Minuchin Family Therapy of Eating Disorders

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Table of Contents

Statistical Research
Family-Based Treatment
Significance of the Findings
My Own Life or Clinical Practice Examples that Support My Research Findings
Conclusion
Reference List

Salvador Minuchin pioneered the structural family therapy (SFT), a psychotherapy that is used to address family problems. Therapists operate by joining the family to understand how it functions. They observe the familial operations to understand the relationships among members. This way, therapists can identify disruptions in the relationships. The ultimate aim is to stabilize these relationships. Minuchin believes that pathology rests within the family system as opposed to the individual. Therefore, identifying the core of the problem is more effective compared to focusing on the symptoms of the victim. Minuchin family therapy has been applied in various aspects of family-related problems. This paper will examine how this therapy can be applied in correcting eating disorders in adolescents.

Statistical Research

Eating disorders, particularly, anorexia nervosa, is a serious psychiatric problem with a considerable prevalence among adolescents. Touchette et al. (2011) estimate that between 0.48% and 0.7% adolescents aged 15 to 19 years have an eating disorder. This figure shows a high prevalence. Hence, psychiatrists have been engaged in attempts to control this problem. Additionally, people with anorexia tend to have a high likelihood of developing comorbid psychological conditions. Touchette et al. (2011) also found that nearly 60% of adolescents with eating disorders tend to have a lifetime anxiety or affective mayhem. Eating disorders are a major cause of concern since they contribute to suicide. According to Forcano et al. (2011), suicide cases associated with eating disorders are higher compared to any other psychiatric disarray. Anorexia nervosa may also result in death because of physical complications in victims.

Anorexia is demonstrated through various ways. The diagnostic criteria observe particular behaviors in the victim. The common form in which anorexia is demonstrated is refusing to maintain body weight or only maintaining a body weight that is slightly above the normal levels based on the adolescents’ BMI (Hurst, Read, & Wallis, 2012). In addition, the adolescent may demonstrate an intense fear of gaining weight while he or she is in fact underweight. Thirdly, the victim may be incessantly obsessed with how other people view his or her body shape. Anorexic adolescents also actively deny that they have a low weight issue. In girls, amenorrhea may be experienced, lasting up to three menstrual cycles (Hurst et al., 2012). According to Hurst et al. (2012), two types of anorexia exist. Restricting anorexia occurs when the victim has strictly avoided binge eating. On the other hand, binge-eating anorexia occurs where the victim has been engaged in purging (Hurst et al., 2012).

Anorexia occurs because of multifactorial causes. However, genetic predisposition is the most common risk factor (Hurst et al., 2012). Hurst et al. (2012) found that personality traits such as perfectionism and practicing dieting at an early age could contribute greatly to anorexia incidence. It is important to observe that anorexia is much more common in female adolescents relative to their male counterparts. Hurst et al. (2012) assert that changes in the female’s body during puberty can raise the risk of engaging in poor eating habits. Body dissatisfaction, particularly, becomes heightened during puberty. If not detected and corrected early, these eating habits can then compound to become anorexia.

The question of whether anorexia is a chronic illness arises often. Hurst et al. (2012) argue that anorexia is a chronic disease, which can subsist for up to between four and seven years. Contrasting research indicates that patients can fully recover from anorexia within a reasonable duration (Touchette et al., 2011). Recovery is subject to the proper intervention mechanism. Interestingly, chances of relapse are uncommon with former anorexic patients. It is for this reason that the family-based treatment was conceived and implemented to involve the family in the recovery of adolescents.

Family-Based Treatment

Family therapy is one of the ways of addressing eating disorders. Researchers such as Barker and Chang (2013) examine the effectiveness of this approach in addressing eating disorders in adolescents. Traditionally, parents were not involved in interventions aimed at correcting eating disorders in their children because they (parents) are likely to make strong interventions on the eating habit of the child, often resulting in undesirable consequences (Hurst et al., 2012). However, recent developments have suggested that parents and the entire family should be involved in arresting eating disorders. This new revelation follows Minchin’s contention that psychiatric problems are found within the family system, as opposed to being primarily a problem with the adolescents themselves (Barker & Chang, 2013).

