The Maudsley Approach: A Family Treatment for Anorexia Nervosa

20 August, 2020
The Maudsley approach is an empirically-supported family-focused therapy for the treatment of anorexia nervosa in teenagers. Unlike other approaches, it takes the blame of the disorder from the family or the patient.

The Maudsley approach is a family-focused therapy for individuals under 18 years old who suffer from anorexia nervosa. Christopher Dare and his colleagues at Maudsley Hospital in London created this method.

The first time anorexia nervosa was recognized was more than 125 years ago. This disorder still baffles patients and their families – it even puzzles doctors to this day. One thing’s for certain: treatments are generally effective in restoring weight.

Despite this, however, many of them can be detrimental to the teenager’s family, social, and educational life. In addition to this, weight restoration alone isn’t enough for recovery, so relapses are oftentimes common.

The Maudsley approach for anorexia nervosa is a successful and alternative outpatient model for the expensive hospitalization programs that the Maudsley Hospital had available.

The Maudsley approach for the treatment of anorexia nervosa

Professionals have conducted only a few controlled clinical trials to explore effective outpatient treatments for teenagers with anorexia. Although the research hasn’t been extensive, recently published reports on the treatment of adolescent anorexia nervosa have been very encouraging about the efficacy of the Maudsley approach.

After reviewing all the research conducted at the National Institute for Health and Care Excellence (NICE) in England, doctors concluded that all health services should prioritize family-focused therapies when it comes to this disorder. Therefore, the Maudsley approach seems to be an excellent treatment option. Many books provide an explanation regarding what this therapy is all about.

Additionally, the Maudsley approach aims to correct the wrong attributions of blame for the patient’s illness. It tries to make the parents and the patient see that they’re not at fault for the occurrence of this illness. Neither of them is responsible. Therefore, this method adopts a theoretically agnostic approach to the etiology of anorexia.

Phases of the Maudsley approach

The Maudsley approach progresses through three clearly defined phases. Now, the patient and their family carry out said phases within 15-20 treatment sessions over a period of approximately 12 months.

Phase I: weight restoration

In phase I, also known as the weight restoration phase, the therapist focuses on the dangers of severe malnutrition associated with anorexia nervosa. It addresses symptoms such as hypothermia, changes in growth hormones, cardiac dysfunction, or cognitive and emotional changes.

During this phase, the professional evaluates the patient’s typical family interaction pattern and their eating habits. The therapist will do everything possible to assist parents in their joint attempt to restore their child’s weight. Most of this first phase consists of training parents towards weight-restoration success.

Restructuring the teen’s relationship with their siblings or peers is also very important. This will help them form stronger, more age-appropriate relationships instead of being “involved” in a simple parenting relationship.

A girl with a measuring tape in her hand.

Phase II: restoring control over the patient’s nutrition

Phase II of treatment focuses on encouraging the parents to help their child take more control over food. Symptoms are still the main discussion between the therapist and the family. Despite this, the therapist encourages weight gain little by little.

In addition, during this phase, it’s important to address any other general family relationship problems or difficulties. Everyone involved works together in order to address all those concerns that the family’s had to postpone. Above all, the professional analyzes the effect that some of those problems have had on the task of gaining weight.

Phase III: establishing a healthy identity

Phase III begins when, first off, the patient no longer starves themselves, and secondly, when they can maintain their weight above 95% of the ideal weight.

The focus of the treatment begins to change. Now, the analysis of the impact that anorexia nervosa has had on the individual starts. Through this study, the teenager begins establishing a healthy identity. This implies a review of the central problems of adolescence, as well as support for greater personal autonomy for the patient.

As of now, research professionals are working toward developing appropriate parental boundaries and helping them reorganize their lives in order to give their child a correct dismissal.

A therapist using the Maudsley method with a teenager.

The promise of the Maudsley approach

In summary, this approach holds great promise for most teenagers who have been ill for a relatively short period of time (about less than three years).

This family-based treatment can prevent hospitalization and assist the teen in their recovery since it considers the patient’s parents as a resource that should play an active role in the treatment.