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Just one rule: Eat

A new eating-disorder therapy makes meals about discipline -- and puts parents in control.

October 03, 2005|Shari Roan | Times Staff Writer

BY the spring of 2001, Chrissie Henneberg had become excessively thin, almost skeletal. But even as the pounds fell away -- 35 in all -- the once normal-weight teenager laced up her sneakers every day for a five-mile run.

She denied there was a problem. But her increasingly worried parents, who had been planning to send the 17-year-old to college in the fall, took her to a family doctor, then to a clinic specializing in eating disorders.

The news wasn't good. "They said she was severely anorexic and needed to go into the hospital right away," said her mother, Jeanne Moulton. "That was a real blow to us."

But, devastated though they were, the Palo Alto family did not embark on the traditional treatment for anorexia. That approach -- lengthy psychotherapy that often views the family as a cause or contributor to the problem -- entrusts patients to arrive at their own decisions. Instead, the family participated in a novel treatment that is gaining favor -- and some criticism -- across the country. Its early stage has a single goal: Get the kid to eat.

Already used at about half a dozen U.S. clinics, including a program at Stanford University, where Chrissie was treated, so-called family-based treatment casts no blame.

Parents, and even siblings, enter therapy with the patients, learning how to out-maneuver the attempts to avoid food. They prepare all meals for the patients, eat with them, cheer them on and work closely with therapists.

"The family has an integral role in the promotion of their daughter's recovery, and that is a real shift from before," says Dr. Jennifer Hagman, an eating disorders specialist at the Children's Hospital in Denver. "The family starts on Day 1 learning how to take care of their child."

Under the family-based approach, parents can inform the child that, if she cannot eat most of her food, she will have to consume a liquid supplement. Further, refusal to eat has consequences, such as not being allowed to attend a social event or return to school. Parents use social pressure too, by not allowing anyone, including siblings, to leave the table until the child with the eating disorder has eaten a sufficient amount.

"The rules were laid down. There was a diet and we had to follow it," Moulton recalls. "She was cooperative, but she was super sensitive about certain things."

Yearning to attend college in the fall, Chrissie frequently became frustrated with her parents' intensive management of her life and what she believed were insults.

"I remember one of the first days I was back from the hospital," says Chrissie, now 21 and a recent graduate of Pomona College. "I had prepared this big plate of food for dinner. My dad looked at it and said, 'You get to have a real feast.' To me, that was the most upsetting thing he could have said. It was like I was pigging out."

The summer was marked by occasional tears, accusations, tensions -- and meals that took center stage. Gradually, the dedication paid off.

"I could see how much effort my parents were making," Chrissie says. "I guess that is the most important thing: I knew how much they were learning and how hard they were trying."

With Chrissie on her way to recovery, her parents kept up their end of the bargain, allowing her to go away to college while she continued therapy. She suffered no relapses and today considers herself healthy.

Hard-earned healing

Families who use the method admit it's not easy. But in the world of eating disorders, nothing is.

Such disorders include anorexia nervosa, in which a distorted body image leads a person to deliberately restrict food, and bulimia, in which an obsession with food causes cycles of bingeing and purging. Compulsive exercise is common in both syndromes.

The conditions affect an estimated 8 million Americans, men and women of all ages and races. But they occur most often in teenage girls.

The last few decades have produced only incremental advances in treating the disorders, which are among the most lethal of any psychiatric illness, experts say. An estimated 5% to 10% of anorexics eventually die as a result of the illness.

Recovery is hard-earned and relapse is common. Two-thirds of anorexics report their illness lasted more than five years, according to the National Assn. of Anorexia Nervosa and Associated Disorders, and only half consider themselves cured.

Chronic illness can result in a ruptured stomach; serious heart, kidney and liver damage; osteoporosis; tooth or gum erosion and esophageal tears. Deaths usually result from heart failure or suicide.

With little scientific evidence to show what works best, most therapists say they use a variety of treatments.

One approach includes individual psychotherapy to explore the possible causes of the disorder, such as anxiety about growing up, body changes associated with puberty and cultural pressures on girls to be thin.

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