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"[Anorexia is] highly heritable, it runs in families, and it's clear now that it's affected by a cluster of [early life] vulnerabilities like anxiety and perfectionism. If you don't have those vulnerabilities, you are very unlikely to develop anorexia," says Dr. Walter Kaye, director of the eating-disorders program at the University of California, San Diego.
Practically speaking, that means researchers may be able to pinpoint specific early risk factors to help identify kids who are vulnerable to developing anorexia much the same way specialists can now recognize signs of autism as early as 12 months. "We are where autism was 20 years ago. There were the same discussions about the mother causing kids to be autistic, and most of the theory and treatment was based on that," says Kaye, referring to the outdated notion that autism was caused by cold, neglectful "refrigerator" mothers. "I think that anorexia is as biological as autism. It's just 20 years behind in terms of research."
Treasure's colleagues at the Maudsley Hospital say current treatments are equally obsolete. In the late 1980s, the British researchers published the earliest studies describing what has become known as the Maudsley method of treating anorexia in teens and it remains the only therapy that has proved effective in controlled trials. Unlike traditional treatment, which assumes that anorexia is caused by environmental factors and low self-esteem and often involves intense therapy at residential treatment centers, the outpatient Maudsley method does not focus on psychological therapies or on "parent-ectomy" removing the teen from the home.
Instead, researchers encourage patients and families to regard food as medicine, and caregivers are instructed to use rewards and positive pressure to restore patients' weight. Use of the car and access to other activities desired by teens are offered as incentives for regularly completing meals, for example. Antidepressant medications, like Prozac, which affect serotonin levels and reduce obsessive thinking among anorexics, may later be prescribed, but not until patients have reached a healthy weight without enough nutrients in the brain, medications can't work.
Essentially, Treasure and her colleagues have abandoned the idea that family dysfunction causes eating disorders and instead enlist the family to help guide patients' recovery. Most recently, the Maudsley method has also incorporated a new type of cognitive behavioral therapy, based on the autism connection, which aims to broaden the narrow thinking routines of people with anorexia. "We try to get them be more flexible," she says, "They want to have these rigid habits and we try to get them to break out of that and see the bigger picture."
The treatment worked for Laura Collins' 14-year-old daughter, who developed anorexia in 2002. "She ate an apple and thought she could see her arm growing," says Collins, who says it was clear that her daughter's condition was more than an obsession with being fashionably thin. Collins read about the Maudsley method in a newspaper article and sought clinicians who were willing to try it. "In the U.S., almost all treatment is predicated on blaming or marginalizing the parents," Collins says. Today, her daughter is thriving in college, and Collins runs a group called FEAST, which is dedicated to helping families find evidence-based treatment for eating disorders.
Meanwhile, researchers like Kaye have launched a six-site National Institutes of Healthfunded clinical trial to compare the Maudsley method to more traditional family therapies. At U.C. San Diego, Kaye's group also provides affected families a weeklong intensive introduction to the Maudsley method. "At first," he says, he thought it was "preposterous" that such a short period of treatment would help at all, but "now I'm a believer. It doesn't work for everyone, but it does work."