The role of the family in managing anorexia has always been controversial since the disorder was declared a medical condition. Wiliam Gull, a psychiatrist from the 19^th-century, called family members the “worst attendants” in addressing eating disorders in their offspring (Silber, Lyster-Mensh, & DuVal, 2011). Parents, particularly, have often been regarded as “pernicious influence” on their children who are suffering from eating disorder. This view is linked to the usual strictness of parents, which may have counterproductive effects on the adolescent. Therefore, it is understandable that clinical interventions saw parents excluded from the care of adolescents with anorexia. Others such as Goldenberg and Goldenberg (2012) who justify the exclusion of family from the adolescent’s recovery cite the developmental needs of the adolescents such as the need for autonomy, self-control, and aggressiveness.

Therefore, Minuchin and his colleagues were going against this tradition when they recommended family involvement in the recovery from anorexia (Goldenberg & Goldenberg, 2012). Proponents of Minuchin family therapy argue that it improves family pathology in areas such as rigidity, conflict, and overprotectiveness. This approach has become commonly accepted in treating and counseling adolescents with anorexia in many countries. Dare and Eisler from Maudsley Hospital in London successfully incorporated Minuchin family therapy in their treatment procedures with positive results (Couturier, Kimber, & Szatmari, 2013). Therefore, family-based treatment follows Minchin’s assertions in addressing the problem of anorexia in youngsters. Dare and Eisler also established that with appropriate intervention, inpatient adolescents were able to recover the original body weight (Godart et al., 2012). Therefore, the conclusion was that with appropriate guidance, parents could help their children in making a full recovery.

Various guidelines and a manual are available to parents on how to approach the family-based treatment. Early in the treatment, parents are assisted in understanding medical and psychiatric direness of anorexia, including its high mortality rate. Mortality in adolescents with anorexia usually results from suicide or heart failure. Preti, Rocchi, Sisti, Camboni, and Miotto (2011) found that suicide incidence in adolescents with anorexia is alarming. For instance, out of 16 342 patients who had the disorder, 245 committed suicide in a span of 11 years.

While this information is likely to cause anxiety on the part of parents, it is crucial in making parents understand that they are an integral part of the intervention mechanism. Once parents are made aware of the medical and psychiatric seriousness of the disorder, they are encouraged to seek solutions to problems of refusing food by the adolescent. Parents are then reminded to avoid using aggressive approaches as they may backfire, worsening the problem. The strategy adopted must be agreed upon between the parents and therapists. It often involves increasing the adolescents’ food intake while reducing physical exercise.

Therefore, the first phase of the family-based treatment is dedicated to helping the parent to become organized, consistent, and persistent without becoming impatient (Downs & Blow, 2013). The aim of this stage is to help in eliminating food refusal and promoting weight gain in the adolescent. Once the adolescents have regained weight and/or are eating normally, they are allowed to be in control of their eating habits (Downs & Blow, 2013).

Finally, after the adolescent demonstrates a consistent ability to eat normally, the therapy shifts to general aspects of adolescent development. This systematic approach helps in undermining feelings of helplessness by the adolescents. As they regain control of their eating habits, they become more capable of handling life’s situations generally. Involving the family is important since the adolescent does not feel like he or she is carrying the burden alone. Family-based treatment also assists parents to appreciate eating disorder as a serious problem, hence making efforts to assist the adolescent. This approach makes the recovery easier relative to instances where the parents leave the adolescent to deal with anorexia alone.

Significance of the Findings

Anorexia is a serious disorder that has a sobering mortality rate. As observed, anorexia has the highest mortality rate of all psychiatric disorders. Therefore, obtaining the relevant information about diagnosis, treatment, and prevention of this disorder is critical. Anorexia is a particularly complex condition because it affects mostly adolescents. Since adolescents are in the prime of their developmental stage, it becomes difficult to seek or accept help when they discover they have developed dangerous eating habits. This section presents the importance of the knowledge of anorexia to the field of psychology, including how it can contribute to better eating habits, and importantly, rescue adolescents from the life-threatening condition.

