to help their child better should not be excluded and should be “pathologized”.
The principles of FBT
The illness is not attributed to the parents or the child. Nobody has “guilt”. The family is not pathological. The patient must under no circumstances be accused of “bad behaviour”. If your child has cancer, he or she will be treated immediately without trying to understand the causes.
The same should apply to anorexia or bulimia or uncontrolled hyperphagia syndrome. The causes are complex and interdependent (biology, genetics, environment), and science does not yet provide a complete explanation.
The therapeutic team specializes in eating disorders.
Diagnosis and treatment are urgent (in England you should have a treatment place after one week maximum). Treat before the symptoms are serious. Do not wait until the patient is underweight.
Restoring weight is quick. With weight recovery and the establishment of new habits (normalisation of eating behaviour), the patient’s condition usually improves significantly. (Recent research suggests that weight gain must be rapid as soon as there is a risk of inappropriate renutrition syndrome).
The family (parents, brothers, sisters) is an essential resource.
Therapists are their advisors. Everyone has their own expertise. It is the opposite of patriarchal medicine from “above down”. Parents and therapists are a team.