Eating Disorders

Because the eating disorders are complex, serious and varied, there can be no one simple approach to treatment (Lask and Bryant-Waugh 2000; Brownell and Fairburn 2001). For children and adolescents who live at home, working with the parents as well as the child is essential. Focusing on the factors that appear to maintain the problem is an essential part of the treatment program. Whether this is achieved through parental counseling and individual therapy for the child, or family therapy, or a combination of these, matters less than the family's involvement. For young adults, individual therapy/counseling is of undoubted help, so long as it focuses on the "here and now" problems that the individual is experiencing. There is no evidence that therapy focused on "subconscious" material or the distant past is of particular value. A problem-solving approach that looks at why it is necessary to maintain an eating disorder and that helps to enhance self-esteem is far more likely to work.

Many of these comments also apply to the treatment of bulimia nervosa, although in addition, medication can be valuable. Fluoxetine or related drugs do seem to reduce the urge to binge and can improve mood. Antidepressants can also be useful when there is marked mood lowering.

For the other eating disorders that occur in childhood, a combination of working through the parents and various individual approaches is usually helpful (Lask and Bryant-Waugh 2000). Medication that is chosen judiciously and monitored carefully may also have value.

Whichever condition is being treated, the involvement of family members and open exploration of issues and problems that contribute to and maintain the eating disorder will help people with eating disorders to feel less guilty, less abnormal, and will enhance their self-worth and self-confidence. Thus, although families may be part of the problem, they are equally part of the solution. A number of self-help and parent guides are available (Bryant-Waugh and Lask 1999; Schmidt and Treasure 1993; Siegel, Brisman, and Weinshel 1988).