Psychiatrists spend numerous hours studying mental disorders. Information on mental disorders is important since it can help patients and the people around them to lead better lives. Chesney, Goodwin, and Fazel (2014) assert that mental disorders increase the risk of suicide in victims. Anorexia, particularly, is the leading psychiatric illness regarding suicide. Anorexia also predisposes the patient to possible death because of related complications.

Due to its seriousness, it is important for psychiatrists to learn ways of identifying anorexia in its early stages. In fact, despite the disease being curable, the treatment procedure is very delicate. It has a high risk of failure. Therefore, early detection and possible prevention may help to avoid the treatment altogether. The discussion above has identified ways by which anorexia can be identified. The symptoms do not require medical expertise to determine. This situation makes it easy for parents or older family members to observe anorexic behavior in adolescents, thus making an appropriate intervention.

Unlike in the past, psychiatrists now believe that families are instrumental in the recovery of adolescents from anorexia. Hildebrandt, Bacow, Markella, and Loeb (2012) assert that habituation to food in an environment that the patient is comfortable in [at home] results in effective outcomes. This finding has been backed by numerous researchers, including Dire and Eisler, who are responsible for the Maudsley treatment program, which is also known as the family-based treatment. Involving the adolescent’s family directly in the recovery has several benefits besides effective recovery.

Because the patients are in an environment that they are comfortable with, they are more likely to be willing to take up the treatment compared to a hospital situation. Additionally, as the adolescents are surrounded by family members, they are likely to feel open to discuss difficulties encountered during recovery. In addition, because family-based treatment studies focus on the relationships in the family, it is easy to identify the underlying reasons why the adolescent resorted to extreme eating habits. Therefore, the root of the problem can be corrected, instead of focusing only on symptoms.

Family-based treatment is designed to allow recovery in a systematic manner. The methodical recovery ensures that the patient fully recovers in any one stage before proceeding to the next. The importance of this plan is that it minimizes the risk of relapse by the victim (Hurst et al., 2012). Additionally, parents are trained on how to carry out the family-based treatment effectively to ensure it is successful. This knowledge is important for the parents since it can be applied in the event another child has developed anorexia. Besides, family-based treatment helps the family to avoid the huge costs of treating anorexia in a hospital facility (Touchette et al., 2011). The findings of this paper are useful since they can help psychiatrists to improve the family-based treatment. The approach has been proven effective, with a success rate of about 75% of all cases (Touchette et al., 2011). Therefore, future policies on anorexia treatment can be designed according to the family-based treatment.

My Own Life or Clinical Practice Examples that Support My Research Findings

I work in a mid-size health facility in Miami. For three years now, I have worked in the psychiatric unit. In the course of carrying out my nursing duties, I have encountered numerous cases of eating disorders among adolescents. Some patients are placed on the traditional individual-based treatment where they are admitted as inpatients. Other patients, through the intervention of their parents, opt for family-based treatment. Overall, patients who opt for family-based treatment recover faster compared to those under individual-based inpatient treatment. The most notable case of family-based treatment involved a twelve-year-old girl, Tina [real name withheld at her family’s request].

Tina was diagnosed with anorexia in 2013 by her pediatrician. This diagnosis had followed several weeks of acute weight loss. Tina’s parents became alarmed because at 12 years, their daughter would have been gaining weight instead of losing, much like her peers. Tina’s parents quickly arranged for a meeting with a pediatric dietician who would assist Tina to recover her normal body weight. An additional meeting was arranged with a psychologist to offer cognitive-behavioral therapy to Tina. When Tina’s parents discovered that the measures they had taken were not working to reverse her condition, they began seeking alternative help. A friend informed them about the family-based treatment coordinated by our hospital. After adopting Maudsley’s approach, Tina began to regain weight. I had been deployed to assist the family in implementing the program, which I did four times a week.

