Abstract:
Anorexia Nervosa can becharacterized as distorting the body image along withdeliberately maintained low body weight. The long term prognosis’sof a patient suffering from this condition is often poor, with severe medical, developmental and psychosocial complications, high rates of relapse and mortality (Wiley). This condition is mainly seen in adolescent females from ages 12-25. According to the National Eating Disorder Association, twenty million women worldwide suffer from Anorexia Nervosa and 40-60% of middle school girls start to show signs of Anorexia Nervosa.
In Judy’s case I would use Structural Family Therapy. Gladding defines Structural Family Therapy as, “An individual’s symptoms are sum of its units, parts, or members because of the dynamic interaction of each with the others, for example, an engine.” One of the founding therapists in Structural Family Therapy was, Salvador Minuchin. “Minuchin outlined a practical guide for conducting structural family therapy… followed this publication later in the decade with a complementary coauthored text entitled Psychosomatic Families: Anorexia Nervosa in Context which showcased in a dramatic way the power of the therapy he had created” (Gladding). Structural Family is used to see a circular view of the family, with anorexia nervosa the therapist is able to consider the friction within the whole family. The social pressures a young woman who is displaying symptoms of the disorder is examined in a much broader interactive context with not only the person who has the disorder but with their family and the therapist as well (Gladding). “Psychosomatic disorders, substance abuse, and juvenile anorexia nervosa can be treated successfully with a modified version of structural family therapy” (Wiliey).
Some causes for this condition could be genetically related, most females who have this condition have a sibling or parent that has an eating disorder. People who suffer from Anorexia Nervosa often suffer from low self-esteem which could be cause from neglect as a child. Compulsive personality traits and perfectionism is also traits that people with this condition also suffer from. Some research indicates that low levels of serotonin within the brain may also trigger Anorexia Nervosa along with depression (Fisherman).
Case Study:
Judy Jones (age 14) has lost 30 pounds in the last year, and now weighs a very unhealthy 85 pounds. Her primary care doctor has ruled out physical causes, and given her a diagnosis of anorexia nervosa. The doctor has referred the family to you, the best family therapist in town, for therapy.
As previously stated I would use Structural Family Therapy with Judy. Although there is no right way to treat someone with Anorexia Nervosa, research has shown with family treatment, rather than blaming the individual family member with the condition, are essential in understanding and treating the disorder. Judy is an only child and comes to her first session with her mother, Tammy and her father, Kyle. With Structural Family Therapy it is important that the whole family is present at the sessions and is able to understand and power the family member on their road to recovery. “The major principles of this therapy include the acknowledgment that the adolescent lacks control over their weight and eating habits, work to address cognitive distortions andproblems with the family structure, as well as work to overcomecognitive distortions of the patient, and in later stages, to promote autonomy” (Robin).
There are three basic phases in trying to recover someone with Anorexia Nervosa; the first is focus on positive weight gain. This can be achieved by placing responsibility for Judy’s eating habits in the hands of her parents. I would suggest that both Tammy and Kyle see a nutritionist to help them establish a safe and healthy diet plan for Judy. It is necessary for Judy and her parents to develop a positive and supportive way in which food, weight, and body image are not attached to negative comments. To do so Tammy and Kyle need to have the least amount of food rules possible, they shouldn’t discourage Judy for not eating everything on her plate but rather praise her for the amount she did consume. In addition, Wiley states that, providing healthy food and positive mealtime experiences, and cooking together should provide the best positive outcome in weight gain. Every night the family should have a sit down meal with no distractions. Mealtime should be a family experience filled with laughter and positive feedback from all.
The second phase should focus on family problem solving and issues that lead to Judy’s condition. In her sessions Judy confesses that she feels neglected, parents work full time jobs and get home late, leaving Judy home alone most of the time. Judy is using starvation as a way to seek attention from her parents. It is imperative that Tammy and Kyle set aside more time for their family. I would recommend a family game night or some sort of activity they all can do together as team. Also communication within the family is something that needs to be addressed and perfected. Family meal time should be a time where they are able to discuss their events from the day and positive feedback from one another. During this phase it is also important that Judy takes responsibility of her eating habits and is continuing to gain weight. Exercise is another aspect that Judy needs to be incorporating in her recovery.Tammy and Kyle should continue to provide positive feedback however should allow Judy to decide what and how much to eat. I would also recommend at this phase that Judy is seeing a dietitian to ensure she is aware of good eating habits.
The third phase is centered more from the psychological issues within the family. Typically this is achieved by working with the individual (Judy) separately from the parents (Tammy and Kyle). Phase three can only be accomplished when parental monitoring is no longer needed in Tammy’s eating habits. Judy’s eating habits and weight is in an acceptable healthy range. At this time I would focus more on the psychological issues within Judy. Most people who suffer from Anorexia Nervosa also suffer from depression, Judy is no exception. Judy expresses her concern over her parents’ marriage and how they fight all the time. She is afraid that her parents will soon one day decide to get a divorce. Judy blames a lot of the stress her parents have upon herself and her disorder. Judy must understand that she cannot take fault for her parent’s actions. While working with Kyle and Tammy I inform them how there fighting is affecting Judy. Both were unaware that it was affecting her to this point. I would continue to work with Kyle and Tammy on their marriage and relationship problems in effort to help establish a better relationship between them and Judy. With working with Judy and her parents separately I am able to better repair the psychological issues within the marriage, Judy’s relationship with her parents, and help them all build better communication techniques.
As with any dependency or condition there is always the fear or relapse. Kyle and Tammy need to continue be supportive and positive in Judy’s recovery. Judy also needs to believe in herself and herself image. With tools provided in the therapy sessions Judy along with her family should be set on a successful road to recovery.
References:
Fishman, H. C. (2006). Juvenile anorexia nervosa: Family therapy’s natural niche. Journal of
Marital and Family Therapy, 32, 505–514.
Gladding, S. T. (2011). Family Therapy: History, Theory, and Practice. Fifth Edition, Published
by Pearson Education.
Nation Eating Disorder Association (2014) Retrieved from:
https://www.nationaleatingdisorders.org/get-facts-eating-disorders
Minuchin, S., Rosman, B., & Baker, L. (1978). Psychosomatic families: Anorexia nervosa in
context. Cambridge, MA: Harvard University Press.
Robin A. (2010) Behavioral family systems therapy for adolescents with anorexia nervosa. In:
Kazdin, AE editor(s). Evidence-based Psychotherapies for Children
Wiley, J. (2010) Family therapy for anorexia nervosa; The Cochrane Collaboration.