Tina’s diet comprised high calories, usually double what an average healthy person should consume. Additionally, we took turns in supervising the girl to make sure she took all her meals. Although it was a tiring experience, I was happy to note that she was improving. Sometimes, she would out rightly refuse to eat. We had to cajole her to take even the slightest portion. I observed that as time went on, Tina’s parents had begun appreciating that she needed more affection, as opposed to scolding. Her mother told me in the few days that she had learned that anorexia is a disease of the mind as much as it is of the body. It took 15 months for Tina’s full weight to be fully restored. Now a fifteen-year-old Tina has fully recovered. Her eating habits have become fully normalized. She works part time in a volunteer program run by our hospital that seeks to reach out to adolescents battling with anorexia.

Conclusion

Anorexia has become a serious health concern due to its relatively high incidence and mortality rate. While it is a curable disease, the treatment of anorexia is both expensive and complex. The family-based treatment was developed by Dire and Eisler from Maudsley Hospital London to help adolescents battling with anorexia. Originally based on Minuchin’s concept of family therapy, Maudsley’s approach has become widely adopted due to its success rate. About 75% of all cases of anorexia treated have been successful under the family-based training. This figure is high compared to the traditional individual-based approach. Family-based treatment helps the adolescent to feel more comfortable when they are being attended to by relatives as opposed to strangers in the hospital situation. Importantly, family-based treatment focuses on the underlying relationships in the family. This plan can help to identify the root of the anorexia problem.

Reference List

Barker, P., & Chang, J. (2013). Basic family therapy. Hoboken, NJ: John Wiley & Sons.

Chesney, E., Goodwin, G. M., & Fazel, S. (2014). Risks of all‐cause and suicide mortality in mental disorders: a meta‐review. World Psychiatry, 13(2), 153-160.

Couturier, J., Kimber, M., & Szatmari, P. (2013). Efficacy of family‐based treatment for adolescents with eating disorders: A systematic review and meta‐analysis. International Journal of Eating Disorders, 46(1), 3-11.

Downs, K. J., & Blow, A. J. (2013). A substantive and methodological review of family‐based treatment for eating disorders: the last 25 years of research. Journal of Family Therapy, 35(1), 3-28.

Forcano, L., Álvarez, E., Santamaría, J. J., Jimenez-Murcia, S., Granero, R., Penelo, E.,… & Bulik, C. M. (2011). Suicide attempts in anorexia nervosa subtypes. Comprehensive Psychiatry, 52(4), 352-358.

Godart, N., Berthoz, S., Curt, F., Perdereau, F., Rein, Z., Wallier, J.,… & Corcos, M. (2012). A randomized controlled trial of adjunctive family therapy and treatment as usual following inpatient treatment for anorexia nervosa adolescents. PloS One, 7(1), 28249-28250.

Goldenberg, H., & Goldenberg, I. (2012). Family therapy: An overview. Boston, MA: Cengage Learning.

Hildebrandt, T., Bacow, T., Markella, M., & Loeb, K. L. (2012). Anxiety in anorexia nervosa and its management using family‐based treatment. European Eating Disorders Review, 20(1), 1-16.

Hurst, K., Read, S., & Wallis, A. (2012). Anorexia nervosa in adolescence and Maudsley family‐based treatment. Journal of Counseling & Development, 90(3), 339-345.

Preti, A., Rocchi, M. B. L., Sisti, D., Camboni, M. V., & Miotto, P. (2011). A comprehensive meta‐analysis of the risk of suicide in eating disorders. Acta Psychiatrica Scandinavica, 124(1), 6-17.

Silber, T. J., Lyster-Mensh, L. C., & DuVal, J. (2011). Anorexia nervosa: Patient and family-centered care. Pediatric nursing, 37(6), 331-331.

Touchette, E., Henegar, A., Godart, N. T., Pryor, L., Falissard, B., Tremblay, R. E., & Côté, S. M. (2011). Subclinical eating disorders and their comorbidity with mood and anxiety disorders in adolescent girls. Psychiatry research, 185(1), 185-192.

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